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Two sweeping studies released today appear to explode the long-held myth that half of heart attacks result from bad genes or bad luck.
The studies, focusing on different populations totaling about half a million people, indicate that about 90% of people with severe heart disease have one or more of four classic risk factors: smoking, diabetes, high cholesterol and high blood pressure.
That means the vast majority of the 650,000 new heart attacks each year could be prevented or delayed for decades by quitting smoking, reducing cholesterol and controlling hypertension and diabetes.
''If we could eliminate smoking and get people to be fit and trim, we could turn this thing around without unraveling the genes that cause heart disease,'' says researcher Eric Topol of the Cleveland Clinic Foundation. He is co-author of a study involving more than 120,000 heart patients.
The research has major policy implications. It suggests that doctors and patients should place even greater emphasis on prevention. The American Heart Association and National Cholesterol Education Program both have emphasized aggressively treating people who have not yet had a heart attack if their ''global risk'' is high.
''I think these studies will wake people up and renew the emphasis on traditional risk factors,'' says Philip Greenland of Northwestern University. He is lead author of a study involving almost 400,000 people enrolled in lifestyle studies and followed for up to 30 years.
The researchers analyzed data from previous major studies. The reports appear in today's Journal of the American Medical Association.
''These papers are just amazing. They're basically blowing away the myth that only half of the people who have heart disease have traditional risk factors,'' says John Canto of the University of Alabama-Birmingham. He co-wrote an accompanying editorial in the journal.
None of the researchers could identify the source of the erroneous assertion, cited by experts for years. ''It's folklore,'' Greenland says.
A separate analysis in the journal concludes that there isn't enough evidence to conclude that so-called new risk factors for heart disease, including inflammatory proteins called Lipoprotein-A, C-reactive protein and homocysteine, add much to the predictive value of the four classic risks.
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