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How is familial hypercholesterolemia treated? Early and intensive treatment is needed to lower LDL cholesterol and, in turn, the likelihood of heart attack, stroke or dying early.

A reasonable initial approach is to try to cut LDL cholesterol by half. Other recommendations suggest getting LDL to below 100 mg/dL if you have no other heart disease risk factors and under 70 mg/dL if you do. Your health care provider is the best person to advise you on this.  

Although a healthy diet, regular exercise, weight loss and not smoking are essential to staying healthy, for many people with FH these changes aren’t enough. Instead, a combination of therapies is often needed.

  • Lifestyle changes
    • eat a diet low in saturated fats, trans fats and cholesterol, while high in soluble fiber, fresh fruits and vegetables
    • exercise regularly
    • lose weight, if needed
    • quit smoking

  • Lipid-lowering or other medications, including:
    • “High potency” statins, or statins (which block an enzyme needed to produce cholesterol) given at high doses.
    • Bile acid sequestrants to help remove cholesterol from the body.
    • Cholesterol absorption inhibitors, which block cholesterol from being absorbed.
    • Other medications include PCSK9 inhibitors, and for people with homozygous FH in which both parents have FH, lomitapide is an approved option.

  • Lipoprotein apheresis—a nonsurgical therapy that removes LDL cholesterol from the blood. This is usually an option when medications are not adequate or well tolerated.

  • Ongoing monitoring
Keeping Track of Your Cholesterol

If you have FH, you will need to keep a close eye on your cholesterol. Talk with your health care team about how often you need to get your blood cholesterol checked, and any other steps you can take to stay healthy.
  • Last Edited 03/31/2019