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A major international analysis reveals that almost every heart attack and stroke is preceded by at least one of four well-known risk factors: high blood pressure, high cholesterol, high blood sugar, or tobacco use. The discovery underscores the critical importance of early screening and prevention strategies for millions who may appear otherwise healthy.
What the Study Found
Involving over 9 million adults from South Korea and the United States, the study, led by Dr. Hokyou Lee at Yonsei University College of Medicine, tracked individuals’ health records before their first cardiac or neurological event. The research found that 99 percent of those experiencing a heart attack or stroke had previously displayed at least one of these key risk factors. Specifically:
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High blood pressure was the most common precursor.
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High cholesterol and high blood sugar were frequent but varied by population.
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Past or current tobacco use was the least common but still significant.
Crucially, the study used modest thresholds — not solely formal diagnoses — to better capture everyday risk patterns. For example, blood pressure at or above 120/80 mm Hg, total cholesterol at or above 200 mg/dL, or fasting glucose at or above 100 mg/dL qualified as “at risk.” Many participants had routinely attended clinic visits prior to their event, offering multiple missed opportunities for intervention.
Expert Commentary and Medical Context
Dr. Hokyou Lee emphasizes, “Damage to arteries builds slowly when blood pressure, glucose, or lipids sit above ideal levels. The body handles small shifts, but steady exposure over years increases strain and raises the chances of a serious event.” This slow progression means that small, seemingly insignificant changes in lab results can add up over time, increasing risk even when numbers don’t seem alarming.
Independent cardiologists not associated with the study, such as Dr. Meena Sreenivasan of Johns Hopkins University, advise, “Screening at routine visits, early correction of risk factors, and consistent follow-up offer the best route for prevention. No risk is too small to monitor.”
Implications for Public Health
Routine checkups and basic lab tests play a crucial role in revealing early shifts in blood pressure, cholesterol, and glucose. Addressing these issues when they’re still mild can dramatically alter long-term outcomes and may help prevent future emergencies.
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Cardiovascular disease remains the leading cause of death in the United States, accounting for over 941,652 deaths in 2022 (American Heart Association).
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Even in women under 60, more than 95 percent of heart failure and stroke cases were preceded by one or more nonoptimal risk factors, challenging the notion that such events always occur “out of the blue”.
Strategies such as blood pressure control, cholesterol-lowering therapies, smoking cessation, and glucose management are not only effective but accessible in modern healthcare. Experts recommend therapeutic combinations and steady lifestyle changes — including diet, exercise, and medication adherence — for the greatest benefit.
Study Limitations and Counterarguments
The research was observational, meaning it found patterns but cannot prove causality. This design leaves room for confounding variables, such as genetics or unreported lifestyle factors, which might also influence outcomes. Although the study spanned different countries and healthcare systems, the consistency in findings strengthens its validity.
Some critics point out that not every event will be caught through screening, and not all individuals with risk factors will develop heart disease or stroke. The thresholds used for defining “risk” were intentionally broad, potentially including people with minor or temporary elevations.
Practical Steps for Individuals
What does this mean for daily life? Health professionals urge:
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Regular blood pressure, cholesterol, and glucose screening, especially during annual health visits.
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Avoiding tobacco use (smoking, vaping, and smokeless forms).
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Addressing any abnormal lab results early, regardless of symptom severity.
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Maintaining lifestyle changes that benefit heart health, such as balanced nutrition, regular exercise, and stress management.
Reference Section
Study Citation:
Lee H, et al. “Four common risk factors precede 99% of heart attacks and strokes.” Journal of the American College of Cardiology. Published 2025. [DOI pending]
Expert Interview Source:
Meena Sreenivasan, MD, Cardiologist, Johns Hopkins University (independent interview; not involved in research).
Statistical Sources:
American Heart Association. “2022 Heart Disease and Stroke Statistics.” Accessed 2025.
Additional Supporting Materials:
Earth.com News portal. Article: “Four common factors appear prior to 99% of heart attacks and strokes.” November 2025.
Medical Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with qualified healthcare professionals before making any health-related decisions or changes to your treatment plan. The information presented here is based on current research and expert opinions, which may evolve as new evidence emerges.
