Black people with the genetic condition familial hypercholesterolemia (FH) are drastically underdiagnosed and untreated compared with white people.

People with FH are essentially born with high cholesterol levels that increase with age. FH also impairs the way the body recycles “bad” LDL cholesterol, which could lead to serious heart conditions requiring surgery.

The condition affects about 1 in every 250 people, according to the Centers for Disease Control and Prevention. Black people tend to be diagnosed at an older age than any other racial group.

Due to the genetic nature of FH, lifestyle modifications such as quitting smoking and losing weight aren’t enough to lower the risk for heart disease and high cholesterol and must be combined with medications. However, only 61% of Black people with FH are prescribed cholesterol-lowering medications compared with 73% of whites, according to a study published in the Journal of the American Heart Association (AHA).

People with FH are 20 times more likely to develop heart disease if they are not treated, according to the AHA.

“It’s most important to recognize that people with FH are at risk not just because they have an unhealthy lifestyle or diet,” said Keith Ferdinand, PhD, chair of preventive cardiology at Tulane University School of Medicine in New Orleans, in a U.S. News article. “Many of these patients will need not only statins but three to five medications to lower cholesterol.”

People with FH are much more likely to develop heart disease earlier in life, and half of men with untreated FH will experience a heart attack or angina before age 50, according to the AHA. Women with FH often develop heart disease 20 to 30 years earlier than those without the condition.

Health professionals encourage Black people to be proactive when it comes to their heart health.

“Every adult should have his or her cholesterol checked. Know your cholesterol,” Ferdinand said. “And if you have a family history of people having heart attacks, strokes, especially early on in their 50s and early 60s, then it’s not enough to just say that heart disease runs in your family. You should receive a specific diagnosis.”