Heart attacks and strokes rarely strike without warning. A large new analysis suggests that the signs are usually present years before a medical emergency occurs. Researchers examined health records from more than 9 million adults in South Korea and the United States and found that nearly all major cardiovascular events were preceded by one or more common risk factors.
Those four risks were high blood pressure, high cholesterol, high blood sugar, and tobacco use. Together, they appeared before more than 99% of heart attacks, strokes, and heart failure cases. High blood pressure stood out as the most powerful predictor. Over 93% of people who later experienced a serious heart event already had hypertension beforehand.
The findings highlight an important reality. Most heart attacks and strokes are not sudden or random. They develop slowly, driven by risks that often go untreated or underestimated for years. Preventing these events may depend less on discovering new causes and more on controlling the ones already well known, especially blood pressure, blood sugar, cholesterol levels, and smoking habits, before they quietly lead to life-threatening outcomes.
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