Fig. 2.

Examples of area under the LDL-C versus age curves.

Each color represents a different patient population plotting cumulative low-density lipoprotein cholesterol (LDL-C) years versus age and the average onset of atherosclerotic cardiovascular disease (ASCVD)(black dashed horizontal line). Individuals with genetically determined severe hypercholesterolemia from birth (e.g., familial hypercholesterolemia [FH]) have the largest area under the curve at any given age (red dashed vertical line) and steepest slope of LDL-C versus age. Thus, they experience the earliest onset of ASCVD. Individuals with moderate hypercholesterolemia starting in the teenage years secondary to genetics and/or suboptimal lifestyle habits are at risk for relatively early ASCVD due to a lengthy cumulative exposure to LDL-C. Those with modest hypercholesterolemia from adulthood, often due to suboptimal lifestyle habits, generally develop ASCVD later than the other 2 groups. Individuals genetically endowed with low LDL-C from birth have a markedly reduced risk of developing ASCVD. (Figure and legend reproduced from Shapiro and Bhatt with permission [208]).