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- Cardiovascular diseases, such as heart failure, heart attack, and stroke, are the leading causes of death around the world.
- Previous research shows there are a number of modifiable lifestyle factors that can help a person lower their risk for heart disease.
- A new study reports that more than 99% of people who experienced a heart attack, heart failure, or stroke had at least one of four major cardiovascular risk factors above healthy levels beforehand.
- Scientists also found that of the four major cardiovascular disease risk factors studied, high blood pressure was the most common issue.
Cardiovascular diseases, such as heart failure, heart attack, and stroke, are the leading causes of death around the world.
Researchers estimate that about 85% of all cardiovascular disease-related deaths are due to heart attack and stroke, and more than 64 million people globally are affected by heart failure.
Past studies show there are a number of modifiable lifestyle factors that can help a person lower their risk for heart disease, including smoking, obesity, high blood pressure, high cholesterol, drinking alcohol in excess, following an unhealthy diet filled with ultra-processed foods, and leading a sedentary lifestyle.
Now, a new study of more than 9,000 adults reports that more than 99% of people who experienced a heart attack, heart failure, or stroke had at least one of four major cardiovascular risk factors — high blood pressure, cholesterol, or fasting glucose, as well as tobacco use — above ideal healthy levels beforehand.
Scientists also found that of the four major cardiovascular disease risk factors studied, high blood pressure was the most common issue.
The study findings appear in the Journal of the American College of Cardiology.
What are the 4 major cardiovascular risk factors?
For this study, researchers analyzed medical data from more than 9 million adults in South Korea and almost 7,000 adults in the United States.
Study participants were followed for up to 20 years, allowing scientists to see multiple measurements for blood pressure, cholesterol, glucose, and smoking exposure before a participant had their first cardiovascular issue.
“Some recent studies have suggested that the major modifiable risk factors are ‘often’ absent in people who experienced heart attacks and similar cardiac or vascular diseases,” Philip Greenland, MD, FAHA, FACC, FESC, the Harry W. Dingman Professor of Cardiology and professor of preventive medicine at Northwestern University Feinberg School of Medicine, and senior author of this study, told Medical News Today.
“We doubted that and suspected that that research was missing previous risk factor exposures that could only be studied in long-term data sources,” Greenland added.
For this study, researchers focused on what they considered the four major”risk factors for heart disease, and and used the American Heart Association’s ideal cardiovascular health definitions, which describe not ideal levels as:
- blood pressure of 120/80 millimeters of mercury (mm Hg) or over, or on treatment
- fasting glucose of 100 milligrams per deciliter (mg/dL) or over, diagnosis of diabetes, or on treatment
- past or current tobacco use
- total cholesterol of 200 mg/dL or over, or on treatment.
“These are the ‘major’ risk factors and they are modifiable, at least potentially,” Greenland said. “Some of the other factors that are suggested to be ‘risk factors’ for cardiovascular disease — like genetics or certain blood markers like C-reactive protein — are not modifiable. So, if the modifiable factors are actually present in almost all cases, then there is an opportunity for prevention.”
High blood pressure most common risk factor for heart attack, stroke
At the study’s conclusion, researchers found that more than 99% of study participants had at least one risk factor at unhealthy levels before experiencing heart failure, stroke, or heart attack.
Of these four major risk factors, scientists discovered high blood pressure to be the biggest offender, affecting more than 95% of South Korean participants and over 93% of U.S. participants.
“This is important because high blood pressure is fairly easily detectable but it is asymptomatic, so often overlooked,” Greenfield said. “Our findings show how important it is to recognize it and treat it.”
Researchers also reported that even in women under 60 years of age, which are considered to usually be at the lowest risk for cardiovascular disease, more than 95% of study participants still had at least one non-optimal risk factor before experiencing a stroke or heart failure.
“In brief, as we have known for many years, there are a small number of modifiable risk factors for heart disease, and at least one, but often more than one, are present in the background leading up to heart attacks, heart failure, or strokes. Patients [should] be sure that these four factors are assessed at every medical visit, and if there is even a slight elevation as per our paper, efforts need to be made to treat that factor to prevent heart attack, stroke, or heart failure.”
– Philip Greenland, MD, FAHA, FACC, FESC
“From here, the next step is to improve implementation of what we already know,” Greenland added.
Need for aggressive screening of heart-related risk factors
MNT had the opportunity to speak with Cheng-Han Chen, MD, a board-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, about this study.
“Cardiovascular disease is the leading cause of death in the United States,” Chen, who was not involved in this research, commented. “This study reaffirms our need to aggressively screen for and manage the risk factors for heart disease in order to decrease the burden of this major problem in our society.”
“This study should further drive public health screening and prevention of cardiovascular disease risk factors,” he added.
