Methods:

Data from the National Health and Nutrition Examination Survey (NHANES), 1999-2012, were used for the present analysis. Adults ≥20 years of age who provided blood samples from which lipid profiles were measured were included. The Dutch Lipid Clinic criteria were used to estimate the prevalence of FH. These criteria include points for low-density lipoprotein (LDL) >330 mg/dl (8 points) down to 1 point for LDL between 155 and 189 mg/dl. Points were also given for a known gene defect causative for FH (8 points), personal history of early atherosclerotic cardiovascular disease (ASCVD) (2 points), family history of early ASCVD or high cholesterol (LDL cholesterol >95th percentile for age, sex, and country) in a first-degree relative (1 point each), and personal and physical examination findings of xanthoma (6 points) and arcus cornea (4 points) at a young age. Definite FH was defined as 8 or more points, and probable FH as 6-8 points. A Dutch Lipid Clinic criterion that was not collected in NHANES (including genetic testing, family history of hypercholesterolemia, or personal history of peripheral arterial disease) was not considered in this analysis.