The National Lipid Association (NLA) recently released a clinical consensus update on familial hypercholesterolemia (FH). The update emphasizes early detection, lifelong treatment, and risk stratification with lipoprotein(a) assessment and imaging. The update also addresses special populations and features strategies for reducing disparities across populations.

The 2026 update replaces the 2011 NLA publication, Familial Hypercholesterolemia: Screening, Diagnosis and Management of Pediatric and Adult Patients: Clinical Guidance from the National Lipid Association Expert Panel on Familial Hypercholesterolemia. This updated version features sections on genetics, ASCVD risk stratification, treatment, the economic impact of hypercholesterolemia, and more.

The NLA provides some key points regarding the definition and diagnosis of FH in the 2026 consensus update:

  • FH is broadly defined as severe hypercholesterolemia inherited in an autosomal semidominant pattern.
  • Either clinical or genetic criteria can be used to diagnose FH. Country specific criteria may be used.
  • Among individuals who are genetically tested for FH, the absence of an identifiable pathogenic variant does not exclude a diagnosis of FH.
  • When FH is diagnosed, the affected individual should be assigned the specific ICD-10 code for FH.
Key Lifestyle and Nutrition Recommendations

In the 2026 update, the NLA provided lifestyle and dietary recommendations. All the recommendations are chronicled in table 8 of the clinical consensus, but some key recommendations include:

  • Trans fatty acids should be avoided for overall cardiovascular health.
  • Replace saturated fatty acids with unsaturated fatty acids to lower LDL-C.
  • Plant protein can be used as a partial replacement for carbohydrate or animal proteins, but no recommendation for youth with FH is provided; Adults are recommended 30g per day. 
  • Sixty minutes of daily physical activity is recommended for youth with FH, and at least 75 minutes of vigorous-intensity physical activity or at least 150 minutes of moderate-intensity physical activity a week for adults with FH.
  • Regarding weight loss, NLA notes that there is marked variation in the LDL-C responses to weight loss. Responses may be larger in younger patients and blunted in older patients. Younger patients are defined as younger than 40, older patients are defined as being 60 or older. 

View the full-text version of the NLA update for a complete look at these recommendations and more.

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