Managing homozygous familial hypercholesterolaemia from cradle to grave

ObjectiveTo describe the phenotypic and genotypic features and management of clinically homozygous familial hypercholesterolaemia (FH).MethodsAn analysis of current knowledge based on personal experience and published evidence.ResultsAtherosclerotic involvement of the aortic root is common in homozygous FH and can cause death before age 5. Receptor negative patients are at greatest risk, irrespective of whether they have identical mutations (homozygous) or dissimilar mutations (compound heterozygous).ConclusionsLipoprotein apheresis combined with high dose statin and ezetimibe slows but does not arrest progression of atherosclerosis. Adjunctive use of novel compounds such as lomitapide and evolocumab should facilitate achieving the latter objective by enhancing the reduction in LDL cholesterol.