title: Familial hypercholesterolemia: developments in diagnosis and treatment.
abstract: BACKGROUND
  Familial hypercholesterolemia (FH) is a congenital disorder of lipid metabolism characterized by a marked elevation of the plasma concentration of LDL (low-density lipoprotein) cholesterol beginning in childhood and by the early onset of coronary heart disease. It is among the commonest genetic disorders, with an estimated prevalence in Germany of at least 1 per 500 persons.
  
  
  METHODS
  Review of pertinent literature retrieved by a selective search.
  
  
  RESULTS
  FH is underdiagnosed and undertreated in Germany. It is clinically diagnosed on the basis of an elevated LDL cholesterol concentration (>190 mg/dL [4.9 mmol/L]), a family history of hypercholesterolemia, and early coronary heart disease, or the demonstration of xanthomas. The gold standard of diagnosis is the identification of the underlying genetic defect, which is possible in 80% of cases and enables the identification of affected relatives of the index patient. The recommended goals of treatment, based on the results of observational studies, are to lower the LDL cholesterol concentration by at least 50% or to less than 100 mg/dL (2.6 mmol/L) (for children: <135 mg/dL [3.5 mmol/L]). The target value is lower for patients with clinically overt atherosclerosis (<70 mg/dL [1.8 mmol/L]). Statins, combined with a health-promoting lifestyle, are the treatment of choice. Lipoprotein apheresis is used in very severe cases; its therapeutic effects on clinical endpoints and its side effect profile have not yet been documented in randomized controlled trials.
  
  
  CONCLUSIONS
  Familial hypercholesterolemia is a common disease that can be diagnosed simply and reliably on clinical grounds and by molecular genetic testing. Timely diagnosis and appropriate treatment can lower the risk of atherosclerosis in heterozygous patients to that of the general population.
authors.affiliation: Private practice for Internal Medicine, Gastroenterology, Cardiology and Preventional Medicine: Dres. T. Beckenbauer und S. Maierhof and joint practice Dres. K. W. Spieker and I van de Loo, Bremen.
authors.forename: Gerald
authors.initials: G
authors.lastname: Klose
authors.affiliation: Department of Internal Medicine III-Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Center, Homburg/Saar.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Laufs
authors.affiliation: Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz; Synlab Academy, Synlab Services GmbH, Mannheim.
authors.forename: Winfried
authors.initials: W
authors.lastname: März
authors.affiliation: Preventive Medicine, Department of General and Interventional Cardiology, University Hospital Hamburg-Eppendorf, Hamburg.
authors.forename: Eberhard
authors.initials: E
authors.lastname: Windler
mesh_terms: D042241:Early Diagnosis; D005820:Genetic Testing / Q000379:methods*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006938:Hyperlipoproteinemia Type II / Q000175:diagnosis* / Q000235:genetics / Q000517:prevention & control*; D008403:Mass Screening / Q000379:methods*; D057089:Pathology, Molecular / Q000379:methods*; D040242:Risk Reduction Behavior
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors