Figure 4. Familial Hypercholesterolemia Universal screening
• Children at age 9-11 • High-risk children ≥ age 2 • Everyone by age 20
Age
≥ 20 < 20
LDL-C
≥ 190 mg/dL ≥ 160 mg/dL
Suspect FH Family history Simon-Broome Registry, Dutch Lipid Clinic Network, or MEDPED Formal criteria
± Cascade screening of relatives
Child Make diagnosis Physical findings non–HDL-C
≥ 220 mg/dL ≥ 190 mg/dL
lifestyle change Therapeutic
LDL-C > 160 (+ FHx) LDL-C ≥ 190 (No FHx)
Statin
≥ 50% LDL-C reduction or
GOAL Possible LDL apheresis LDL-C < 130 mg/dL Lifelong follow-up a Higher-risk patients may need LDL-C < 100 mg/dL ≥ 50% LDL-C reductiona GOAL Lipid specialist Statin
LDL-C ↓ < 50% Combined therapy Not at goal
Adult
