Skill Checkup: A Man With History of Heterozygous Familial Hypercholesterolemia and Premature Coronary Heart Disease

Romesh Khardori, MD, PhD


March 17, 2023

The Skill Checkup series provides a quick, case-style interactive quiz, highlighting key guideline- and evidence-based information to inform clinical practice.

A 43-year-old man in the United States with a history of heterozygous familial hypercholesterolemia (FH) presents for a consultation. He is 5 ft 10 in (1.78 m) and weighs 166.5 lb (75.52 kg; body mass index, 23.9). The patient reports a history of smoking of ≤ 10 years, noting that he quit after college, and has a paternal family history of premature coronary heart disease (CHD). Palpation detects a diffusely thickened Achilles tendon. Treatment with atorvastatin 60 mg/d was attempted, but the dosage was lowered to 40 mg/d owing to tolerability issues. After 3 months of therapy, the patient reports adherence to his statin therapy and a healthy lifestyle (diet and exercise); however, laboratory analysis is remarkable for low-density lipoprotein cholesterol (LDL‐C), with a level of 244 mg/dL. Prior to treatment initiation, his LDL-C level was 310 mg/dL. Other pertinent findings include high-density lipoprotein cholesterol (HDL-C) level of 55 mg/dL, lipoprotein(a) 45 mg/dL, and blood pressure of 130/80 mmHg.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.