Four risk factors are associated with nearly all heart attacks and strokes, according to a study of more than 9 million people in the United States and South Korea. Researchers say identifying and controlling these factors could prevent most serious cardiovascular events.
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Science Alert writes that, taken together, these four factors preceded 99% of all cardiovascular events observed in the long-term study, published in 2025.
These factors are: high blood pressure, high cholesterol, high blood sugar levels and smoking (current or past).
Even in women under 60 – the category with the lowest risk of cardiovascular events – more than 95% of heart attacks and strokes were associated with the existence of one of these risk factors.
Hypertension was the risk factor most frequently associated with cardiovascular events.
In both the US and South Korea, more than 93 percent of people who had a heart attack, stroke, or heart failure had high blood pressure before these problems developed.
Controlling high blood pressure could therefore be essential for preventing serious cardiovascular disease in the long term.
“We believe the study demonstrates very convincingly that exposure to one or more modifiable risk factors prior to the occurrence of these cardiovascular events is present in nearly 100% of cases”said cardiologist Philip Greenland from Northwestern University, when the research was published.
Also, previous studies may have missed certain diagnoses or missed levels of risk factors below commonly used clinical thresholds.
In an editorial accompanying the study, Duke University cardiologist Neha Pagidipati, who was not involved in the research, said the results show how important it is that risk factors are controlled before they lead to serious or even fatal problems.
The findings add to other recent research suggesting that we may be underestimating the role of other causes that contribute to heart attack risk, particularly among young adults.
A study by Mayo Clinic researchers of 1,474 heart attacks in people under the age of 65 showed that the classic mechanism of artery blockage by atherothrombosis does not explain the majority of heart attacks in women.
Although atherothrombosis was responsible for 75% of cases in men, in women it accounted for only 47% of heart attacks, suggesting that other causes play a much larger role than previously thought and could influence the prevention and treatment of the disease.
In women, 34% of all heart attacks were attributed to myocardial infarctions secondary to an imbalance between oxygen demand and supply (SSDM) caused by other stressors on the body, such as anemia or infections.
Among the other important causes identified were spontaneous coronary artery dissections (SCAD), in which the arterial wall ruptures and blood accumulates within it, as well as emboli, which are blood clots originating from other areas of the body.
The study led by Greenland and his collaborators was published in the Journal of the American College of Cardiology.
