Dutch Lipid Clinic Network FH Score Calculator

Score the Dutch Lipid Clinic Network criteria for familial hypercholesterolaemia: family history, personal history, examination, untreated LDL cholesterol and a DNA finding, with only the highest item in each group counting. The total sorts the diagnosis into definite, probable, possible or unlikely — and the sources do not agree about what a total of exactly 8 means, so this page tells you both.

Last updated 21 Sep 2026

DLCN score for familial hypercholesterolaemia

Five groups → definite, probable, possible or unlikely FH

Family history (first-degree relative)Only the highest applicable item counts. A relative with both premature coronary disease and tendon xanthomata scores 2, not 3.

Your own clinical historyPremature means before 55 in men and before 60 in women. Coronary disease outranks cerebral or peripheral disease; they do not add.

Physical examinationTendon xanthomata are close to pathognomonic and score highest. Arcus only counts if it appeared before 45; later arcus is common and non-specific.

Untreated LDL cholesterolThe bands are defined on an UNTREATED LDL-C. A value measured on a statin understates the score; find the pre-treatment result. The mmol/L and mg/dL figures are rounded pairings as the criteria print them, not exact conversions.

DNA analysisA negative test does not subtract anything; it scores 0, the same as not testing. About a fifth to a half of people with a clinical diagnosis have no variant found.

8pointsExample

A 46-year-old man with a myocardial infarction at 44. His father had a myocardial infarction at 50. Untreated LDL-C 7.1 mmol/L (275 mg/dL). No xanthomata, no arcus. No genetic test yet.

The Dutch Lipid Clinic Network criteria

DLCN total = family history (0, 1 or 2) + clinical history (0, 1 or 2) + physical examination (0, 4 or 6) + untreated LDL-C (0, 1, 3, 5 or 8) + DNA analysis (0 or 8)
Only the highest-scoring item in each group counts. Maximum possible total: 2 + 2 + 6 + 8 + 8 = 26.
Definite FH: more than 8 · Probable: 6 to 8 · Possible: 3 to 5 · Unlikely: below 3

untreated LDL-C: the LDL cholesterol before any lipid-lowering therapy. The criteria are defined on it and publish no correction for a treated value
premature: before 55 years in men and before 60 years in women, for both the family history and the personal history items
highest item per group: items within one group are alternatives, not additions — which is why the group maxima are 2, 2, 6, 8 and 8 and the total cannot exceed 26
8: the one total the sources disagree about: probable on the WHO and EAS reading, definite on the Australasian one

Worked example

A 46-year-old man with a myocardial infarction at 44. His father had a myocardial infarction at 50. Untreated LDL-C 7.1 mmol/L (275 mg/dL). No xanthomata, no arcus. No genetic test yet.
Family history: father with premature coronary disease (under 55) → 1
Clinical history: his own myocardial infarction at 44 → premature coronary artery disease → 2
Examination: nothing → 0
Untreated LDL-C 7.1 mmol/L sits in the 6.5 to 8.4 band → 5
DNA: not done → 0
Total 1 + 2 + 0 + 5 + 0 = 8 → probable FH on the WHO and EAS reading, and definite on the Australasian one
The disagreement does not change the action: refer for genetic testing, which would add 8 and settle it, and treat intensively now

Point table, with the group maxima as an arithmetic check

Summing every row instead of the highest per group gives 41, not 26 — which is the error to look for in any reproduction of this table. The mg/dL figures are rounded pairings: 4.0 mmol/L is 154.7 mg/dL, 6.5 is 251.4 and 8.5 is 328.7.
Group	Item	Points	Group maximum
Family history	First-degree relative with premature coronary or vascular disease, or with LDL-C above the 95th percentile	1	2
	First-degree relative with tendon xanthomata or arcus cornealis, or a child under 18 with LDL-C above the 95th percentile	2
Clinical history	Premature coronary artery disease	2	2
	Premature cerebral or peripheral vascular disease	1
Physical examination	Tendon xanthomata	6	6
	Arcus cornealis before 45 years	4
LDL-C, untreated	8.5 mmol/L or above (330 mg/dL or above)	8	8
	6.5 to 8.4 mmol/L (250 to 329 mg/dL)	5
	5.0 to 6.4 mmol/L (190 to 249 mg/dL)	3
	4.0 to 4.9 mmol/L (155 to 189 mg/dL)	1
DNA analysis	Functional variant in LDLR, APOB or PCSK9	8	8
Total			26

