Last reviewed: June 2019
Last updated: April  2018



History and exam

Key diagnostic factors

  • presence of risk factors
  • family history of early onset of coronary heart disease or dyslipidaemia in first-degree relatives
  • history of cardiovascular disease
  • consumption of saturated fats and trans-fatty acids
  • excess body weight (especially abdominal obesity)
  • xanthelasmas
  • tendinous xanthomas

Other diagnostic factors

  • arcus corneae with onset before the age of 45 years
  • tuberous xanthomas

Risk factors

  • insulin resistance and type 2 diabetes mellitus
  • excess body weight (body mass index >25 kg/m²)
  • cigarette smoking
  • hypothyroidism
  • cholestatic liver disease
  • nephrotic syndrome
  • use of certain medications

Diagnostic investigations

1st investigations to order

  • lipid profile
  • serum thyroid-stimulating hormone (TSH)
Full details

Treatment algorithm


Authors VIEW ALL

Raul D. Santos

Associate Professor of Medicine

Director Lipid Clinic Heart Institute (InCor)

University of Sao Paulo Medical School Hospital

Scientific Advisor

Hospital Israelita Albert Einstein

Sao Paulo



RDS has received honoraria for consulting, speaker activities and research from Astra Zeneca, Amgen, Akcea, Biolab, Esperion, Kowa, Pfizer, Merck, Novo-Nordisk, and Sanofi/Regeneron.

Seth S. Martin

Assistant Professor of Medicine/Cardiology

Associate Director

Lipid Clinic

Ciccarone Center for the Prevention of Heart Disease

Johns Hopkins University School of Medicine




SSM has received honoraria from the American College of Cardiology for educational activities. SSM is listed as a co-inventor on a pending patent filed by Johns Hopkins University for a novel method of LDL-cholesterol estimation. SSM received a charitable gift for the VLDL big data project from the Trone Foundation. SSM has received research support from the PJ Schafer Cardiovascular Research Fund, American Heart Association, Aetna Foundation, Google, and Apple. SSM has acted as a consultant for Abbott Nutrition, Pressed Juicery, Quest Diagnostics, Sanofi/Regeneron, Amgen, and the Pew Institute.

Dr Raul D. Santos and Dr Seth S. Martin would like to gratefully acknowledge Dr Martin Engelhardt and Dr Michael Miller, the previous contributors to this topic. ME declares that he has no competing interests. MM has received research grant support and honoraria for lectures from AstraZeneca, Merck-Schering Plough, and Pfizer. MM has received consulting fees from Pfizer, Merck-Schering Plough, and Roche.

Peer reviewers VIEW ALL

Assistant Professor of Medicine

Noninvasive Cardiology

MetroHealth Campus

Case Western Reserve University




MLA declares that he has no competing interests.

Consultant/Senior Lecturer in Diabetes & Metabolism

The Royal Oldham Hospital & University of Manchester Cardiovascular Research Group Diabetes Centre

Royal Oldham Hospital




DB declares that he has no competing interests.

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