Towards Genetic Prediction of Coronary Heart Disease in Familial Hypercholesterolemia

Familial hypercholesterolemia (FH) is an autosomal dominant disorder of lipid metabolism caused by mutations in the gene coding for the low-density lipoprotein (LDL) receptor. The LDL receptor is a transmembrane protein that regulates plasma cholesterol levels by uptake of LDL particles from the blood circulation (Figure). Mutations in the LDL receptor gene cause insufficient uptake of circulating LDL particles, which raises the endogenous cholesterol production by the hepatocytes, resulting in twofold increased plasma concentrations of LDL cholesterol in patients with the heterozygous form of FH. The rare (1/million) homozygous FH patients have severely reduced or completely absent residual function of the LDL receptor causing extremely raised plasma LDL cholesterol concentrations. These patients develop tendon xanthomas in childhood and massive atherosclerosis occurs frequently at a very young age. This thesis, however, focuses on patients with heterozygous FH, which is more common with a prevalence of 1/500 in Western societies. The typical heterozygous FH patients develop tendon xanthomas and have accelerated atherosclerosis and coronary heart disease (CHD) at a young age. Nevertheless, substantial variation is seen in the age of onset of CHD among patients with heterozygous FH.

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