Traditional risk factors for cardiovascular disease (CVD) — high blood pressure (BP), high cholesterol, elevated glucose and a history of smoking — almost always precede any major CVD events, a secondary analysis shows. In this study, CVD events included coronary heart disease (CHD), myocardial infarction (MI), heart failure (HF) or stroke. Rarely do these events occur if a patient does not have any risk factors present. The associated data were reported by Hokyou Lee, MD, PhD, from the Yonsei University College of Medicine, Seoul, South Korea, and colleagues, in a manuscript published online and in the October 7 issue of the Journal of the American College of Cardiology. Health prevention practices have targeted traditional CVD risk factors for a long time. Nonoptimal levels of risk factors heavily influence the development of CHD, but national data on other heart conditions, such as HF and stroke, are lacking. The investigators in this study examined the impacts of nonoptimal levels of BP, cholesterol, glucose and tobacco smoking on CHD, HF and stroke. The KNHIS (Korean National Health Insurance Service) and MESA (Multi-Ethnic Study of Atherosclerosis) population-based prospective cohorts were analyzed in this trial. Traditional risk factors were defined as patients having ≥1 of the following before CVD events: systolic BP ≥120 mmHg or diastolic BP ≥80 mmHg or BP-lowering therapies, total cholesterol ≥200 mg/dL or lipid-lowering therapies, fasting glucose levels ≥100 mg/dL or diabetes or glucose-lowering therapies or smoking at any time. KNHIS (patients n=9,341,1000; 24.1% female) and MESA (patients n=6,803; 39.5% female; 39.3% White, 26.6% Black, 24.4% Hispanic/Latino, 9.7% Chinese) had 601,025 and 1,188 CVD events recorded. Nonoptimal risk factors were highly prevalent in both groups (99.7% and 99.6%) before CHD. Similar outcomes were recorded for HG (99.4% and 99.5%) and stroke (99.3% and 99.5%). Both groups had ≥1 risk factor present in nearly all patients who had CVD (>99%) in men and women. The lowest percentage was seen in HF patients, though it was still high (>95%), in women who were older than 60 years. Many patients also have ≥2 risk factors (93.2%-97.2%) before CVD. Overall, nonoptimal CVD risk factors were seen across the board in almost all patients who experienced CHD, HF or stroke. In a Northwestern University press release on Monday, senior author of the paper, Philip Greenland, from the Northwestern University Feinberg School of Medicine, Chicago, commented on the results. “We think the study shows very convincingly that exposure to one or more nonoptimal risk factors before these cardiovascular outcomes is nearly 100%,” he said. Source: Lee H, Huang X, Khan SS, et al. Very high prevlance of nonoptimally controlled traditional risk factors at the onset of cardiovascular disease. J Am Coll Cardiol. 2025 Oct; 14:1017-1029. Image Credit: Dzmitry – stock.adobe.com