Key Points:
- Stroke risk factors are present in over 99% of heart attack, stroke, and heart failure cases.
- High blood pressure, high cholesterol, elevated glucose, and smoking are the most common risk factors.
- Early detection and lifestyle interventions can prevent most cardiovascular events linked to stroke risk factors.
A new international study has found that more than 99% of people who experienced a heart attack, heart failure, or stroke had at least one major cardiovascular risk factor at unhealthy levels beforehand. The findings, published in the Journal of the American College of Cardiology, suggest that better prevention and treatment of common conditions such as hypertension and high cholesterol could significantly reduce cardiovascular disease worldwide and help address critical stroke risk factors.
Researchers analyzed data from more than 9 million adults in South Korea and nearly 7,000 adults in the United States, following participants for up to 20 years. They examined four major stroke risk factors—high blood pressure, high cholesterol, elevated fasting glucose, and tobacco use—and compared them to the incidence of cardiovascular events.
The study revealed that high blood pressure was the most common factor, affecting more than 95% of South Korean participants and 93% of U.S. participants before their first heart attack, stroke, or heart failure diagnosis. Identifying such stroke risk factors early could make prevention strategies far more effective.
High blood pressure most common
“This is important because high blood pressure is fairly easily detectable but it is asymptomatic, so often overlooked,” said Dr. Philip Greenland, senior author of the study and professor of cardiology and preventive medicine at Northwestern University Feinberg School of Medicine. “Our findings show how important it is to recognize it and treat it as one of the key stroke risk factors.”
The researchers used the American Heart Association’s criteria for ideal cardiovascular health, defining non-ideal levels as blood pressure of 120/80 millimeters of mercury or higher, fasting glucose of 100 milligrams per deciliter or more, current or past tobacco use, and cholesterol of 200 mg/dL or higher.
Even among younger adults, the pattern held. More than 95% of women under 60 who suffered a stroke or heart failure had at least one of the four stroke risk factors at unhealthy levels.
Study tracks millions worldwide
Greenland said the study challenges recent suggestions that many heart attack or stroke patients lack identifiable risk factors. He noted that earlier research may have missed long-term data showing prior exposures to these stroke risk factors.
“In brief, as we have known for many years, there are a small number of modifiable risk factors for heart disease, and at least one, but often more than one, are present in the background leading up to heart attacks, heart failure, or strokes,” Greenland said. “Patients should be sure that these four factors are assessed at every medical visit, and if there is even a slight elevation, efforts need to be made to treat that factor to prevent heart attack, stroke, or heart failure.”
According to the World Health Organization, cardiovascular diseases are the leading cause of death globally, responsible for an estimated 17.9 million deaths each year. About 85% of those are due to heart attacks and strokes. More than 64 million people worldwide live with heart failure.
Experts urge stronger screening
Dr. Cheng-Han Chen, a board-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in California, said the study underscores the importance of prevention.
“Cardiovascular disease is the leading cause of death in the United States,” Chen said. “This study reaffirms our need to aggressively screen for and manage the risk factors for heart disease in order to decrease the burden of this major problem in our society.”
Chen added that the results should prompt stronger public health efforts. “This study should further drive public health screening and prevention of cardiovascular disease risk factors,” he said.
The researchers concluded that while genetic factors and other biomarkers may influence risk, nearly all cardiovascular events can be traced to conditions that are both detectable and modifiable. They called for improved implementation of existing strategies, including lifestyle changes, medication, and routine health checks focused on stroke risk factors.
The study highlights a critical opportunity: addressing high blood pressure, high cholesterol, elevated glucose, and smoking could prevent most heart attacks, strokes, and heart failure cases, potentially saving millions of lives each year.
