In a massive international study, researchers identify four precise warning signs of a heart attack, stroke or heart failure, and understanding these measurable risk factors could help people understand their vulnerabilities long before a health event.
Researchers from Northwestern Medicine and Yonsei University pooled the health data of 9,341,100 South Korean adults, as well as 6,803 US adults, looking at four key risk factors: high blood pressure, cholesterol, blood-sugar levels and smoking. They found that – in both cohorts – more than 99% of people who suffered coronary heart disease (CHD) had problematic levels of at least one of the four risk factors. And the split was similar across the diverse cohorts (99.7% for the Korean data, 99.6% for the US), with 93% having two or more.
“We think the study shows very convincingly that exposure to one or more non-optimal risk factors before these cardiovascular outcomes is nearly 100%,” said senior author Dr. Philip Greenland, professor of cardiology at Northwestern University Feinberg School of Medicine. “The goal now is to work harder on finding ways to control these modifiable risk factors rather than to get off track in pursuing other factors that are not easily treatable and not causal.”
Because both datasets included multiple health screenings for each individual, the researchers could identify the telltale troublesome levels relating to blood pressure, cholesterol, glucose and smoking that were evident years before the first cardiovascular event. Those specific risk factors, the data revealed, were:
- Blood pressure ≥120/80 mm Hg or on treatment
- Total cholesterol ≥200 mg/dL or on treatment
- Fasting glucose ≥100 mg/dL, diagnosis of diabetes or on treatment
- Past or current tobacco use
When the researchers adjusted the data to match thresholds that doctors often use for diagnosis (blood pressure ≥140/90, cholesterol ≥240, glucose ≥126 and current smoking), they found that at least 90% of patients had at least one risk factor in this danger zone when they suffered their first serious heart event.
The most common risk factor was hypertension (high blood pressure), seen in more than 95% of the South Korean patients and more than 93% of those in the US. Interestingly, women under the age of 60 – considered to be lowest risk – who had suffered a heart attack had these telltale health markers, too. Across the two groups, more than 95% of people had at least one of these “non-optimal” factors.
The study shows that it’s a misconception that these serious heart events occur out of the blue, without much warning. And the researchers believe that understanding the specific risk factors that nearly all CHD victims had at least one of is key to better understanding a person’s clinical vulnerabilities.
According to the Centers for Disease Control and Prevention, One person dies every 34 seconds from cardiovascular disease (CVD). In 2023, it claimed nearly a million American lives – the equivalent of one in three deaths per year. Latest figures have again confirmed this sobering statistic.
“In this binational study of two prospective cohorts, the presence of non-optimal levels of ≥1 traditional risk factor was nearly universal before CVD,” the researchers noted. “These results not only challenge claims that CHD events frequently occur without antecedent major risk factors but also demonstrate that other CVD events, including HF (heart failure) or stroke, rarely occur in the absence of non-optimal traditional risk factors, highlighting the importance of primordial prevention efforts.”
The research was published in The Journal of the American College of Cardiology.
Source: Northwestern Medicine
