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 NICE CKS.
All adults and children with homozygous FH should be managed in secondary care by a specialist with expertise in FH NICE CKS.
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 NICE CKS.
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 NICE CG71.
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 NICE CG71.