Analysis of 6,323 adults without baseline coronary artery disease found that poor R-wave progression (PRWP) on electrocardiograms—present in only 3.2% of participants—did not independently predict cardiovascular death or major adverse events over 14.1 years of follow-up. While PRWP showed a borderline association with all-cause mortality (31% increased risk), this was driven by non-cardiovascular deaths and disappeared after adjusting for smoking and emphysema. This challenges the clinical significance of an ECG finding that has historically raised concern among physicians. The results suggest PRWP in isolation may be less ominous than previously thought, particularly in individuals without existing heart disease. However, the study revealed a notable sex difference: women with PRWP had higher stroke rates, warranting further investigation. For clinicians, this preprint—which awaits peer review and could see results refined—provides reassurance that isolated PRWP shouldn't trigger aggressive cardiovascular interventions in otherwise healthy patients. The finding represents an incremental but important clarification in cardiovascular risk stratification, potentially reducing unnecessary anxiety and testing for millions with this common ECG variant.