EAS updates consensus statement on FH management in children and adolescents
The European Atherosclerosis Society (EAS) has updated its recommendations for the diagnosis and management of pediatric familial hypercholesterolemia (FH), with revised diagnostic criteria, lower LDL-c targets, and new treatment algorithms.
The European Atherosclerosis Society (EAS) has published an updated consensus statement on the diagnosis and management of familial hypercholesterolemia (FH) in children and adolescents, replacing its 2015 recommendations. The recommendations advocate earlier diagnosis, lower LDL-c treatment goals, and earlier initiation of lipid-lowering therapy to reduce cumulative LDL-c exposure and prevent premature ASCVD.
The consensus recommends establishing pediatric FH screening programs in all countries and proposes revised diagnostic criteria with lower LDL-c thresholds to improve diagnostic sensitivity. Genetic testing is advised for all children with suspected FH, and Lp(a) measurement should be performed at least once from age 5 years. Pharmacological treatment for heterozygous FH should ideally start from age 6 years, with LDL-c goals of ≤3.5 mmol/L (135 mg/dL) for children aged 6–<10 years and ≤3.0 mmol/L (115 mg/dL) from age 10 years or from 6 years in the presence of major risk enhancers. Statins remain first-line therapy, with ezetimibe and PCSK9 inhibitors recommended when LDL-c targets are not achieved.
For homozygous FH, the consensus stresses diagnosis as early as possible, preferably in infancy, and recommends immediate initiation of intensive lipid-lowering therapy with an LDL-c target of ≤3.0 mmol/L (115 mg/dL) or ≤1.8 mmol/L (70 mg/dL) in those with established ASCVD. Updated treatment algorithms incorporate recently approved therapies such as evinacumab and lomitapide for HoFH alongside lipoprotein apheresis when indicated.