Paul Saladino· MD
there's what they would call monogenetic fh and really what they mean by that is these are what i would like to call the heavy lifters there are really four um apob which of course is the actual protein you described earlier that sits on top of the lipoproteins ldl receptors which i talked about a little bit earlier with mutations and pcsk9 which more and more people are hearing about these days that's a protein that if you're you know if you're over expressing it you're going to have more ldl because it's it's actually tagging a lot of ldl receptors to be dismantled it's almost the same as if you just had a problem with the ldl receptor itself there's also another one called the ldl rap1 it's a little bit of a lesser known one but there are studies that looked at those first three put them in a bucket that they call monogenetic because those are the ones that have a huge association with cardiovascular disease for the level of ldl that they can get you to then they took all of those other ones you just talked about you said there's around 2000 i think in these studies they looked at around something like 223 and put that in another bucket we're going to call those polygenetic fh and if you just get just the polygenetic and leave out the monogenetic you can get ldl levels up to the 95 percentile for the population so you can get really super high levels of ldl but that grouping for likewise levels of ldl have different risk values there's a much higher risk value for those monogenetic for those big three than there is for the polygenic