Ilaria Rosella Pagliaro A new international study debunks the myth of the "sudden" heart attack and identifies the real causes behind almost all cardiovascular diseases
Table of contents
A major research study conducted on a global scale has overturned one of the most widespread beliefs in cardiovascular medicine: that of the 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, elevated blood sugar, or smoking habit, even if past.
The study was led by Hokyou Lee from Yonsei University in Seoul, in collaboration with U.S. researchers, including cardiologist Philip Greenland from Northwestern University. The results, published in the Journal of the American College of Cardiology, leave little room for doubt: almost all cases of heart disease have an explanation traceable to well-known causes, and above all preventable ones.
Data from over 9 million people in 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 has been monitoring the cardiovascular health of thousands of people from different ethnicities for years.
Participants were followed for up to 20 years, tracking health status and risk factors present before the onset of disease. In more than 99% of the cases examined, 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, or smoking.
One of the most surprising aspects concerns the fact that it’s not necessary to have clinically “severe” values to be at risk. Blood pressure 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 recurring was hypertension, present before over 93% of cardiovascular events recorded in both Korea and the United States. A finding that highlights how underestimated and often undiagnosed it is, especially in young adults who rarely measure their blood pressure.
For cardiologist Philip Greenland, the main objective should now be to prevent and treat these modifiable factors more effectively, rather than concentrating resources on less influential or non-treatable 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 monitoring of blood pressure, cholesterol, blood sugar, and smoking cessation.
It’s not about bad luck: prevention begins long before symptoms
According to cardiologist Neha Pagidipati from Duke University, who commented on the study in an editorial, medicine must rethink the concept of “apparent health”. It’s not enough to have no symptoms or feel well: it’s necessary to maintain optimal values, not simply “acceptable” ones, 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. Daily health monitoring must begin before obvious symptoms appear, and not only 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 on the rise. If truly 99% of cardiovascular diseases can be prevented by acting on these factors, the implications for public health are enormous.
As the authors write:
These findings not only debunk 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 and modifiable risk factors.
