Most people already have two or more common heart risk factors—like high blood pressure or cholesterol—before they ever have a heart attack, heart failure, or stroke.

What we've found so far is that most people already have two or more common cardiovascular risk factors before experiencing a first major heart event, such as a heart attack, stroke, or heart failure [1]. Our analysis of the available research shows this pattern is consistent across the evidence we’ve reviewed. The data we examined indicate that high blood pressure, high cholesterol, and other well-known risk factors are frequently present well before any clinical heart issue arises [1]. In fact, every study we analyzed supported this finding—20.0 studies in total—with no studies contradicting it. This suggests that multiple nonoptimal risk factors are not rare exceptions but are instead typical in individuals prior to their first cardiovascular incident. Still, our current analysis is based on a limited set of assertions—only one distinct claim supported by 20 studies. We can’t yet determine how these findings apply across different ages, ethnicities, or lifestyles, because the evidence we’ve reviewed so far doesn’t provide that level of detail. We also don’t have data on how early these risk factors develop or how long they persist before an event occurs. What this means for you is that heart health may depend on managing multiple risks long before any symptoms appear. Waiting until after a heart event to address blood pressure or cholesterol may mean missing a critical window for prevention. Based on what we’ve reviewed so far, paying attention to more than just one risk factor—like focusing only on cholesterol while ignoring blood pressure—might not be enough. We’ll continue to update our analysis as more evidence becomes available. For now, the evidence we’ve reviewed leans toward the idea that multiple risk factors are already present in most people before their first heart problem [1].