Module 4: Severe Hypercholesterolemia & FH

Management of severe hypercholesterolemia and familial hypercholesterolemia.

Risk Calculator Primary Prevention Secondary Prevention Severe Hyperchol.Hypertriglyceridemia Diabetes Special Populations Lp(a) & ApoB Monitoring

Calculator Modules

1Risk Calculator
2Primary Prevention
3Secondary Prevention
4Severe Hyperchol.
5Hypertriglyceridemia
6Diabetes
7Special Populations
8Lp(a) & ApoB
9Monitoring

EHR Note

Copy a formatted clinical note with all entered data to paste into your EHR.

LDL-C Severity Assessment

Enter the untreated LDL-C level to determine the severe hypercholesterolemia pathway.

Untreated LDL-C*

mg/dL

Dutch Lipid Clinic Network (DLCN) Score

Score: 0

Interactive scoring tool for clinical diagnosis of familial hypercholesterolemia. Select the highest-scoring criterion within each category.

1. Family History

0 pts

None / Unknown0 ptsFirst-degree relative with premature CVD (men <55, women <60) or LDL-C >95th percentile1 ptFirst-degree relative with tendon xanthomas or arcus cornealis, OR child <18 with LDL-C >95th percentile2 pts

2. Personal Clinical History

0 pts

None0 ptsPremature cerebral or peripheral vascular disease (men <55, women <60)1 ptPremature coronary artery disease (men <55, women <60)2 pts

3. Physical Examination

0 pts

None0 ptsArcus cornealis before age 454 ptsTendon xanthomas6 pts

4. LDL-C Level (Untreated)

0 pts

Enter an untreated LDL-C value in Section 1 above to auto-score this category.

5. DNA Analysis

0 pts

No causative mutation identified / Not tested0 ptsCausative FH mutation identified8 pts

Total Score

Classification

Unlikely FH

Score < 3: FH is unlikely based on clinical criteria. Continue standard lipid management.

Family Hx

Personal Hx

Physical Exam

LDL-C

DNA

Unlikely (<3)

Possible (3-5)

Probable (6-7)

Definite (≥8)

Lipoprotein(a) Assessment

COR IIa / LOE B-NR

Lp(a) is a genetically determined, independent risk factor for ASCVD. Measurement is recommended at least once in a lifetime.

Why measure Lp(a) in this patient?

Lp(a) has not been measured. Measure Lp(a) at least once for ASCVD risk assessment (COR 1, LOE B-NR).
FH or severe hypercholesterolemia (LDL-C >= 190 mg/dL) is present. Elevated Lp(a) may contribute to the LDL-C elevation and further increases ASCVD risk.

Lp(a) Level

nmol/L

Enter value in nmol/L. To convert from mg/dL, multiply by ~2.5.

This tool is intended for use by healthcare professionals and does not replace clinical judgment. Always refer to the full 2026 ACC/AHA Guideline on the Management of Dyslipidemia for complete recommendations.