Heart attacks and strokes are rarely random events. A major new study involving more than 9 million adults in the United States and South Korea shows that almost all of them are preceded by well-defined risk factors, offering powerful evidence that most cardiovascular emergencies can be anticipated long before they happen.
Even among women under 60, who typically face the lowest risk, the overwhelming majority of incidents were preceded by identifiable health issues. The findings shed light on just how predictable — and preventable — many heart attacks and strokes can be.
H2: Four main risk factors drive nearly all heart attacks and strokes
The study, published in the Journal of the American College of Cardiology, revealed that hypertension, high cholesterol, high blood sugar, and smoking—current or past—accounted for the overwhelming majority of cardiovascular events. When combined, these four factors were present in 99 percent of all cases observed over the long-term study.
High blood pressure emerged as the most common contributor. More than 93 percent of individuals who experienced a heart attack, stroke, or heart failure had hypertension beforehand in both the US and South Korea. Managing blood pressure, therefore, is seen as a critical step in reducing the risk of severe heart conditions.
High cholesterol levels and elevated blood sugar were also frequently identified among patients. Both factors can silently damage arteries over time, increasing the likelihood of plaque buildup, blockages, and eventually cardiovascular events.
Smoking adds another layer of risk, accelerating arterial damage and raising the chances of life-threatening heart problems.
Implications for prevention and long-term health
These findings challenge recent claims suggesting that heart attacks and strokes without traditional risk factors are on the rise. Researchers argue that previous studies may have missed undiagnosed conditions or overlooked risk factors that were below clinical thresholds.
Early identification and intervention are essential. For example, managing blood pressure with lifestyle changes or medication, adopting a heart-healthy diet, maintaining regular physical activity, and quitting smoking can dramatically reduce the risk of major cardiovascular events.
Women under 60 are not immune. Even in this lower-risk group, more than 95 percent of serious heart events were preceded by at least one of these factors. This underscores the importance of proactive health monitoring and preventive care across all age groups.
Duke University cardiologist Neha Pagidipati, who wrote an editorial accompanying the study, stressed that these results show the urgent need to manage health risks before they become deadly. “We can – and must – do better,” she wrote, reinforcing the public health message that prevention is far more effective than treatment after the fact.
Ultimately, focusing on these four modifiable risk factors provides a clear and actionable roadmap for preventing heart attacks, strokes, and other cardiovascular complications. Health professionals urge regular checkups and risk assessments as key steps toward long-term cardiovascular wellness.
Even small, consistent changes—like reducing sodium intake, monitoring cholesterol, managing blood sugar, and quitting smoking—can have a substantial impact on lowering overall risk. This study reinforces that cardiovascular health largely depends on controlling the factors within our reach.