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Strongly favor this test or intervention.

The DLCN criteria for familial hypercholesterolemia (FH) calculator is designed to assess the likelihood that an individual has FH based on specific factors. To determine this, the calculator evaluates five key aspects and assigns a numerical score to each based on predefined criteria.

Family history considerations include whether a first-degree relative has premature coronary or vascular disease—males under 55 or females under 60—or elevated LDL-C levels above the 95th percentile, which contributes 1 point. If a relative has tendinous xanthomata or arcus cornealis, or if children under 18 have high LDL-C, the score is 2.

In regard to clinical history, if the patient has premature coronary artery disease, this is worth 2 points. Premature cerebral or peripheral vascular disease in the patient contributes 1 point.

Physical examination findings, such as tendinous xanthomata, are notably significant, adding 6 points to the score, while observing arcus cornealis before 45 years of age adds 4 points.

For LDL-C levels measured without treatment, a result of 8.5 mmol/L (325 mg/dL) or higher is assigned 8 points; levels between 6.5 and 8.4 mmol/L (251-325 mg/dL) score 5 points; a range of 5.0 to 6.4 mmol/L (191-250 mg/dL) adds 3 points; and 4.0 to 4.9 mmol/L (155-190 mg/dL) results in 1 point.

Discovering a functional mutation in the LDLR, apoB, or PCSK9 genes through DNA analysis also heavily influences the determination by adding 8 points.

After collecting all responses, the individual scores are summed to form a total score which guides the interpretation. If the score is greater than 8, the individual is considered to meet the criteria for definite FH. A score ranging from 6 to 8 suggests probable FH, while scores between 3 and 5 indicate possible FH. Scores falling below 3 imply that the criteria for FH are not met. These scores and interpretations guide clinicians in determining the likelihood of familial hypercholesterolemia based on the patient's information.

The calculator in question is the Dutch Lipid Clinic Network (DLCN) criteria for Familial Hypercholesterolemia (FH). This scoring system is used to diagnose patients with familial hypercholesterolemia, a genetic disorder characterized by high cholesterol levels, specifically very high levels of low-density lipoprotein (LDL), in the blood and early cardiovascular disease.

The DLCN criteria for FH is a comprehensive scoring system that takes into account the patient's personal and family history of premature coronary artery disease, LDL cholesterol levels, presence of physical signs related to high cholesterol (such as tendon xanthomas), and genetic testing results. 

The clinical utility of this calculator is to aid in the diagnosis of FH, which can be challenging due to the wide range of phenotypic expressions. Early diagnosis of FH is crucial as it allows for prompt initiation of lipid-lowering therapy to reduce the risk of atherosclerotic cardiovascular disease.

There are no specific exclusion criteria for the use of the DLCN criteria. However, it should be noted that this scoring system is less useful in populations with a high prevalence of polygenic hypercholesterolemia or in individuals with secondary causes of hypercholesterolemia, as it may overestimate the likelihood of

Familial hypercholesterolemia

Guidelines

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