A European registry analysis published in Diabetes Care revealed that probable familial hypercholesterolemia (FH) affects approximately 1 in 215 children with type 1 diabetes (T1D), yet most remain untreated despite their markedly elevated cardiovascular risk.

The retrospective cohort study analyzed data from 41,992 children with T1D (2014–2023) across 384 centers in the Diabetes Prospective Follow-Up registry. Probable FH was defined as LDL cholesterol (LDL-C) >4.9 mmol/L and possible FH as LDL-C between 4.1 and 4.9 mmol/L.

Among participants, 416 (1.2%) met criteria for possible FH and 195 (0.56%) for probable FH, while 31,862 had LDL-C <4.1 mmol/L. Children with possible or probable FH had higher BMI and HbA1c levels and were more often female. The odds of LDL-C >4.9 mmol/L increased with poor glycemic control (HbA1c >9%, OR 3.85) and higher BMI (OR 1.47).

Despite the elevated atherosclerotic risk, only 20% of those with possible FH and 29% with probable FH were receiving LLT. The findings underscore an urgent need for early FH identification and proactive lipid management in children with T1D to prevent premature cardiovascular disease.