Recommendation ID

What is the utility of routine cardiovascular evaluation for asymptomatic people with FH?

Any explanatory notes
(if applicable)

Because of their inherent high risk of developing premature coronary heart disease, a low threshold of suspicion for coronary disease is recommended for people with FH. Routine monitoring to detect sub-clinical atherosclerosis should be non-invasive, sensitive, specific and cost effective. Research to assess the prevalence of both asymptomatic coronary and non-coronary atherosclerosis in people with definite heterozygous FH is required.

As well as exercise ECG testing followed by stress echocardiography before possible angiography in people with an abnormal exercise test and ankle brachial pressure measures, research should include magnetic resonance imaging (MRI) in addition to other modalities such as carotid IMT and coronary calcification. Outcomes should include changes in exercise ECG/ankle brachial pressure testing/IMT/calcification over time.

Consideration should also be given to the feasibility of conducting a long-term randomised trial to compare the differences in morbidity or mortality attributable to early diagnosis using routine monitoring or symptom-based investigation.

Source guidance details

Comes from guidance
Familial hypercholesterolaemia: identification and management
Date issued
August 2008

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 31/10/2019