What a total means, and where the sources differ

One total, two readings. A pathogenic variant alone scores exactly 8, so on the WHO and EAS reading a genetic diagnosis still needs one other criterion to be called definite by the score.
Total	WHO 1999 and EAS 2013	Australasian model of care (RACGP Red Book)
Above 8	Definite	Definite
8	Probable	Definite
6 to 7	Probable	Probable
3 to 5	Possible	Possible
Below 3	Unlikely	Unlikely

Why the score is built this way, and the one number to watch

Familial hypercholesterolaemia is one of the commonest inherited disorders there is, and one of the most underdiagnosed. The Dutch Lipid Clinic Network criteria, drawn up for a WHO consultation and reproduced in the 2013 European Atherosclerosis Society consensus, turn the things a clinician can gather in an ordinary consultation into a total: the family, the patient’s own history, two physical signs, the untreated LDL cholesterol and, if it has been done, a genetic test. The total then sorts the diagnosis into four categories.

Two rules make the table work, and both are regularly broken in reproductions. First, only the highest-scoring item in each group counts. The items within a group are alternatives: a patient with tendon xanthomata and early arcus scores 6 for the examination, not 10. Adding everything gives an impossible total of 41, where the true maximum is 26. Second, the LDL-C bands are defined on untreated LDL cholesterol. Most people reach a lipid clinic already on a statin, and a treated LDL-C scores low precisely because the treatment worked. The criteria publish no correction factor, and this page does not invent one; correction factors exist in individual studies but are not part of the score. The right move is to find the pre-treatment result in the record. If there is none, say so in the referral and treat the score as a floor rather than a verdict.

The number that deserves attention is 8. The WHO and EAS versions call 6 to 8 probable and more than 8 definite. The Australasian model of care, as reprinted in the RACGP Red Book, calls 8 or more definite. Because a genetic variant on its own is worth exactly 8, the two readings disagree about the one patient for whom the diagnosis is otherwise most secure. In practice nothing hangs on it: probable and definite both mean referral, genetic confirmation, cascade testing of relatives and intensive LDL lowering. It matters for audit, for research eligibility and for anyone comparing counts across services.

The score is built for adults with a lipid result and a family history to hand. It does not suit children, whose LDL-C distribution is different, and it cannot see what nobody has asked about: an unexamined Achilles tendon or an untested sibling scores zero. Use the non-HDL cholesterol calculator and the LDL cholesterol unit converter for the arithmetic, and the LDL target by risk category interpreter once the diagnosis is made, because FH itself moves a patient’s risk category.

Frequently asked questions

What DLCN score means definite familial hypercholesterolaemia?

More than 8 points on the WHO and European Atherosclerosis Society version: 6 to 8 is probable, 3 to 5 possible, and below 3 unlikely. The Australasian model of care printed in the RACGP Red Book calls 8 or more definite, so a total of exactly 8 is probable on one reading and definite on the other.

Do I add up every item that applies?

No. Only the highest-scoring item in each of the five groups counts. A patient with tendon xanthomata and arcus before 45 scores 6 for the examination, not 10. The group maxima are 2, 2, 6, 8 and 8, so the highest possible total is 26.

Can I use an LDL cholesterol measured on a statin?

Not as it stands. The LDL-C bands are defined on untreated LDL cholesterol, and a treated value will under-score. The criteria do not publish a correction factor. Find the pre-treatment result; if none exists, record that the score is a minimum.

Does a positive genetic test on its own make the diagnosis definite?

It scores 8, which is probable on the WHO and EAS reading and definite on the Australasian one. Clinically the distinction does not change what happens next: cascade testing of first-degree relatives and intensive LDL lowering.

Does a negative genetic test rule FH out?

No. It scores 0, the same as not testing, and a substantial minority of people with a strong clinical picture have no variant found in LDLR, APOB or PCSK9. The clinical score stands on its own.

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References

Nordestgaard BG, Chapman MJ, Humphries SE, et al. Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease. Consensus Statement of the European Atherosclerosis Society. Eur Heart J. 2013;34(45):3478–3490a.
World Health Organization. Familial hypercholesterolaemia (FH): report of a second WHO consultation. Geneva: WHO; 1999. WHO/HGN/FH/CONS/99.2.
Watts GF, Sullivan DR, Poplawski N, et al. Familial hypercholesterolaemia: a model of care for Australasia. Atheroscler Suppl. 2011;12(2):221–263; as reproduced in the RACGP Guidelines for preventive activities in general practice (Red Book), Appendix 2B.
Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111–188.

Medical Disclaimer: The tools and content provided here are for educational and reference purposes only. They are not intended to substitute for professional medical advice, diagnosis, or treatment. Clinical decisions should always be based on the comprehensive assessment of a qualified healthcare professional.