Familial hypercholesterolemia (FH) is relatively common among patient with early onset heart attack. There is a suboptimal knowledge and awareness of FH among health professionals involved in the management of cardiac disease. We also highlighted patients with FH and heart disease have different metabolism, course of atherosclerosis and clinical prognosis. Furthermore the results of this thesis support the concept of patients with FH are at high risk of developing coronary disease due to longstanding lipid metabolism issue, and requiring a multidisciplinary approach and an integrated model of care to enhance FH detection and their current standard of care.