In familial hypercholesterolemia (FH), early coronary heart disease (CHD) is a complex trait
that results from a large monogenic component of susceptibility due to elevated LDL
cholesterol. This was demonstrated by observation of the high risk of early CHD in FH
subjects compared with the general population. However, not all subjects with a LDLR gene
mutation suffer with early CHD. Furthermore, studies in extended multigenerational families
showed that even for this strong monogenic effect the environment could substantially …