For many Black families, high cholesterol is not just about diet and exercise; it is driven by an inherited condition that medicine often overlooks. Familial hypercholesterolemia, or FH, raises LDL cholesterol to dangerous levels from birth, yet it is rarely named in exams or community health efforts, even though it affects about 1 in 250 adults nationwide.
That silence has real consequences for racial health disparities. Black Americans with FH are underdiagnosed and undertreated compared with white patients, leaving them at higher risk for severe outcomes such as heart attacks and stroke. Only 61% of Black patients with FH are prescribed cholesterol-lowering medications, compared with 73% of white patients, even as 82% of Black adults with FH have high blood pressure, 39% have diabetes, and 16% are current smokers.
These gaps sit inside a wider crisis in cardiovascular health. Almost 60% of Black adults live with some form of cardiovascular disease, and more than half of heart failure hospitalizations in adults under 50 involve Black patients. Stroke rates are highest among Black men and women, with 5.4% of Black women and 4.8% of Black men affected, showing how missed FH diagnoses feed into an already heavy burden of risk.
Children are part of this inequity as well. Only about 30% of children born with FH are diagnosed early, and delays are even longer for Black children, despite recommendations for screening when there is a family history of early heart disease or cholesterol problems. Just 27.7% of Black patients receive a documented genetic diagnosis, compared with 63.1% of white patients, limiting access to advanced medications that can dramatically lower stubborn LDL cholesterol.
See: “There Are Racial Differences in Inherited High Cholesterol” (November 1, 2025)
