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Familial Hypercholesterolemia and the 2013 American College of Cardiology/American Heart Association Guidelines: Myths, Oversimplification, and Misinterpretation Versus Facts

  • Joshua W. Knowles
    Affiliations
    Cardiovascular Medicine and Cardiovascular Institute, Department of Medicine, Stanford University School of Medicine, Stanford, California
    Familial Hypercholesterolemia Clinic, Stanford Center for Inherited Cardiovascular Disease, Stanford, California
    The FH Foundation, South Pasadena, Stanford, California
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  • Neil J. Stone
    Affiliations
    Feinberg School of Medicine, Northwestern University, Chicago, Illinois
    Vascular Center, Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
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  • Christie M. Ballantyne
    Affiliations
    The FH Foundation, South Pasadena, California
    Sections of Cardiovascular Research and Cardiology, Baylor College of Medicine, Houston, Texas
    Center for Cardiovascular Disease Prevention, Houston Methodist DeBakey Heart and Vascular Center and Baylor College of Medicine, Houston, Texas
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      Familial hypercholesterolemia (FH) is a genetic condition resulting in severe, lifelong elevations in low-density lipoprotein cholesterol and a marked increased risk of early-onset coronary disease. FH is treatable when identified, yet is vastly under-recognized and undertreated. Although the 2013 American College of Cardiology/American Heart Association guidelines on the treatment of cholesterol presented a paradigm shift, we believe that there have been serious oversimplifications, misinterpretations, and erroneous reporting about the current ACC/AHA cholesterol guidelines that have contributed to suboptimal care for these subjects. In summary, the ACC/AHA guidelines place tremendous emphasis on the identification of patients with FH, the initiation of high-intensity statin therapy, the need to obtain follow-up lipid values to assess the efficacy and compliance to lifestyle and medical therapy, and the role of nonstatin drugs when needed for optimal care of the individual patient.
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