Genomics in general practice

Familial hypercholesterolaemia

Last revised: 30 Nov 2018

Practice point

General practitioners (GPs) are well placed to undertake opportunistic screening for familial hypercholesterolaemia (FH).1 Family screening is critical when a diagnosis of FH is made in an individual.2,3

FH is a lipid disorder that leads to premature cardiovascular disease (CVD). FH follows an autosomal dominant inheritance pattern. If FH is left untreated, males have a 50% chance of developing CVD before 50 years of age, and women have a 30% chance of developing CVD by 60 years of age. Early diagnosis and treatment of FH reduces the risk of CVD.1

The risk of FH can be assessed using the Dutch Lipid Clinic Network Criteria (DLCNC; refer to the PDF version of the Red Book appendix 2b ).4

FH assessment should be conducted when an individual presents with:

  • clinical features such as xanthomata
  • low-density lipoprotein cholesterol (LDL-C) >4.0 mmol/L or total cholesterol >7.5 mmol/L
  • premature CVD or a family history of such (CVD <55 years of age for males and <65 years of age for females).1,2,5

While FH can be diagnosed clinically  a confirmatory deoxyribonucleic acid (DNA) test allows for  cascade screening within the family of an affected patient.5

Refer individuals with a DLCNC score of ≥3 (ie possible-to-definite FH) to a cardiologist or lipid clinic for confirmation of diagnosis, including possible genetic testing.2,4

Those diagnosed with FH should be encouraged to:1

  • inform family members that they may be at increased risk of FH
  • direct family members to further information about FH
  • advise family members to discuss their risk of FH with their GP.
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