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Dr. Alessandro Giardini
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A father has a heart attack at 42. A mother is told she needs a stent at 47. An uncle dies suddenly in his early fifties. In the days and weeks that follow, once the immediate crisis settles, the same question surfaces in almost every family: could this happen to our children?
Dr. Alessandro Giardini sees families in exactly this position. The worry is understandable and, in some cases, entirely justified. Certain inherited conditions that cause high cholesterol from birth can run silently through families for generations, only becoming apparent when someone has a premature cardiovascular event. Testing children in those families is not overcautious. It can be one of the most useful things a family does.
Most heart attacks in older adults are the results of decades of accumulated risk from smoking, high blood pressure, diabetes, and lifestyle. A heart attack in a younger person raises a different question. When cardiovascular disease strikes before 55 in a man or before 65 in a woman, there is a meaningful chance that an inherited cholesterol disorder played a role.
The most important of these is familial hypercholesterolaemia. A parent who carries an inherited high cholesterol since young age has a 50 per cent chance of passing it to each child. The condition produces no symptoms in childhood. Children with it look healthy, run around, eat normally, and pass every school medical without difficulty.
That invisibility is precisely the problem. Without testing, nobody knows the child's cholesterol has been elevated since birth. Damage to artery walls accumulates quietly over years. Identifying it early and starting treatment in childhood substantially reduces the risk of cardiovascular disease later in life.
The process is simple. A GP or specialist requests a fasting blood test measuring LDL cholesterol, HDL cholesterol, triglycerides, and total cholesterol. The test itself takes minutes.
What matters more than the blood draw is the conversation around it. Dr. Giardini reviews the family tree in detail during these assessments, looking at which relatives were affected, at what age, and whether anyone has already been diagnosed with any genetic form of high cholesterol or started statin treatment unusually early. That family history often tells as much as the blood result itself.
If cholesterol levels are elevated and the pattern fits an inherited condition, genetic testing may be discussed. This can confirm the diagnosis definitively and guide decisions about testing other family members. The main page on high cholesterol in children covers diagnosis, genetic testing, and treatment options in full detail.
There is no need to rush to a blood test the week a relative has a cardiac event. The priority in those first days belongs with the person who is unwell. Once the situation has stabilised, speaking to your GP about whether the children should have a cholesterol check is a reasonable and proportionate step.
Guidelines generally support testing children from age two onwards when there is a strong family history, though many families first raise the question when children are school-age or older. There is no upper age limit. Teenagers and young adults benefit from testing just as much as younger children.
The reassurance for most families is twofold. Many children tested in this context turn out to have completely normal cholesterol. For those who do not, early identification means early action, and the treatments available today are safe, well tolerated, and genuinely effective at reducing long-term risk.
From age two if there is a significant family history. In practice, testing is appropriate at any age once a family history concern has been identified. There is no scenario in which it is too late to check.
Not necessarily. If your high cholesterol is caused by familial hypercholesterolaemia, each child has a 50 per cent chance of inheriting it. A simple blood test can determine whether they are affected.
The next steps depend on how elevated the levels are and whether the pattern suggests an inherited condition. Most children with confirmed inherited cholesterol disorders are monitored regularly and may start treatment in later childhood or adolescence. Dr. Giardini discusses every step with families before any decisions are made.
Yes. GPs can request a fasting lipid profile. If the results raise concern, referral to a paediatric cardiologist or lipid specialist is the usual next step. Mentioning the specific family history when booking the appointment helps ensure the right tests are requested.
Author: Dr. Alessandro Giardini, MD, PhD
Written 09/05/2026