Familial hypercholesterolemia can be divided into two types: homozygous and heterozygous.
Homozygous familial hypercholesterolemia
The treatment of patients with homozygous familial hypercholesterolemia is very challenging, as their liver surfaces lack specific low-density lipoprotein (LDL) receptors. Dietary treatment and most cholesterol-lowering drugs are ineffective for these patients, and even gastric bypass surgery has no effect. However, due to the cholesterol-lowering effect of propofol not relying on the LDL receptor pathway, it can moderately reduce blood cholesterol levels and shrink some patients’ xanthomas. Additionally, plasma exchange therapy can selectively clear very low-density lipoprotein-cholesterol (VLDL-C) and low-density lipoprotein-cholesterol (LDL-C) from the blood, making it suitable for the treatment of this type of patient. This treatment helps to slow down the formation and development of atherosclerosis.
Heterozygous familial hypercholesterolemia
The treatment of heterozygous familial hypercholesterolemia patients includes two aspects: dietary treatment and medication. These patients can simply use cholestyramine, nicotinic acid, or statin drugs to lower serum total cholesterol levels. For severe patients, combined medication such as cholestyramine and nicotinic acid or cholestyramine and statin drugs is recommended. Some studies have shown that on the basis of dietary treatment, long-term combined use of two or three lipid-lowering drugs can inhibit the development of atherosclerosis or partially regress atherosclerotic plaques. If patients cannot tolerate drug treatment, gastric bypass surgery can help lower serum cholesterol levels.
