Familial hypercholesterolaemia (FH) is a monogenic inherited condition with high risk of premature CHD. We present the extent of LDL-C lowering, DNA testing and cascade testing in adults with FH attending UK lipid clinics. Only 44% of the patients achieved a >50% lowering of LDL-C from the baseline value. Half of all patients and 53% of women with CHD failed to achieve the target >50% reduction in LDL-C. There is a major lack of family “cascade” testing. Funding for DNA testing and cascade testing is lacking in many parts of the UK.