According to a major study from the US and South Korea, published in the Journal of the American College of Cardiology, more than 99 per cent of people who suffer a heart attack, stroke or heart failure have at least one modifiable cardiovascular risk factor above optimal levels, often years in advance.
Cardiovascular disease remains the leading cause of death worldwide.
The researchers reviewed health records from more than 9.3 million South Korean adults and nearly 7,000 adults in the US, followed for up to 20 years. They focused on four major traditional cardiovascular risk factors, defining non-ideal levels based on American Heart Association guidelines as follows: blood pressure ≥120/80 mm Hg or on treatment; total cholesterol ≥200 mg/dL or on treatment; fasting blood sugar ≥100 mg/dL or diagnosed with diabetes or receiving treatment; and past or current tobacco use. The analysis was based on 601,025 cardiovascular events in South Korea and 1,188 in the US.
More than 99 per cent of people who developed coronary heart disease, heart failure or stroke had at least one non-optimal risk factor before the event. Over 93 per cent had two or more risk factors. High blood pressure was the most prevalent, affecting over 95 per cent of patients in South Korea and 93 per cent in the US. Even among women under 60, typically considered lower risk, over 95 per cent had at least one risk factor before experiencing heart failure or stroke.
A secondary analysis using higher thresholds doctors often use for diagnosis—blood pressure ≥140/90, cholesterol ≥240, glucose ≥126, and current smoking—showed similar results. At least 90 per cent had a major risk factor before their first cardiac event.
These findings challenge the belief that life-threatening cardiac events occur without warning and highlight the importance of early detection and management of modifiable risk factors.