Nearly all heart attacks and strokes are linked to just four common health risk factors, according to a large international study that examined medical data from millions of people across two countries.
Researchers analysing records from more than nine million adults in the United States and South Korea found that 99 percent of heart attacks, strokes, and major cardiovascular events were associated with high blood pressure, high cholesterol, high blood sugar, or tobacco use. The findings highlight how much of the global heart disease burden is tied to conditions that are both measurable and, in many cases, manageable.
The study was conducted by researchers from Northwestern Medicine in the United States and Yonsei University in South Korea. By combining long-term population data from two very different healthcare systems, the researchers were able to track how these risk factors shaped outcomes across age groups, genders, and ethnic backgrounds.
High blood pressure emerged as the single most influential factor. Even modestly elevated readings were linked to a sharply higher risk of heart attack and stroke over time. High cholesterol and high blood sugar followed closely, particularly when they occurred together. Tobacco use, whether current or past, further compounded the risk.
Doctors have long known that these factors matter, but the scale of the study reinforces just how central they are. Rather than rare genetic conditions or sudden shocks, most heart events appear to develop slowly, driven by years of exposure to these everyday risks.
Cardiologists say the findings underline the importance of routine screening. Many people live for years with high blood pressure or elevated blood sugar without noticeable symptoms. By the time warning signs appear, significant damage may already have been done.
The results also challenge the idea that heart disease is inevitable with age. While risk does increase over time, the study suggests that people who keep these four factors under control dramatically reduce their chances of experiencing a major cardiovascular event.
Public health experts point out that the findings have implications beyond individual behaviour. Access to regular check-ups, affordable medication, smoking cessation support and healthier food environments all play a role in reducing population-level risk.
The researchers stress that the study does not suggest perfection is required. Small improvements in blood pressure, cholesterol levels or blood sugar can translate into meaningful reductions in risk.
In simple terms, the message is not new, but it is now harder to ignore. Most heart attacks do not come out of nowhere. They are the end result of a few familiar problems left unattended for too long.
The study adds weight to a growing consensus in medicine: when it comes to protecting the heart, the biggest gains come from focusing on the basics, consistently and early.
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