A very high cholesterol can run in families. What we check, what happens next, and why it matters for your relatives.

Your cholesterol is very high, and we want to look into why

What this result means

Your cholesterol is high enough that we do not want to treat it as ordinary. At this level there are two things to sort out: whether something else is pushing it up, and whether you have an inherited condition called familial hypercholesterolaemia, usually shortened to FH.

FH is not rare. Around 1 in 250 people have it. It is caused by a single gene passed down through families, and it means the body cannot clear cholesterol properly from birth. People with FH have a high cholesterol whatever they eat, which is why diet alone never fixes it, and why it is not something you have caused.

The good news is that it responds very well to treatment, and treatment works best when it starts early.

What we have done

We have arranged blood tests to check the things that can raise cholesterol on their own: your thyroid, your blood sugar, your kidneys and your liver. If one of those is the answer, we treat that.

We have also looked at your record for the pointers to FH: cholesterol above a certain level, a close relative who had a heart attack or stroke young, and certain changes in the tendons and eyes.

What happens next

Your text message says which of these applies to you.

We are referring you to a specialist lipid clinic

They confirm the diagnosis, often with a genetic test, and set the long-term plan. They will write to you directly with an appointment. Waits vary. If we have started a tablet in the meantime, keep taking it while you wait.

We are waiting for your other blood tests first

Please book them if you have not already. Once they are back we will contact you with the plan. If they show something treatable, that may be all that is needed.

We have started you on a tablet now

Because your cholesterol is high, we do not wait to start lowering it. This is usually Atorvastatin 20mg once a day. It does not commit you to anything and the specialist can change it.

Why this matters for your family

If you do have FH, each of your children, brothers and sisters and parents has a 1 in 2 chance of having it too, and most of them will not know. Finding them and treating them early is the single most valuable thing that comes out of this diagnosis.

You do not need to do anything about that yet. If FH is confirmed, the specialist clinic organises the family testing and will talk you through how to raise it with relatives.

What you need to do

Book any blood tests we have asked for.
If we have started a tablet, take it every day and collect your repeat.
Have a think about your family history: any parent, brother, sister or child with a heart attack, angina or stroke, and how old they were. Bring it to your appointment.
Do not smoke. With a high cholesterol, smoking matters more than usual.

When to contact us

Contact the practice if you get new muscle pain or weakness on a tablet, or if you have not heard from the clinic within 8 weeks. Chest pain on exertion or new breathlessness: contact us the same day. Chest pain at rest, or sudden face, arm or speech changes: call 999.

More information

HEART UKWhat is familial hypercholesterolaemia?chmg.co.uk/heartuk-fh - opens their website NHS.UKHigh cholesterol: causes, tests and treatmentchmg.co.uk/nhs-cholesterol - opens their website

Emergency? Chest pain at rest, or sudden face, arm or speech changes: call 999. Otherwise contact the practice.