Important research conducted on a global scale has overturned one of the most widespread beliefs in cardiovascular medicine: that of a heart attack or stroke that strikes without warning. According to the data collected, over 99% of serious cardiovascular events, such as heart attacks, strokes and heart failure, are preceded by at least one of four main modifiable risk factors: high blood pressure, high cholesterol, high blood sugar or smoking habits, even if previous.
The study was led by Hokyou Lee of Yonsei University in Seoul, in collaboration with US researchers, including cardiologist Philip Greenland of Northwestern University. The results, published on Journal of the American College of Cardiologyleave little room for doubt: almost all cases of heart disease have an explanation attributable to well-known, and above all avoidable, causes.
Data from over 9 million people between South Korea and the United States analyzed
To reach these conclusions, the team examined two of the largest existing databases: that of the South Korean National Health Service, containing data from over 9 million adults, and the American Multi-Ethnic Study of Atherosclerosis, which for years has monitored the cardiovascular health of thousands of people of different ethnicities.
Participants were followed for up to 20 years, keeping track of their health status and risk factors present before the onset of the disease. In more than 99% of the cases examined, the subjects had at least one of the four risk factors already present before the cardiovascular event.
Even among women under 60, considered at lower risk, over 95% of heart attacks and strokes were associated with high blood pressure, cholesterol, altered blood sugar levels or smoking.
One of the most surprising aspects concerns the fact that it is not necessary to have clinically “severe” values to be at risk. Blood pressures just above 120/80 mmHg or total cholesterol above 200 mg/dL — values often considered borderline — can already significantly increase the likelihood of developing cardiovascular disease over time.
Hypertension is the most common risk factor
Among all risk factors, the most recurrent was hypertension, present in more than 93% of cardiovascular events recorded in both Korea and the United States. A fact that highlights how underestimated and often undiagnosed it is, especially in young adults who rarely measure blood pressure.
For cardiologist Philip Greenland, the main goal should now be to prevent and treat these modifiable factors more effectively, rather than focusing resources on less influential or untreatable secondary causes.
This message aligns perfectly with the preventive strategy proposed by the American Heart Association, called “Life’s Essential 8”, which promotes optimal health through constant control of blood pressure, cholesterol, blood sugar and the elimination of smoking.
It’s not just bad luck: prevention begins long before the symptoms
According to cardiologist Neha Pagidipati of Duke University, who commented on the study in an editorial, medicine must rethink the concept of “apparent health”. It is not enough to have no symptoms or feel well: it is necessary to maintain optimal, and not simply “acceptable”, values from a young age.
This means not ignoring “slightly high” blood pressure or “almost normal” cholesterol, but acting promptly, with regular monitoring and lifestyle changes. Your daily health check should begin before any noticeable symptoms appear, and not just when you arrive at the cardiologist’s office.
The picture is made even more urgent by the worldwide increase in chronic diseases such as hypertension, diabetes and obesity, all of which are growing. If indeed 99% of cardiovascular diseases can be prevented by addressing these factors, the implications for public health are enormous.
As the authors write:
These findings not only dispel the idea that cardiac events occur without warning signs, but also demonstrate that serious conditions such as stroke and heart failure rarely occur in the absence of traditional, modifiable risk factors.
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