Here’s a startling fact: nearly every heart attack and stroke can be traced back to just four risk factors. Yes, you read that right. A groundbreaking study involving over 9 million adults from South Korea and the U.S. has revealed that a staggering 99% of cardiovascular events are linked to high blood pressure, high cholesterol, elevated blood sugar levels, or tobacco smoking—whether past or present. But here’s where it gets even more eye-opening: even among women under 60, the group least likely to experience these events, over 95% of heart attacks and strokes were tied to one of these factors. And this is the part most people miss: high blood pressure alone was the culprit in more than 93% of cases across both countries, making it the most dominant risk factor by far.
Published in 2025 in the Journal of the American College of Cardiology, this research challenges the notion that cardiovascular events often strike without warning. Instead, it underscores the critical importance of managing these preventable risks. As senior author and cardiologist Philip Greenland from Northwestern University puts it, ‘The study convincingly shows that exposure to one or more of these risk factors is nearly universal before a cardiovascular event occurs.’ The focus, he argues, should now shift to controlling these modifiable factors rather than chasing less treatable or non-causal elements.
But here’s where it gets controversial: this study directly contradicts recent claims that cardiovascular events without identifiable risk factors are on the rise. Greenland and his team suggest that previous research may have overlooked subtle risk factors or missed diagnoses altogether. For instance, could some cases have been attributed to risk levels below clinical thresholds but still dangerous? This counterpoint invites a deeper discussion: Are we underestimating the role of these four factors, or are there other hidden contributors we’re missing?
In an accompanying editorial, Duke University cardiologist Neha Pagidipati emphasizes the urgency of proactive health management. ‘We can—and must—do better,’ she writes, highlighting the need for earlier intervention to prevent life-threatening outcomes. After all, if 99% of these events are tied to just four factors, the path to prevention seems clearer than ever—yet why do so many still fall through the cracks?
Thought-provoking question for you: If managing these four risk factors is so crucial, why aren’t more people aware of their own health status? And what role should healthcare systems play in making screenings and interventions more accessible? Share your thoughts in the comments—let’s spark a conversation that could save lives.
