Introduction:Familial hypercholesterolemia (FH) is an inherited disorder with increased coronary heart disease related to LDL-cholesterol (LDL-C). The clinical diagnosis can be made with the Dutch Lipid Clinic Network Diagnostic Criteria (DLCNDC), in which a score ?6 indicates a need for genetic testing. FH is an underdiagnosed disorder, possibly due to false negative LDL-C interpretation by physicians during lipid-lowering therapy (LLT). We hypothesized that automated medical record-based integration of data can provide a signal to increase identification of FH patients.Methods:We included patients with LDL-C ?5 mmol/L after correction for LLT in all patients testing LDL-C in Northwest Clinics, The Netherlands. Patients previously diagnosed with FH were excluded. The primary endpoint was the number of patients with DLCNDC ?6. Secondary endpoints were the additional number of patients with DLCNDC ?6 after adding data on patient- and family history when available and LDL-C before and after correction for LLT. Analysis was performed in a daily automated routine (HiX ChipSoft).Results:In a total of 12.443 LDL-C measurements during 44 days, LDL-C was ?5 mmol/l in 78 patients after automated correction for LLT. FH had previously been diagnosed in 16 patients. In the remaining 62 patients (58% female; age (mean?SD): 69?11 yrs; 77% on LLT), the number of patients with DLCNDC ?6 after correction for LLT was 11, and 17 after adding data on patient- and family history (Table 1). The median LDL-C before and after correction for LLT was 4,4 [IQR 3,8-5,6] mmol/L and 7,1 [IQR 6,7-8,4] mmol/L (p<0,001), respectively. In 42 patients (68%) LDL-C was ?5 mmol/l before correction for LLT.Conclusion:We conclude that automated medical record-based integration of LDL-C, LLT and patient- and family history can provide a signal to increase identification of FH. Whether this signal results in subsequent genetic identification of FH in patients and their relatives requires further study.