Genetic testing
Familial hypercholesterolaemia genetic test
The genetic test behind severe inherited high cholesterol - confirming a diagnosis that changes treatment for whole families.
Key facts
At a glance
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The clue: LDL cholesterol persistently above roughly 4.9, early heart disease in the family, or cholesterol deposits around eyes or tendons.
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The test: blood or saliva analysis of LDLR, APOB and PCSK9 genes confirms familial hypercholesterolaemia (FH).
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Why confirmation matters: FH means lifelong exposure to high LDL - treatment targets are stricter and start earlier.
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Family cascade: each first-degree relative has a 50% chance - cascade testing finds affected siblings and children early.
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Follow-up: a lipid specialist sets treatment - statins and newer agents bring risks close to normal when started early.
The full picture
What this test involves, and how to get it
Familial hypercholesterolaemia (FH) affects roughly 1 in 250 people, making it one of the most common serious inherited conditions - and one of the most underdiagnosed. A variant in LDLR, APOB or PCSK9 impairs cholesterol clearance from birth, so arteries face high LDL for decades longer than in ordinary high cholesterol, bringing heart attacks forward by twenty years or more when untreated. Genetic testing turns a suspicious lipid profile into a confirmed diagnosis: it distinguishes true FH from lifestyle-related cholesterol elevations, hardens the case for early and intensive treatment, and - because inheritance is dominant - triggers cascade testing that finds affected relatives, including children, at an age when prevention is most powerful.
The treatment story is genuinely optimistic: statins, ezetimibe and PCSK9 inhibitors can bring FH risk close to population levels when started early, which is exactly why finding carriers matters. NHS lipid clinics offer genetic testing where criteria (such as the Simon Broome or Dutch Lipid Network scores) are met, with cascade programmes in many regions, though provision is uneven. Privately, lipid specialists and genetics services can arrange testing within weeks, useful for people with borderline criteria or families wanting resolution quickly. Genetic counselling is lighter-touch than in cancer genetics but still valuable, covering children’s testing timing and the UK insurance code - under which predictive results are not requested by insurers for standard levels of cover.
A quiet reminder
This guide is for information, not medical advice.
Your own clinician knows your history and can tell you which parts apply to you. Next review of this page: 2027-09-27.
Frequently asked
Common questions about Familial hypercholesterolaemia genetic test.
Quick, plain-English answers to what people ask us most.
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What does Familial hypercholesterolaemia genetic test involve?
Familial hypercholesterolaemia genetic test looks at specific genes or genetic markers, usually from a blood or saliva sample, to identify inherited variants that may be relevant to your health or that of your family. It's typically requested because of a personal or family history that raises the possibility of a specific inherited condition. Results are usually discussed with genetic counselling support given the personal implications involved.
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Who should consider this kind of testing?
This is usually most relevant for people with a relevant family history, a personal diagnosis that suggests a genetic cause, or specific ethnic or population risk factors. A genetic counsellor or specialist can help assess whether testing is likely to be useful in your particular situation before you proceed. Testing is a personal decision, and support is available to help you weigh up the potential implications beforehand.
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Do I need to prepare beforehand?
Most genetic tests need no physical preparation beyond providing a blood or saliva sample, but pre-test counselling is often recommended so you understand what a result could mean. This is different from most other tests, since the implications can extend to other family members as well as yourself. The clinic will explain what to expect during the consent and counselling process.
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What happens during testing?
The sample collection itself is usually quick and straightforward — typically a blood draw or a saliva/cheek swab. Analysis is carried out in a specialist laboratory and takes considerably longer than a standard blood test because of the complexity involved. You'll usually have a consultation both before and after testing to discuss what's involved and what the result means.
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Are there any risks to having the test?
The physical risks of sample collection are minimal, similar to a standard blood test. The more significant considerations are emotional and practical — how you might feel about a result, and potential implications for insurance, family planning or relatives. Genetic counselling before testing is designed to help you think through these issues in advance.
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How long does it take to get results?
Genetic tests generally take longer than routine blood tests, often several weeks, because of the detailed laboratory analysis involved. Your clinician will give you an expected timeframe specific to the test being carried out. Results are usually delivered in a follow-up consultation rather than a written report alone.
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What happens if the result is positive?
A positive result means a specific genetic variant has been identified, and a specialist will explain what this means for your health risk and any recommended next steps, such as increased monitoring or preventative options. It may also have implications for blood relatives, who can be offered testing of their own if relevant. You'll be supported through this discussion rather than simply given a result on paper.
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Is genetic testing available on the NHS?
NHS genetic testing is generally available where specific clinical criteria are met, such as a strong family history, though this can involve a wait for assessment and results. Private genetic testing can offer quicker access and may be considered by people who don't meet NHS eligibility criteria but still want to understand their risk. Cost varies by provider and varies depending on the scope of the test.
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How accurate is this kind of test?
Modern genetic testing is highly accurate at detecting the specific variants it's designed to look for, when carried out in an accredited laboratory. However, a negative result doesn't rule out all possible genetic contributions to a condition, and results are best interpreted with specialist input. Your genetic counsellor or specialist can explain the specific accuracy and limitations relevant to your test.
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How do I arrange this kind of testing privately?
You can typically arrange an initial consultation with a private clinic or genetic specialist to discuss whether testing is appropriate for you. This usually includes pre-test counselling, the test itself, and a follow-up appointment to discuss results. Contact the clinic to ask about availability and what the process involves.