Familial Hypercholesterolemia Follow-up

Updated: Jul 20, 2023
  • Author: Mose July, MD, CCD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Identifying relatives who are carriers of the FH gene allows medical intervention to prevent patients from developing CAD.

In addition to treating hypercholesterolemia, cardiovascular risk factors should be identified and treated aggressively. Advise patients to begin aerobic exercise and, if indicated, a weight-loss program.



The adverse effects of medications used to treat hypercholesterolemia can pose major, though uncommon, complications.

Statin therapy carries a negligible risk of liver toxicity.

Myositis progressing to rhabdomyolysis is a rare but life-threatening complication of statin therapy.

Statins in combination with a variety of medications (particularly cyclosporine, as well as gemfibrozil, verapamil, amiodarone, etc) increase the risk of myositis (see Medication).

Niacin may cause gout, peptic ulcer disease, increased insulin resistance, and severe hepatotoxicity. Fulminant hepatic failure has been reported with time-release niacin therapy.



Prognosis depends heavily on the extent to which LDLc levels can be reduced.

Patients with homozygous FH have and extremely limited life expectancy without major medical intervention.

Treatment of other modifiable risk factors such as smoking, hypertension, and diabetes further decreases the risk of CAD.

Because long-term prospective studies on subjects with FH are not available, precise predictions regarding improved outcomes are difficult.


Patient Education

Adult patients with FH must understand their high risk for premature CAD. Emphasizing the importance of complying with dietary and drug management of their hypercholesterolemia must be emphasized.

Other modifiable risk factors should be identified, and their additive impact on the risk of a cardiovascular event should be explained. Offer assistance with stopping smoking. Explain the importance of exercise and appropriate weight reduction in terms of the lipid and cardiovascular effects and the prevention or improvement in diabetes and hypertension.

For excellent patient education resources, visit eMedicineHealth's Cholesterol Center. Also, see eMedicineHealth's patient education articles High Cholesterol, Cholesterol Charts, Lifestyle Cholesterol Management, Cholesterol-Lowering Medications, and Statins for Cholesterol.