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.

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Cite this: Romesh Khardori. Skill Checkup: A Man With History of Heterozygous Familial Hypercholesterolemia and Premature Coronary Heart Disease - Medscape - Mar 17, 2023.

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