Ninety nine per cent of heart attacks, strokes and heart failures are linked to just four modifiable risk factors. High blood pressure, high cholesterol, elevated blood sugar and tobacco use—past or present—preceded nearly every major cardiovascular event in this long-term study published in 2025.
Even among women under 60, the lowest-risk group, over 95% of incidents tied back to these factors, says a groundbreaking analysis of over 9 million adults across South Korea and the US links.
Four Factors Drive Nearly All CVD Events
Researchers tracked millions through health records, confirming hypertension as the top culprit—over 93% of victims in both nations had high blood pressure beforehand. High cholesterol, diabetes (high blood sugar), and smoking followed closely, combining to flag virtually all cases. Senior author Philip Greenland from Northwestern University emphasized: “Exposure to one or more nonoptimal risk factors precedes these outcomes nearly 100 percent.”
This challenges claims of “mystery” events without warnings, suggesting prior studies missed subclinical risks or undiagnosed factors. Women under 60 still showed 95%+ linkage, proving no true “healthy” surprises exist.
Hypertension Emerges as Top Preventable Threat
High blood pressure topped associations in both datasets, appearing before most heart attacks, strokes, and failures. Managing it through lifestyle, medication, and monitoring could slash global CVD burden dramatically. The study urges intensified focus on these controllables over hard-to-treat or non-causal elements.
Consistent findings across diverse populations strengthen the case for universal screening and intervention.
Implications for Prevention Strategies
These insights redirect efforts: Routine checks catch risks early, while quitting smoking, diet/exercise for cholesterol/sugar, and BP meds save millions. Public health campaigns should prioritize these over exotic theories. Even low-risk demographics benefit, underscoring universal vigilance.
Key Questions Answered
What are the four factors? High blood pressure, high cholesterol, high blood sugar, smoking.
Women under 60 safe? No—95%+ events still linked to these risks.
Why hypertension #1? Present in 93%+ of cases across US and South Korea.
Q&A: CVD Risk Essentials
Q: Study size and scope?
A: 9M+ adults from South Korea/US health data, long-term tracking.
Q: Debunks what myth?
A: Rising “unexplained” events without risk factors.
Q: Actionable steps?
A: Control BP/cholesterol/sugar; quit smoking—nearly 100% preventable.
FAQ
First sign always present?
Yes—99% show at least one factor beforehand.
Global applicability?
Strong—two nations’ data align perfectly.
Younger people affected?
Absolutely; even under-60 women hit 95% linkage.
Next research focus?
Better control methods for these proven risks.
