vascular cardiology

Dutch Lipid Clinic Network Criteria for Familial Hypercholesterolaemia (FH)

Validated scoring system for diagnosing familial hypercholesterolaemia (FH) based on family history, personal history, physical examination, LDL-cholesterol levels, and DNA analysis. Score ≥8 = definite FH. NICE and EAS recommended.

Family history*

Personal history of premature atherosclerotic disease*

Physical examination findings*

Untreated LDL-cholesterol level (mmol/L) — use pre-treatment value or calculate back-transformed value*

DNA analysis*

Score interpretation

Unlikely FH 0–2

Dutch score <3 — FH unlikely

→ Assess other causes of hypercholesterolaemia (secondary dyslipidaemia — hypothyroidism, nephrotic syndrome, ETOH); cardiovascular risk assessment (QRISK3); standard lipid management per NICE NG238; reassess if further family history obtained

Possible FH 3–5

Dutch score 3–5 — possible FH

→ Refer to lipid clinic or FH specialist; cascade testing of first-degree relatives; full FH workup (fasting lipids, LDL-C, family history tree); genetic testing; statin therapy (high-intensity); target LDL-C <2.5 mmol/L; lifestyle modification; PCSK9 inhibitor consideration if LDL inadequately controlled

Probable FH 6–7

Dutch score 6–7 — probable FH

→ Confirm FH diagnosis; lipid clinic referral; genetic testing (LDLR, APOB, PCSK9 panel); cascade screening all first-degree relatives; high-intensity statin ± ezetimibe; target LDL-C <2.5 mmol/L (or <1.8 if prior CVD); PCSK9 inhibitor if targets not met; annual lipid, LFT, CK monitoring; CVD risk assessment and management

Definite FH 8–99

Dutch score ≥8 — definite FH

→ Definite FH confirmed: lipid clinic referral; genetic testing mandatory; cascade screening all first-degree relatives (family notification letter via lipid clinic); high-intensity statin + ezetimibe; PCSK9 inhibitor (alirocumab/evolocumab) if LDL-C >2.5 mmol/L on maximal therapy (NICE approval criteria); lipoprotein apheresis if refractory; Lp(a) measurement; CVD imaging if symptomatic; register with HEART UK

Interpretation bands for the Dutch Criteria FH. Apply clinical judgement and local guidance.

References

Nordestgaard BG et al. Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease. Eur Heart J. 2013;34(45):3478–3490.
NICE CG71. Identification and management of familial hypercholesterolaemia. 2008 (updated 2017).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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