Virtual genetic diagnosis for familial hypercholesterolemia powered by machine learning published in European Journal of Preventive Cardiology

Neural networks consist of a series of connected layers of neurons, whose connection weights are adjusted to learn how to determine the diagnosis from the input data.

Virtual genetic diagnosis for familial hypercholesterolemia powered by machine learning
Anna Pina, Saga Helgadottir, Rosellina Margherita Mancina, Chiara Pavanello, Carlo Pirazzi, Tiziana Montalcini, Roberto Henriques, Laura Calabresi, Olov Wiklund, M Paula Macedo, Luca Valenti, Giovanni Volpe, Stefano Romeo
European Journal of Preventive Cardiology (2020)


Familial hypercholesterolemia (FH) is the most common genetic disorder of lipid metabolism. The gold standard for FH diagnosis is genetic testing, available, however, only in selected university hospitals. Clinical scores – for example, the Dutch Lipid Score – are often employed as alternative, more accessible, albeit less accurate FH diagnostic tools. The aim of this study is to obtain a more reliable approach to FH diagnosis by a “virtual” genetic test using machine-learning approaches.

Methods and results

We used three machine-learning algorithms (a classification tree (CT), a gradient boosting machine (GBM), a neural network (NN)) to predict the presence of FH-causative genetic mutations in two independent FH cohorts: the FH Gothenburg cohort (split into training data (N = 174) and internal test (N = 74)) and the FH-CEGP Milan cohort (external test, N = 364). By evaluating their area under the receiver operating characteristic (AUROC) curves, we found that the three machine-learning algorithms performed better (AUROC 0.79 (CT), 0.83 (GBM), and 0.83 (NN) on the Gothenburg cohort, and 0.70 (CT), 0.78 (GBM), and 0.76 (NN) on the Milan cohort) than the clinical Dutch Lipid Score (AUROC 0.68 and 0.64 on the Gothenburg and Milan cohorts, respectively) in predicting carriers of FH-causative mutations.


In the diagnosis of FH-causative genetic mutations, all three machine-learning approaches we have tested outperform the Dutch Lipid Score, which is the clinical standard. We expect these machine-learning algorithms to provide the tools to implement a virtual genetic test of FH. These tools might prove particularly important for lipid clinics without access to genetic testing.