More than 99% of heart disease cases have a risk factor you can address before you get sick, study shows

By Madeline Holcombe, CNN

(CNN) — Before a heart attack, stroke or other cardiovascular disease hit, there are almost always warning signs, according to a new study.

Those warning signs are well-known cardiovascular disease risk factors, but more can still be done to reduce cases of heart disease, according to a study published Monday in the Journal of the American College of Cardiology.

For this study, researchers analyzed data from two groups: more than 600,000 cases of cardiovascular disease in South Korea and another 1,000 cases in the United States.

Researchers analyzed what percentage of those cases were preceded by traditional risk factors for cardiovascular disease, including blood pressure levels, blood sugar, cholesterol and smoking.

In more than 99% of cases of cardiovascular disease, heart failure or stroke, the patient had at least one of the risk factors before the incident occurred, according to the data.

“Even ‘mild’ elevations of these 4 factors should be addressed with lifestyle treatments or medications,” said Dr. Philip Greenland, one of the study’s lead authors, in an email. He is also a professor of preventive medicine and the Harry W. Dingman Professor of Cardiology at Northwestern University’s Feinberg School of Medicine in Chicago.

Beyond diagnoses

The new study is particularly important because it reinforces that doctors and patients can manage the risk factors for almost all cases of heart disease, said Dr. Susan Cheng, professor and vice chair of research affairs in the department of cardiology at the Smidt Heart Institute at Cedars-Sinai Medical Center in Los Angeles. She was not involved in the research.

Some research has suggested that a growing number of cardiovascular disease cases have no traditional indicators of risk beforehand. That could imply that although the health care profession has addressed the factors you can control, other elements researchers don’t yet understand could be a factor, and so they don’t have good prevention strategies to offer, Cheng added.

What differentiates this research, she said, is that scientists did not rely solely on a diagnosis of diabetes or high blood pressure to determine if the risk factors were present –– they looked at the patients’ medical data.

Sometimes, just because someone isn’t labeled as having high blood pressure or high blood sugar doesn’t mean their levels don’t indicate risk factors. And by looking at the broader scope of medical data, these researchers found that almost all the cases did have traditional, modifiable risks in their chart before developing cardiovascular disease, Cheng said.

So, if clinicians and patients want to mitigate heart disease risk, the best course of action is likely to continue encouraging management of risk factors like blood sugar, blood pressure, cholesterol and smoking, she said.

It’s not fighting aging. It’s improving longevity

The medical field has learned a lot about heart disease in the past century, and the common knowledge on how to prevent it has been consistent for many years, said Dr. Karen Joynt Maddox, professor of medicine in cardiology at Washington University Medical School in St. Louis, Missouri. She was not involved in the research.

But still, implementing those changes continues to prove difficult. Part of the problem is often the abstract nature of heart disease risk, Joynt Maddox said.

When a patient has a disease, it is easier to motivate making changes and implementing treatments to address what they are dealing with, she said. But it is harder to effectively communicate the importance of taking steps to address the very real risks a person faces for a disease down the line.

Another roadblock is that adding medications or other protocols to address heart disease risk can be associated with the aging process, which can feel scary and unappealing to some patients, said Dr. Ahmed Tawakol, a cardiologist at Massachusetts General Hospital and associate professor of medicine at Harvard Medical School. He was not involved in the research.

Instead, he thinks of it as steps toward longevity. Managing blood pressure, blood sugar and cholesterol doesn’t mean you are losing things — it means you are taking steps to preserve your lifespan and health span, creating more years for yourself to feel young and do the things that have meaning for you, he said.

Healthy lab results and healthy behaviors

While the risk factors for cardiovascular disease have remained consistent, the technology for managing them has evolved.

Managing high blood pressure is often a good place to start, and just getting a blood pressure cuff means you can get a sense of your levels at home, Joynt Maddox said. Then, work with your doctor to keep an eye on your risk factors and make a plan for management.

In addition to the clinical risk factors studied in the research, it is also important to improve your lifestyle risk factors, Tawakol said.

Maintaining good sleep, exercise, nutrition, a healthy weight and low levels of stress are key to lowering cardiovascular disease risk, he said.

“For example, stress and depression turn out to be as potent risk factors as smoking and diabetes,” Tawakol said.

“I’m hoping that the more we double down and show the efficacy of treating all these things together, that more people will combine these approaches and actually enjoy much longer health spans.”

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