Genetic testing in dyslipidemia: A scientific statement from the National Lipid Association

• Published in: Journal of clinical lipidology Vol. 14; no. 4; pp. 398 - 413
• Main Authors: Brown, Emily E., Sturm, Amy C., Cuchel, Marina, Braun, Lynne T., Duell, P. Barton, Underberg, James A., Jacobson, Terry A., Hegele, Robert A.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.07.2020
• Subjects: DNA sequencing; Genetic counseling; Hyperlipidemia; Hypolipidemia; Monogenic; Polygenic; Genetic counseling; Polygenic; Hyperlipidemia; Monogenic; Hypolipidemia; DNA sequencing
• ISSN: 1933-2874; 1876-4789
• DOI: 10.1016/j.jacl.2020.04.011

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. •In selected patients, genetic testing can help in diagnosis and management.•Pursuit of genetic testing must weigh potential benefits, risks, and patient preference.•Genetic counseling is recommended before and after genetic testing.•Understanding limitations of genetic testing is central to deriving the greatest benefit.