A 40-year-old woman has lipid investigations suggesting familial hypercholesterolemia (increased cholesterol, increased low-density lipoprotein , and normal triglycerides). This condition is characterized by increased risk for premature atherosclerosis and by the occurrence of tuberous and tendon xanthomas. Before making the assumption of familial hypercholesterolemia, secondary causes need to be considered. Which of the following conditions is most likely to cause secondary hyperlipidemia?

Important secondary causes include DM, obesity/dietary intake, hypothyroidism, renal disease (nephritic syndrome), and cholestatic liver disease. Alcohol in small amount improves lipid profiles and in excess causes increase in triglycerides. Estrogen too improves lipid profiles. The other choices are not important in affecting lipid levels.In familial hypercholesterolemia, there is an increased incidence of CAD, and hypercholesterolemia occurs along with tuberous xanthomas, arcus senilis, and atheromas. Most affected individuals are heterozygous for the mutant gene.