01/16/2026
prospective cohorts to determine how prevalent four traditional risk factors are before the first occurrence of cardiovascular disease (CVD), i.e., coronary heart disease, myocardial infarction, heart failure, or stroke. They determined the percent of people in two cohorts exposed to at least one traditional risk factor, specifically, past/current smoking, fasting glucose of 100 mg/dL or more (or diabetes, or related medication use), total cholesterol of 200 mg/dL or more (or on treatment), and either a systolic blood pressure of 120 mmHg or a diastolic pressure of 80 mmHg or more (or treatment). The cohorts included over 9.3 million adults in the Korean National Health Insurance Service (KNHIS) cohort, and almost 7,000 from the Multi-Ethnic Study of Atherosclerosis (MESA) cohort.
The takeaway from this analysis is that having at least one non-optimal risk factor was nearly universal among people that went on to have a CVD event. For example, only 0.4% of people in MESA and 0.3% of people in KNHIS diagnosed with CHD had optimal values for all four risk factors. Over 99% of people in both cohorts and for each diagnosis (e.g., stroke, myocardial infarction, etc.) had at least one suboptimal risk factor. Indeed, between 93.2 to 97.2% had at least two suboptimal risk factors. This challenges the belief that CVD events frequently occur without the presence of any risk factors, when indeed they almost never appear to, providing a strong incentive to emphasize preventative interventions
