We present a 15 year old boy presenting to the Department of Cardiology with complain of tuberous eruptions over knees and elbows not responding to the antilipidemic drugs. He has lost his elder brother at 10 years of age secondary to sudden cardiac death. Father was quite apprehensive to save his single child surviving. Child was nonobese, nondiabetic, nonhypertensive and belonged to low socioeconomic status. Lipid panel showed total cholesterol being 467mg/dl with LDL as 298 mg/dl with normal HDL and TG level. Patient was on highest dose of statin with life style modification but lipid panel were not in the way to regress, we thought to put the patient on PCSK 9 inhibitor which was ultimately available with much difficulty, to get some improvement. FH was a foe before the era of new antilipidemic drugs but it is a friend now with new therapeutic strategies.

Keywords: Familial Hypercholesterolemia; PCSK 9 inhibitor; LDL; HDL.