Age (<i>P</i> < .001), LDL-C (<i>P</i> < .001), smoking status (<i>P</i> < .05), and NLR (<i>P</i> < .05) were independently associated with subclinical atherosclerosis.<h4>Conclusion</h4>FH subjects with LDLR mutations had a higher NLR and a more severe atherosclerosis distribution. Here, LDLR is linked to atherosclerosis.