Genetic testing in dyslipidemia: A scientific statement from the National Lipid Association
Abstract
The genetic basis for more than 2 dozen monogenic dyslipidemias has largely been defined. Genetic technologies, such as DNA sequencing, can detect both rare and common DNA variants underlying dyslipidemias, and these methods are increasingly available. Although patients with extreme abnormalities in low-density lipoprotein cholesterol, triglycerides, or high-density lipoprotein cholesterol may be considered for genetic testing, it is only in a minority of patients that the results will alter treatment or outcomes. Currently, there is potential clinical utility of genetic testing for familial hypercholesterolemia, familial chylomicronemia syndrome, sitosterolemia, lysosomal acid lipase deficiency, and a few other rare disorders, and this will increase the demand for reliable genetic diagnostic methods at lower cost. Clinical indications for genetic testing for most dyslipidemias are not clearly established and currently no guidelines exist. A shared decision-making model between the patient and the provider is essential as patient values and preferences play a very strong role. Potential benefits of genetic testing include providing a firm diagnosis in many cases, guiding optimal management and prevention strategies, advancing care strategies beyond currently available treatments, and contributing to overall scientific progress. Understanding the limitations and risks of genetic testing techniques is also important, as is careful interpretation of genetic test results to achieve the greatest benefit. Here we review laboratory methods, as well as technical, biological, clinical, and ethical implications and applications of genetic testing in dyslipidemias.
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Familial chylomicronemia syndrome is caused by biallelic loss-of-function variants in LPL or in related genes needed for LPL activity.
“The condition is caused by biallelic loss-of-function variants in LPL (encoding lipoprotein lipase) or in related genes needed for LPL activity. 10-12”
From Olezarsen, Acute Pancreatitis, and Familial Chylomicronemia Syndrome (2024) · cites this paper as [11]
Loss of LPL activity results in a reduced ability to hydrolyze triglycerides in triglyceride-rich lipoproteins, leading to their accumulation in plasma and subsequent severe hypertriglyceridemia.
“Loss of LPL activity results in a reduced ability to hydrolyze triglycerides in triglyceride-rich lipoproteins, such as intestinally derived chylomicrons and hepatically derived very-low-density lipoproteins, leading to their accumulation in plasma and subsequent severe hypertriglyceridemia. 10-12”
From Olezarsen, Acute Pancreatitis, and Familial Chylomicronemia Syndrome (2024) · cites this paper as [11]
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Olezarsen, Acute Pancreatitis, and Familial Chylomicronemia Syndrome
Stroes, E. S. G., Alexander, V. J., Karwatowska-Prokopczuk, E., Hegele, R. A., Arca, M., Ballantyne, C. M., Soran, H., Prohaska, T. A., Xia, S., Ginsberg, H. N., et al. (2024) · New England Journal of Medicine · doi:10.1056/nejmoa2400201 · Cited by 271 · see citing works
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- Authors
- Brown, E. E., Sturm, A. C., Cuchel, M., Braun, L. T., Duell, P. B., Underberg, J. A., Jacobson, T. A., & Hegele, R. A.
- Affiliations
- Johns Hopkins University (US)
- Geisinger Health System (US)
- University of Pennsylvania (US)
- Rush University (US)
- Oregon Health & Science University (US)
- NYU Langone Health (US)
- Emory University (US)
- Western University (CA)
- Corresponding author
- Hegele, Robert A.
- ORCID
- Venue
- Journal of Clinical Lipidology
- Publisher
- Elsevier BV
- Published
- 2020-07
- Volume
- 14
- Issue
- 4
- Pages
- 398-413
- ISSN
- 1876-4789 (ISSN-L)
- 1933-2874
- OpenAlex
- W3021549637
- Cited by
- 148
- References
- 69
- Citations by year
- 2026: 20 · 2025: 23 · 2024: 21 · 2023: 30 · 2022: 22 · 2021: 25 · 2020: 6 · 2019: 1
- FWCI
- 23.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of clinical lipidology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Heart and Stroke Foundation of Canada (G-18-0022147)
- Regeneron Pharmaceuticals
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genomics and Rare Diseases
- Keywords
- genetic testing, dyslipidemia, familial hypercholesterolemia, familial chylomicronemia syndrome, sitosterolemia, lysosomal acid lipase deficiency, LDL cholesterol, triglycerides, HDL cholesterol, shared decision-making, genetic test result interpretation, genetic counseling, DNA sequencing
- MeSH terms
- Decision Making, Genetic Testing, Humans, Risk, Societies, Scientific, Dyslipidemias
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