One in ten young heart attack survivors have a dangerous cholesterol disorder, yet few are properly treated, finds a recent study of familial hypercholesterolemia. Findings were published in the Journal of the American College of Cardiology and stress the importance of early diagnosis and treatment of this common, yet under-recognized, condition.

Known as the YOUNG-MI registry, this study followed 1,996 adults who experienced a heart attack before the age of 50. Participants were treated at two academic centers in Boston, MA, between 2000 and 2016 and were followed for 1 year.

The study was designed to look at a range of risk factors, symptoms, and outcomes in this population. The recent analysis, however, looked only at the role of familial hypercholesterolemia—a dangerous genetic cholesterol disorder—in young heart attack survivors.

Familial hypercholesterolemia, often referred to as FH, is a genetic condition that causes dangerously high cholesterol levels beginning at birth. FH increases risk for heart disease and life-threatening heart events, especially at a young age.

In the recent study, experts looked at how common the condition is among young heart attack survivors. Researchers also looked into the diagnosis and treatment of FH in patients after a heart event. Unfortunately, findings are less than promising.

Based on a review of blood tests, exams, and medical histories, researchers estimate that 9% of participants had either probable or definite FH. Of those, less than half were on statins, which are the first line of treatment for cholesterol disorders.

After tracking participants for a year after their heart attack, researchers found that around 90% of all patients were prescribed statins. However, only two-thirds of patients with FH were prescribed high-intensity statins, which are strongly recommended for high-risk patients. As a result, patients with FH were significantly more likely to still have elevated cholesterol levels after 1 year despite treatment.

What findings show, according to authors, is that FH is common, yet underdiagnosed and undertreated. As a result, it could be to blame for many heart attacks in young adults.

It’s estimated that FH is relatively common and affects an estimated 1 in 250 Americans. However, FH affected nearly 1 in 10 participants in this study. Very few were treated with statins before their heart attack, suggesting the condition went undiagnosed and untreated. Even after experiencing a heart attack, only two-thirds received ideal treatment to reduce risk for a second event.

According to authors, these findings highlight the need for better diagnosis and treatment of FH. When treated early, FH can be closely managed and risk for complications can be reduced. Left undiagnosed, it can lead to heart attacks—especially early in life—as this study shows.