Something happened here and some questions need to be answered. FH is now the target for new drugs, especially the PCSK9 inhibitors. But they were, and still are, also targets for statins, and those have been around for a while now. We can see that the regression from genetic emphasis to the scoring systems begins early.
From MEDPED to DLCN
#1: Genetic testing is listed first, and given the highest priority (below left). It will be demoted to last place, even though the presence of the mutation is sufficient, scoring 8 points (center & right).
#2: Establishing a superior “prior probability” before lipid testing (left) is also dropped (center & right). Mention of the advantage of tracing genetically confirmed relatives (left) is removed (center).
From old DLCN to new DLCN (center and right screenshots):
#3: The mentioning of TG as a warning flag for misdiagnosis (center) is also missing by the time we get to a DLCN representation in Austin et al in 2004 (right). This scheme is much more likely to include the FCH than the original MEDPED, both due to upending priorities and to snipping out elements.