People who have a heart attack but don’t have the usual risk factors like high blood pressure or smoking are actually more likely to die in the hospital than those who do have those risks — which is surprising because they seem healthier on paper.

What we've found so far is that heart attack patients who don’t have traditional risk factors—like high blood pressure, high cholesterol, or a history of smoking—may actually face a higher risk of dying during their hospital stay compared to those who do have those risks [1]. This might seem unexpected, since the absence of these risk factors usually suggests better overall health. Our analysis of the available research shows that, based on the evidence we’ve reviewed, this pattern is supported by 42.0 studies or assertions, with no studies found that refute it [1]. That means the evidence we’ve examined consistently points in one direction: lacking traditional risk factors does not appear to protect against in-hospital death after a heart attack. In fact, it may be linked to worse outcomes in the hospital setting. We don’t yet know why this is the case. The evidence we’ve reviewed does not explain the reasons behind this increased risk. It’s possible that these patients have other, less obvious health issues that aren’t captured by standard risk assessments. Or, because they’re seen as “healthier,” they might be diagnosed later or receive different care. But based on what we’ve reviewed so far, we can’t draw conclusions about the causes. Our current analysis shows the pattern is there, but the reasons remain unclear. We also don’t know how this finding might affect long-term survival or recovery after leaving the hospital. Practical takeaway: Just because someone seems healthy on paper doesn’t mean they’re out of danger during a heart attack. Recognizing symptoms early and getting fast medical care matters for everyone—regardless of risk factors.