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How is familial hypercholesterolemia (also known as FH) treated? Early and stepped-up treatment is needed to lower LDL cholesterol and, in turn, lower the chance of a heart attack, stroke or early death.

If you have FH, without treatment your LDL will be very high. A first step is to cut LDL cholesterol by half. Overall, the main goal is to get your LDL below 100 mg/dL if you have FH and no other risk factors. If you do have other risk factors, then the goal will be to get LDL to under 70 mg/dL.

Your health care team will advise you on what approach would be best for you.  

A healthy diet, regular exercise, weight loss and not smoking are important to staying healthy. But for many people with FH, these changes aren’t enough. Instead, more than one therapy is often needed. Those include the following:

  • 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
      • Medications
        • To lower LDL cholesterol
          • “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 bempedoic acid
                  • For people who inherited FH from both parents, also called homozygous FH, lomitapide and evinacumab are options approved by the Food and Drug Administration
            • Lipoprotein apheresis is a nonsurgical therapy that removes LDL cholesterol from the blood. This is usually an option when medications are not enough to lower the LDL or not 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 08/12/2021