Prevalence of Familial Hypercholesterolemia Among the General Population and Patients With ASCVD: A Systematic Review and Meta-Analysis

This very large meta-analysis — over 7 million people — provides the most robust global estimate of how common familial hypercholesterolemia (FH) is, and where to find it.

In the general population, FH affects about 1 in 311 — roughly double the long-quoted figure of 1 in 500. Among patients who already have atherosclerotic cardiovascular disease, the prevalence jumps to 1 in 17, an 18-fold enrichment, and similar across world regions and between adults and children. Yet only about 1 percent of an estimated 25 million affected people worldwide are currently diagnosed.

The strategic message is the same as the companion Beheshti meta-analysis: the highest-yield place to find undiagnosed FH is among patients with established disease, making cascade screening from those index cases a high-impact, underused opportunity to catch an inherited, treatable, dangerous condition early.

We rate the evidence strong. It is a rigorous, enormous meta-analysis that both updates a key epidemiological figure and points clearly toward where targeted screening should focus.