There are substantial issues in applying this type of genetic screening for severe hypercholesterolemia to clinical practice.  

• One issue, of course, is the availability of Clinical Laboratory Improvement Amendments
  (CLIA)-compliant sequencing of the LDL receptor and the other genes;
  
  
• A second issue is cost and reimbursement - this is not a procedure that has classically
  been reimbursable; 
  
  
• A third issue concerns the question of actionability: exactly how will the results impact on
  the physician's decision to treat the patient?

All of these issues will impact how this field might develop - although perhaps of primary importance is the clear implication that more needs to be done in terms of proving that genotyping leads to actionability that actually benefits the patient.