The Centers for Disease Contol and Prevention reported one in every four deaths each year is a result of poor heart health. Heart disease remains the number one killer of men and women — and a new study suggests reversing this statistic is dependent upon more than quality health care.

Researchers from the Population Health Research Institute (PHRI) at McMaster University and Hamilton Health Sciences in Ontario analyzed existing data from the over 150,000 people participating in Urban Rural Epidemiologic (PURE) Study. Seventeen countries were represented. And surprisingly, the results found that low-income countries had the people with the lowest risk factors for troubled heart health, yet they had a higher rate of cardiovascular death. As for those living in higher-income countries, people had higher risk factors and a lower rate of death.

"There is a real paradox,” Dr. Salim Yusuf, lead study author and director of PHRI, said in a press release. “We found that richer countries with higher risk factors have less heart disease and once people have a heart attack or stroke, the risk of dying is substantially less compared to poor countries.”

This, Yusuf added, is in spite of the 80 percent of deaths that occur from cardiovascular disease in low and middle income countries each year. It’s also in spite of the over $100 billion Americans, per the CDC, solely spend on coronary heart care.

The results of this study demonstrate how important it is to both seek out quality health care, as well as the ways a person can mitigate risk factors. What factors are those exactly? High blood pressure, smoking, stress, diabetes, obesity, poor diet, too much alcohol and not enough physical activity.

According to the World Health Organization (WHO), most cardiovascular diseases can be prevented by addressing risk factors. And WHO recommends intervention-related programs for encouraging this type of prevention. Think regulated tobacco and taxation on processed, high-fat foods.

Yet, the solution isn't quite so simple for low-income countries without great access to health care. In some cases, there's only one option. Which means patients should work on preparing the right questions to ask the doctors and health care providers they are able to see.

The American Heart Assocation offers complete guides to help people prepare for their appointment. The first outlines all the ways people can maximize their appointments, getting insight to heart disease, and the available screening tests and medications. A second categorizes questions by concern, which is to say the best questions to ask regarding medications, the best questions to ask regarding diet, and so on.

A great doctor is definitely going to be able to help you. But being able to help yourself, too, is even better.