In homozygous recessive FH, LDL levels are typically?

• A. LDL levels below 100 mg/dL
• B. LDL levels 300-350 mg/dL
• C. LDL levels over 600 mg/dL
• D. LDL levels around 150-200 mg/dL

Answer: (A)

In this condition, the LDL receptor isn’t working on both gene copies, so the body can’t clear LDL cholesterol from the blood effectively. That leaves LDL circulating at very high levels. Because clearance is so severely impaired, individuals with homozygous familial hypercholesterolemia have extremely elevated LDL from a young age, which drives early cardiovascular disease and can lead to visible signs like tendon xanthomas. So the key idea is that LDL is not just high—it is markedly or severely elevated, far above normal levels. Normal LDL is kept low by functional receptors, so descriptions of very high LDL best reflect this condition.