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Homozygous Familial Hypercholesterolemia

Information for
Healthcare Professionals

Is HoFH hiding in your practice?

Homozygous familial hypercholesterolemia (HoFH) is an ultra rare, inherited genetic disorder of lipid metabolism1,2

HoFH is characterized by:1-4

  • Markedly elevated plasma levels of LDL-C (untreated LDL-C >10 mmol/L)3
  • Premature atherosclerotic cardiovascular disease and cardiovascular morbidity and mortality
  • Cholesterol buildup:
    • around the joints and on the tendons (xanthomas)
    • in the eyes (corneal arcus) and around the eyelids (xanthelasmas)

The current estimated prevalence of HoFH is 1 in 300,000.4

Prevalence is higher in these groups:

  • 1 in 275,000 French Canadians5
  • 1 in 30,000 Afrikaners in South Africa6
  • 1 in 10,000 Christian Lebanese7

HoFH is genetic and inherited

HoFH occurs when two copies of the alleles bearing the familial hypercholesterolemia (FH)-causing genes are inherited, one from each parent.1

HoFH differs from HeFH

Homozygous FH (HoFH)3 Heterozygous FH (HeFH)3
Mutated genes inherited from both parents Mutated gene inherited from one parent
Occurs in 1 in 300,000 persons Occurs in 1 in 250 persons
LDL-C >10 mmol/L (untreated) LDL-C cholesterol ≥4.1 mmol/L in children
LDL-C cholesterol ≥4.9 mmol/L in adults
Likely physical symptoms, such as cholesterol deposits in the eye, tendons, knees, elbows and/ or between fingers and toes; these deposits are not always present May have physical symptoms, such as cholesterol deposits in the eye, tendons, knees, elbows and/or between fingers and toes
Treatment at time of diagnosis, no matter the age, with a specialist Treatment as early as age 10

Adapted from McGowan and Cuchel et al.

Look for HoFH in your practice

Physical signs and risk factors associated with HoFH:1,3,8

  • Untreated LDL-C >10 mmol/L – lower levels should not be discounted if other factors are present
  • Cutaneous or tuberous xanthomas – highly suggestive of HoFH in children
  • Corneal arcus – highly suggestive of HoFH
  • Evidence of CVD – in young children early signs and symptoms are linked to aortic stenosis and regurgitation
  • Family history of premature CVD
  • Family history of HeFH


1. Cuchel M et al. Eur Heart J. 2023;00:1–15; 2. Raal FJ et al. Atherosclerosis. 2018;277:483–492; 3. McGowan MP et al. J Am Heart Assoc. 2019;8:e013225; 4.Tromp TR et al. The Lancet. 2022;399:719-728; 5. Moorjani S et al. Arteriosclerosis. 1989;9:211-6; 6. Seftel HC et al. Br Med J. 1980;281:633-6; 7. Slack J. Atheroscler Rev, 1979;5:35–66; 8. France M et al. Atherosclerosis. 2016;255:128–139;