Advancing early detection and care of familial hypercholesterolaemia in children and adolescents: a consensus statement from the European Atherosclerosis Society

Gothenburg, Sweden, May 25, 2026

A new consensus statement from the European Atherosclerosis Society (EAS) highlights the need to improve the detection and management of familial hypercholesterolaemia (FH) in children and adolescents. The panel proposes widespread paediatric screening, earlier treatment, and updated approaches to diagnosis and care.

A preventable cause of early cardiovascular disease

FH is an inherited condition that causes lifelong elevated levels of low-density lipoprotein (LDL)-cholesterol. It affects 1 in 300 people worldwide in its heterozygous form (HeFH), and 1 in 300,000 in its rarer, severest homozygous form (HoFH). Individuals with FH face a markedly increased risk of premature atherosclerotic cardiovascular disease and early death. In HoFH, cardiovascular complications can develop in childhood if left untreated.

Over the past decade, major advances in understanding FH have been accompanied by the development of a broader range of lipid-lowering therapies. Despite this progress, FH remains underdiagnosed and undertreated, particularly in children where it is rarely identified despite being one of the most common inherited conditions. As Co-Chair Professor Albert Wiegman (Amsterdam University Medical Center, Netherlands) explains, “This is a missed opportunity, because we now have highly effective treatments that can normalize cholesterol levels and prevent cholesterol from accumulating in the arteries when started early in life.”

Call for national screening programmes

To address gaps in diagnosis, the EAS consensus panel proposes updated diagnostic criteria aimed at improving detection rates in younger populations. The panel also encourages all countries to establish paediatric screening programmes for FH. Systematic screening approaches, including family cascade screening and universal paediatric screening, have been shown to improve detection rates, but are not consistently used worldwide. “We cannot rely on chance diagnosis in adulthood,” says Co-Chair Professor Jeanine Roeters van Lennep (Erasmus Medical Center, Netherlands). “Systematic screening is essential to find children with FH early and intervene effectively.”

Start treatment early before damage begins

A central message of the statement is the importance of starting on a lipid-lowering therapy early in life. For children with HeFH, treatment should begin before puberty so it can be integrated into their daily lives. In certain high-risk cases, such as when a family member has experienced a myocardial infarction at a young age, treatment may need to start as early as six years of age. The panel also proposes updated LDL-cholesterol treatment goals, reflecting the need for more intensive treatment to reduce long-term risk, and particularly in children with additional major risk factors. “Lowering LDL-cholesterol levels from a young age has a profound impact on cholesterol exposure and thus on lifetime cardiovascular risk,” says Professor Albert Wiegman. “Delaying treatment allows the disease to progress silently for years.”

Effective care depends not only on starting treatment early, but also on intensifying therapy appropriately and long-term adherence. The article provides practical guidance to support clinicians in delivering timely and effective care.

Expanding treatment options and improving care pathways

Recent advances in lipid-lowering therapies have expanded the treatment options available for children with FH, enabling more personalized and effective care. “We now have more tools than ever to manage FH, even in its most severe forms,” notes Professor Jeanine Roeters van Lennep. “The challenge is ensuring timely access to these therapies.”

The statement also highlights the importance of continuity of care, including the transition from paediatric to adult healthcare.

A global call to action

The authors emphasise that improving outcomes for children with FH will require coordinated efforts to raise awareness, implement screening programmes, and ensure access to appropriate treatments globally. If implemented widely, these measures could substantially reduce premature cardiovascular disease and save lives worldwide.

Wiegman A, Bourbon M, Freiberger T, Gidding SS, Greber-Platzer S, Groselj U, Holven KB, Hudgins LC, Humphries SE, Hutten BA, Ibarretxe B, Pederiva C, Peretti N, Raal FJ, Ramaswami U, Sanin V, Santos RD, Steinhagen-Thiessen E, Watts GF, Perkins R, Benn M, Binder CJ, Romeo S, Roeters van Lennep J. Familial hypercholesterolaemia in children and adolescents: a European Atherosclerosis Society consensus statement. EUR Heart J 2026 DOI: 10.1093/eurheartj/ehag382

Notes for editors and history of the EAS Consensus

For this article, the EAS Consensus Panel was co-chaired by Professor Albert Wiegman (Netherlands) and Professor Jeanine Roeters van Lennep (Netherlands) and comprised experts from Europe, North and South America, South Africa and Australia.

The EAS Consensus Panel, comprising internationally renowned experts in atherosclerosis and cardiovascular disease, first convened in November 2009. The panel was originally co-chaired by Professor John Chapman (France) and Professor Henry N. Ginsberg (USA).

From 2021 to 2024, the EAS consensus programme was overseen by the coordinators Professor Alberico Catapano (Italy), Professor Lale Tokgözoğlu (Turkey) and Professor Kausik Ray (UK). From 2025 to 2028, the coordinators are Professor Christoph Binder (Austria), Professor Marianne Benn (Denmark), Professor Stefano Romeo (Sweden) and Professor Jeanine Roeters van Lennep (Netherlands).