Mr. Dupois is a 35-year-old French-Canadian man born in rural Quebec who moved to Hamilton with his wife a few years ago. His family physician noted a persistent rash around his eyes that he identified as xanthelasma. This prompted some blood tests and a referral to the Lipid Clinic. He is rather reluctant to see you at the Lipid Clinic because he is completely asymptomatic. He denies any significant medical history and is taking no medications. He is a lifelong non-smoker who faithfully walks to work for 1 km with no problems. A family history indicates that Mr. Dupois’ father died suddenly at the age of 46 with no clear explanation. He has multiple family members on his father’s side had a history of heart attacks, some at an unusually young age. His mother is healthy. On physical exam he has soft, velvety, yellowish, non-tender plaques in the palpebral area. Thickening of the Achilles tendons bilaterally were also noted. His blood pressure was 145/90 and waist circumference 98 cm.