I believe i have familial hypercholesterolemia, does this need to be treated?

Yes: I would imagine that you have a high LDL cholesterol and that other family members have as well, despite eating sensibly and staying fit. The question is "how" to treat it. When I was a med student, true familial hypercholesterolemia guaranteed early death. The statins were life-savers for these folks. Get a proper workup from a competent physician.