2014 Skoumas vs 2011 Goldberg: The FCH score as FH if not precluded by TG

Here we will juxtapose characteristics consistent with both FCH and FH to illustrate the overlap between the two diseases when high TG is not stressed as a red flag within the FH scoring system. High LDLC dominates the FH scoring system, and it is also a characteristic shared with FCH.  Higher scoring FCH, if there is no consideration for TG levels, will inflate the FH count. On the left in Skoumas et al, the average LDLC level for FCH was 209 mg/dl. On the right, Goldberg et al’s report recommended an LDLC cutoff point of 190 mg/dl.  A family history of early heart disease is also a part of both diagnostic systems. Prevalence for the FCH is five times greater than that of FH . Without a concern for TG levels, if a patient is first diagnosed as FH and is later subjected to a genetic test, it is highly likely, given base rate analysis, that the patient is probably FCH and will not have an LDLR mutation. With the industry’s funded research, we do not even get a red flag.   One neighbor, Mr. Brown, has an oak tree and the other neighbor, Mr. Smith, has a maple tree. Each pays Tom Sawyer to rake up the leaves. How much Tom gets paid depends upon the height of the pile.So Tom rakes up both sets of leaves, raking Mr. Smith’s just over Mr. Brown’s boundary. Tom shows Mr. Brown and asks him to pay. Then Tom rakes all of the leaves from that pile back over Mr. Smith’s boundary and shows Mr. Smith, collecting payment. Likewise, the same patients can be FCH now and FH later, as we care now and don’t care later about TG levels and genetic testing.

2014 Skoumas vs 2011 Goldberg: The FCH score as FH if not precluded by TG