When should I consider referring a patient with familial hypercholesterolaemia to a specialist for further management?

Refer a patient with familial hypercholesterolaemia (FH) to a specialist with expertise in FH if they are assessed to be at very high risk of a coronary event, which includes having established coronary heart disease (CHD), a family history of premature CHD, or two or more other cardiovascular risk factors such as smoking, hypertension, or diabetes ¹.

All adults and children with homozygous FH should be managed in secondary care by a specialist with expertise in FH ¹.

Children and young people with confirmed or suspected FH should be referred to a specialist in children and young people, especially if they have homozygous FH or if lipid-modifying drug therapy is being considered ¹.

Patients with FH who have symptoms or signs of possible coronary heart disease that are not immediately life-threatening should be urgently referred for specialist evaluation ².

Patients with FH and symptoms or signs of immediate life-threatening coronary disease, such as acute coronary syndrome, should be referred to hospital as an emergency ².