99% of heart attacks and strokes are linked to these four risk factors, reveals new study

Heart attacks rarely come “out of the blue.” A landmark study finds four risk factors behind almost every case — and you can control all of them. (Image: Pexels)

A striking new study reveals that nearly all major cardiovascular events — including heart attacks and strokes — are tied to just four key modifiable risk factors. For anyone concerned about heart health, this research underscores both the danger and the opportunity in prevention.

What the Study Found

The study published in the Journal of the American College of Cardiology analysed health data from over 9 million adults across South Korea and the United States. Their conclusions were stark:

• 99 per cent of heart attacks, strokes or heart failures occurred in people who had at least one of four risk factors prior to the event.
• Even in women under age 60 — typically considered to be at lower risk — more than 95 per cent of such cardiovascular events were linked to one or more of the four risk factors.
• The most commonly implicated factor was high blood pressure (hypertension): over 93 per cent of those who suffered a cardiovascular event had a history of high blood pressure. Also Read: Cardiologist explains who is more at risk of heart attack: Men or women?

The Four Risk Factors in Focus

The study identified these as the principal “modifiable” risk factors preceding major cardiovascular events:

High Blood Pressure (Hypertension)

High Blood Sugar / Glucose / Diabetes

High Cholesterol / Lipids

Tobacco Smoking (past or present)

Because each of these can be detected — and, often, managed — they represent critical levers for prevention.

What This Means for You

The implications of this research are powerful—it’s not about rare causes. The idea that heart attacks or strokes often occur “out of the blue” in people with no risk factors is challenged by this study. Instead, undiagnosed or untreated conditions may be more common than we think.

Prevention is still in your hands. Focusing on regular screening and early intervention for blood pressure, blood sugar, cholesterol, and quitting tobacco use can dramatically reduce your risk.

Be proactive, not reactive. Don’t wait until symptoms emerge; early detection and control of these factors is key.

Practical Steps You Can Take Now

Also Read: Heart health: Everyday changes that lower your heart risk, boost energy

Cardiologist Philip Greenland, commenting on the study, noted that, “We think the study shows very convincingly that exposure to one or more nonoptimal risk factors … is nearly 100 per cent.”

An accompanying editorial from Duke University emphasised that instead of chasing speculative “unknown causes,” the medical community should double down on controlling these established risk factors.