In primary care, the recommended lipid-lowering therapy for patients diagnosed with familial hypercholesterolaemia (FH) is a high-intensity statin, such as atorvastatin 20 mg or rosuvastatin 10 mg, with the aim of achieving at least a 50% reduction in LDL cholesterol from baseline NICE CG71.
If statins are contraindicated or not tolerated, ezetimibe 10 mg once daily can be considered as an alternative or adjunct therapy NICE CG71.
For patients with FH who do not reach treatment targets despite maximal tolerated doses of statins and ezetimibe, referral to a specialist for further management, including options like PCSK9 inhibitors, may be necessary NICE CG71.
Monitoring of liver function tests and creatine kinase is recommended before and during treatment, especially if symptoms suggest adverse effects NICE CG71.