Cardiovascular disease remains a leading cause of death globally. Many of the patients who suffer heart attacks or strokes share common modifiable risk factors. In a recent Instagram post, Dr. Jeremy London, a renowned cardiovascular surgeon with over 25 years of experience, shared an observation drawn from decades in the operating room. Dr. London shared that most of his heart patients have four things in common. According to him, these lifestyle and metabolic factors not only coexist frequently but also interact in ways that dramatically increase the risk of heart disease.
4 things most heart patients have in common
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Smoking
Dr. London asserts “smoking is the single worst thing you can do to your body, and it doubles the risk of heart attack.”According to the US Centers for Disease Control and Prevention, smoking is responsible for about ¼ of all cardiovascular‐disease deaths. Smokers have roughly 2-4 × higher risk of coronary heart disease and for stroke compared to never-smokers.According to the American Heart Association, smoking causes endothelial dysfunction, i.e; damage to the lining of blood vessels, which is a key early step in atherosclerosis. As per studies, other factors that smoking influences are promoting oxidative stress and inflammation, reducing good cholesterol and increasing platelet activation.
Dr. Jeremy London suggests if a smoker quits smoking, within five to seven years the effects can get reversed.A study review published in JAMA Network showed that among heavy smokers, quitting was associated with approximately a 39 percent reduction in the risk of developing cardiovascular disease within about five years compared to those who continued smoking. The hazard ratio was around 0.61, although the risk remained higher than that of people who had never smoked for many years afterward.
High blood pressure
Dr London says high blood pressure is called “the silent killer” for a reason. High blood pressure overworks the heart and damages arteries over time. According to the World Health Organization (WHO), an estimated 1.28 billion adults worldwide aged 30–79 years have hypertension, and nearly 46 percent of them are unaware of their condition.
Dr. Jeremy says high blood pressure is also the most modifiable risk factor of heart diseases. Evidence shows that even modest reductions in blood pressure can have profound benefits. A meta-analysis showed that a 5 mmHg reduction in systolic blood pressure can lower the risk of major cardiovascular events by about 10 percent, regardless of starting levels. Dr. London suggests weight loss and exercise are powerful interventions to reduce it and after professional consultation, medications can also help normalise blood pressure.
Diabetes
The third factor on Dr. Jeremy London’s list is diabetes. Diabetes is one of the most common metabolic disorders among his heart patients, and a major driver of cardiovascular disease. NIH research has shown that chronic hyperglycemia leads to endothelial dysfunction, oxidative stress, and accelerated atherosclerosis. Excess glucose also alters lipid metabolism, promoting the formation of small, dense LDL particles that more easily penetrate arterial walls.
The landmark UKPDS (United Kingdom Prospective Diabetes Study) found that every 1 percent reduction in HbA1c was linked to a 14 percent lower risk of myocardial infarction and other vascular events. Cardiologist Dr. Jeremy London says reducing abdominal fat, sugar intake, and carbs can make a big difference.
High cholesterol
Dr. London identifies high cholesterol as another hallmark trait shared by most of his cardiac patients. Elevated levels of low-density lipoprotein (LDL) cholesterol, often called “bad cholesterol,” contribute directly to plaque buildup within the arteries, a process known as atherosclerosis.The American Heart Association (AHA) reports that individuals with high LDL cholesterol levels have about twice the risk of developing coronary artery disease compared to those with optimal levels.Encouragingly, Diets rich in fiber, unsaturated fats, nuts, and omega-3 fatty acids, combined with regular exercise and maintaining a healthy weight, can effectively improve lipid profiles.
“If you have any of these, be proactive”
Having one or more of these risk factors doesn’t automatically mean heart disease is inevitable, but it does mean your risk is significantly higher.The key is early intervention. Small, consistent lifestyle changes such as quitting smoking, eating more whole foods, exercising regularly, and managing stress can have powerful cumulative effects on cardiovascular health. Regular health check-ups, including blood pressure, fasting glucose, and lipid profile screenings, allow early detection and timely management.Dr. Jeremy emphasizes, being free of these four risk factors doesn’t guarantee protection from heart disease. Genetic predisposition, chronic stress, sleep deprivation, and unhealthy dietary habits can still silently affect heart health over time.