Here are the four essential areas where we can all make a difference:
1. Quit smoking combustible tobacco products
Smoking remains the single most harmful behaviour for heart health. It injures the lining of the arteries, triggers inflammation and increases the blood’s tendency to clot. Over time, plaques develop in the arterial wall, and if they rupture, they may cause an acute problem such as a heart attack or stroke.
On average, smoking reduces life expectancy by around 10 years, but large population studies have shown that quitting early, by 40, can allow you to reclaim around 90% of that lost decade.
This does not, however, mean smoking is safe at younger ages. Damage starts immediately, so avoiding cigarettes entirely or stopping as early as possible remains essential. Most smokers want to quit but can find it extremely challenging. Nicotine replacement therapies are far more effective now than they used to be, so speak to your GP if you need support.
2. Control your cholesterol
Cholesterol is essential for life – it builds cells, produces hormones and vitamin D, and makes bile acids to digest food – but when blood levels are too high, the excess is deposited inside arteries (a process called atherosclerosis, which underlies most heart attacks and strokes). Low-density lipoprotein (LDL) cholesterol enters the artery wall and triggers inflammation, plaque formation and arterial narrowing, reducing blood flow to vital organs including the heart, brain and kidneys. This process is silent and begins many years before heart disease symptoms appear.
A lipid profile blood test can show whether a person’s levels are healthy. Traditionally guidelines recommended a total cholesterol below 5.0 mmol/L and an LDL cholesterol below 3.0 mmol/L for most adults, with lower targets for people at higher risk. However, current guidelines propose levels of 1.4 mmol/L, as increasing evidence shows that lowering LDL to these levels reduces the risk of cardiovascular events. That is why treatments should now be tailored to the patient, with no firm lower limit for high-risk individuals.
Lipoprotein(a), or Lp(a), levels are largely genetically determined and increasingly recognised as an additional risk factor for heart disease. If significantly elevated, it increases the risk of atherosclerosis and usually warrants more intensive lipid lowering. Testing is not currently routine, so discuss it with your GP or specialist, especially if you have a family history of premature heart disease.
There is currently no licensed treatment that directly lowers Lp(a), so when levels are high, we focus on reducing overall cardiovascular risk, particularly by lowering LDL cholesterol. Lifestyle changes play an important role, but many people need medication to reach optimal levels. Statins were a major breakthrough in the 1990s, with many large trials demonstrating their ability to reduce cardiovascular events. Reducing cholesterol slows or prevents disease progression and stabilises existing plaque, reducing immediate risk.
If statins alone do not achieve the required reduction, or if someone is among the 5-10% who cannot tolerate them, other effective cholesterol-lowering treatments are now available. Some newer cholesterol-lowering treatments are given just twice a year after the initial dose. These options should always be discussed with your GP or specialist.
3. Keep your blood pressure in check
High blood pressure is often referred to as the “silent killer” and data suggest it contributes to more than 50% of strokes worldwide. It rarely produces symptoms, yet over time, it damages the blood vessels supplying the heart, brain and kidneys, and amplifies the risks posed by high cholesterol.
Raised blood pressure is not an inevitable part of ageing. It is a sign of disease development. As arteries become stiffer with age and disease, blood pressure rises. It becomes both a cause and a consequence of arterial damage, which is why it is important for people to know their numbers. Blood pressure targets have come down in recent years. In general, the lower we can keep systolic pressure, the better – below 140mmHg, and often closer to 120mmHg.
Diets high in salt or processed foods, excessive alcohol, excess weight and a lack of exercise all push blood pressure up. Alcohol also raises it both in the short and long term. We once thought moderate drinking might even be beneficial, but the evidence has moved on. While it can still fit within a balanced diet, alcohol should be consumed in moderation. Reducing processed foods and cooking more from fresh ingredients can be a simple but effective change.
If lifestyle adjustments are not enough, medications such as ACE inhibitors, ARBs, calcium channel blockers or thiazide diuretics – often used in low-dose combinations – can be effective. The key is consistency: if you stop treatment, blood pressure generally rises again.
4. Manage weight and reduce the risk of diabetes
Obesity has become a global public health crisis in recent decades. Excess abdominal fat is one of the strongest modifiable risk factors for developing type 2 diabetes, which itself greatly increases the risk of heart disease. Chronic high blood sugar damages the arterial wall, raising the likelihood of heart attack, stroke and kidney disease.
Thankfully, we now have treatments that can help people achieve substantial and sustained weight loss when combined with lifestyle improvements. GLP-1 receptor agonists were once thought to benefit only people with diabetes, but large trials now show they can reduce cardiovascular complications even in those without the condition.
Emerging data suggest so-called “fat jabs” may also improve outcomes in a range of other conditions, including kidney and liver disease, and potentially some neurological disorders. The evidence so far indicates that these effects are not solely because of weight loss, and research is continuing. They also appear to encourage healthier eating, reduced alcohol intake and lower smoking rates. Used appropriately, they may help support a broader shift towards healthier long-term habits.
What else matters? More than you might think
While the four risk factors above remain central, emerging research is highlighting other contributors to heart disease. Chronic inflammation is one of them. A surprisingly common source is gum disease, or periodontitis, which affects around 40% of adults.
A randomised clinical trial we carried out at University College London examined the effect of intensive oral hygiene therapy on patients with gum disease. As their oral health improved, we saw a significant improvement in arterial health over the following six months. In other words, looking after your teeth may help protect your heart as well.
There is also increasing interest in the gut microbiome – the trillions of bacteria that live in your gut – and the influence they may have on metabolism, inflammation and long-term health.
The bottom line: act now and keep going
The message is simple: the earlier you act, the greater the benefit. Whether it is quitting smoking, checking your cholesterol and blood pressure, managing your weight or improving your oral hygiene, the choices you make today can have a profound impact on your future wellbeing.
We should all take control of our most important asset – our health – from early in life. Small, sustainable improvements can delay or prevent heart attacks and help us live longer, healthier lives.
How do statins work?
The cholesterol in your blood is made by the liver, and mostly secreted as LDL cholesterol. Statins lower levels of harmful LDL by 15-40%, depending on the individual and the type of statin.
They work by inhibiting an enzyme called HMG-CoA reductase, which is found in the liver and is involved in the production of cholesterol, so they essentially block LDL cholesterol being produced by the liver. They also help the liver remove cholesterol that’s already in the blood.
John Deanfield is a leading professor of cardiology at University College London and a consultant cardiologist with expertise in congenital heart disease, preventive cardiology and atherosclerosis.
