Statins for Familial Hypercholesterolemia
Familial hypercholesterolemia (FH) is a life-threating condition that can lead to heart attacks and even death. But with early diagnosis and treatment to lower LDL cholesterol, individuals with FH can enjoy healthy lives. Familial hypercholesterolemia (FH) can affect individuals from birth, which means treatment for the condition can be a life-long journey. Typically children with high LDL cholesterol from FH start treatment at 8 to 10 years of age.
In addition to lifestyle modifications, patients with FH usually take cholesterol-lowering medications to manage their condition. The most common type of medication are statins, a class of drugs known as HMG-CoA reductase inhibitors.
Statins block a key enzyme in the liver that is responsible for producing cholesterol. This leads to the liver sending a signal to clear cholesterol from the bloodstream. The way the liver gets this cholesterol is by making more LDL receptors to get the cholesterol from the blood. The liver makes more healthy LDL receptors in response to this signal.
Studies have shown that statins can reduce LDL-cholesterol by 35 to 55 percent and can reduce the risk of cardiovascular disease (CVD) by 22 percent for each 40 mg/dL (1 mmol/L)reduction in LDL cholesterol. 
Types of Statins
There are 7 statin medications available. Individuals with FH are often prescribed high potency statins because of the very high LDL cholesterol associated with FH.
High Potency Statins
- Rosuvastatin (Crestor)
- Atorvastatin (Lipitor)
- Pitavastatin (Livalo)
- Simvastatin (Zocor)
- Lovastatin (Mevacor, Altoprev)
- Pravastatin (Pravachol)
- Fluvastatin (Lescol, Lescol XL)
Information on COVID-19 and Heart Disease
Who Are Recommended to Take Statins?
- People who already have atherosclerotic cardiovascular disease. This group includes people who have had heart attacks, strokes caused by blockages in a blood vessel, mini-strokes (transient ischemic attacks), peripheral artery disease, or prior surgery to open or bypass coronary arteries.
- People who have very high LDL cholesterol. This group includes adults who have LDL-cholesterol levels of 190 mg/dL (4.9 mmol/L) or higher. This group includes people with Familial Hypercholesterolemia, including children who can begin taking statins between the ages of 8-10.
- People who have diabetes. This group includes adults who have diabetes and an LDL-cholesterol between 70 and 189 mg/dL (1.8 and 4.9 mmol/L), especially if they have evidence of vascular disease.
- People who have a higher 10-year risk of heart attack. This group includes people who have an LDL- cholesterol between 70 and 189 mg/dL (1.8 and 4.9 mmol/L), and whose 10-year risk of a heart attack is 7.5 percent or higher.
Not everyone can take statins such as women who are trying to conceive, pregnant, or nursing. Talk to you doctor about other therapy options.