99 Percent of Heart Attacks and Strokes Are Linked to Modifiable Risk Factors

More than 99 percent of people who experienced a cardiovascular event had at least one risk factor. For example, 0.7 percent of people in the South Korean cohort didn’t have risk factors compared with 0.5% in the American cohort. More than 93 percent of people had two or more. 

“The goal now is to work harder on finding ways to control these modifiable risk factors,” said Greenland in a news release.

High blood pressure was the most common risk factor among people included in the study.  Dr. Neha J. Pagidipati, an assistant professor of medicine and cardiovascular disease prevention specialist at Duke University School of Medicine, said in an accompanying editorial  that uncontrolled high blood pressure is likely the biggest contributor to cardiovascular disease that people can change.

Above-optimal levels: What to know

Many people fall in the nonoptimal category with raised — but not terribly high — levels of key heart disease risk factors, says Dr. Paul Leis, a cardiologist at Mount Sinai Fuster Heart Hospital in New York City.

For instance, an older adult may have blood pressure that’s above normal (defined as less than 120/80 mm Hg) but is “still acceptable” and not high enough to warrant prescription medication, especially if the doctor is concerned about falls if their blood pressure gets too low, Leis explains.

Doctors need to help people stay as close to optimal levels, but in a way that the person can tolerate, he adds. “It’s not as black-and-white, because every patient reacts differently [to treatment],” Leis says.

When doctors look at the whole picture, including age and whether you’re higher than where you should be for a few risk factors, and not just one, it could mean that you may benefit from treatment, Leis says. “If you control one, you likely will improve the others as well,” he adds.

To lower cardiovascular risks, Dr. Michael Miller, a cardiologist at Penn Medicine in Philadelphia, says most people should aim for:

• Total cholesterol less than 200 mg/dL
• Blood pressure less than 120/80
• Fasting glucose less than 100 mg/dL
• No history of smoking, ideally

What do you do if you’re not at these optimal levels? If you have a blood pressure, cholesterol or blood sugar reading that’s above optimal, pay attention to it, Greenland tells AARP.

Doctors often advise patients to lower their levels and follow up to check progress, but that doesn’t always occur in a timely way. If your numbers are elevated, don’t wait six months to a year to follow up — do so two to three months after you get your blood work back and first learn about the issue, Greenland advises.

People should be making lifestyle modifications if they’re in that middle ground, Greenland says. In some cases, they may also benefit from medication.

“If you have a little elevation of blood pressure, a little elevation of cholesterol, that can mean that your risk is actually quite high,” Greenland says. “And in some cases, that would justify medication, but that’s an important individual decision.”

Doctors can also use risk scores to devise a treatment plan, Greenland says. Additionally, he recommends adhering to Life’s Essential 8 for good cardiovascular health, which, in addition to managing cardiovascular risk factors, promotes healthy habits such as regular exercise and adequate sleep.

Often the focus is on treating heart attacks after they happen, rather than preventing them in the first place, Miller says. “Hopefully, the new study provides a solid foundation so that doctors can focus more on preventing heart disease in the first place,” he says.