A new study reveals that nearly all heart attacks, strokes, and other cardiovascular diseases are preceded by detectable warning signs, offering significant opportunities for prevention. 

Published last week in the Journal of the American College of Cardiology the research analysed over 600,000 cases in South Korea and 1,000 in the United States. In more than 99% of cases, patients had at least one traditional cardiovascular risk factor before the disease struck—elevated blood pressure, high blood sugar, high cholesterol, or smoking. 

“Even mild elevations in these risk factors should be addressed through lifestyle changes or medication,” Dr Philip Greenland, Northwestern University professor and one of the study’s lead authors, said. 

The study stands out because, instead of relying solely on formal diagnoses, researchers examined patients’ measurable health data. This revealed that people who were not officially diagnosed with hypertension or high blood sugar often still had levels indicating elevated risk. 

Previous findings countered

Dr Susan Cheng of Cedars-Sinai Medical Centre noted that these findings counter previous suggestions that some heart disease cases occur without traditional indicators. Almost all cases involve modifiable, measurable risks—meaning prevention remains possible. 

Despite decades of knowledge about prevention, implementation remains difficult. Dr Karen Joynt Maddox of Washington University Medical School says people are more motivated to make changes once a disease appears, but risk factors—being abstract and future-oriented—can be harder to address. 

Another barrier, according to Dr Ahmed Tawakol of Massachusetts General Hospital, is that preventive treatment is often associated with ageing, which some find discouraging. He reframes it as an investment in longevity: controlling blood pressure, sugar, and cholesterol adds healthy years, not limitations. 

Technology for managing heart disease risks has improved. Home blood pressure cuffs, for example, make it easier to track levels, allowing patients and doctors to adjust treatment plans early. 

Beyond clinical measures, lifestyle adjustments are critical. Dr Tawakol emphasised that good sleep, regular exercise, balanced nutrition, healthy weight, and low stress levels can significantly reduce the risk.

Stress and depression, he said, can be as harmful as smoking or diabetes.  Experts agree that a combined approach—managing medical risk factors alongside healthy habits—has the greatest potential to extend both lifespan and health span.

The core prevention message remains consistent: identify and control the key risks before cardiovascular disease strikes.