Cardiovascular prevention starts much earlier than we think, and that is precisely what changes everything. At the 2026 Healthy Longevity course in Singapore, Professor John Deanfield restated a powerful idea: investing in your arteries pays compound interest. Acting young on risk factors protects the heart for decades.
Cardiovascular prevention: a question of cumulative exposure
Cardiovascular disease causes around 17.9 million deaths a year worldwide, close to 31% of all deaths. Yet it is largely preventable. The INTERHEART study (Yusuf, Lancet 2004) showed that nine risk factors explain 90% of heart attacks in men and 94% in women.
The central concept is cumulative exposure. Atherosclerosis builds up slowly, year after year. Tuzcu's data (Circulation 2001) are telling: coronary atherosclerosis is present in 17% of people under 20, 60% of those aged 30-39 and 85% of those over 50. In other words, most of us already have some arterial damage.
The decisive role of LDL cholesterol and the arteries
Ference's work (Eur Heart J 2017; JAMA 2019), covering more than 438,000 patients and then 2 million participants, is decisive for cardiovascular prevention. It shows that naturally lower LDL cholesterol, combined with lower blood pressure, strongly reduces major coronary events.
The lesson is clear: arterial disease is "largely preventable" through early and sustained reduction of risk factors. What matters most is not the intensity of late treatment, but the duration of exposure. Every year of lowered LDL acts like compound interest on arterial health.
Why risk models work against younger people
One major obstacle exists. Widely used 10-year risk estimates bias against real prevention and "disinherit" younger people, particularly women (Ference, JACC 2018). A young adult can already have struggling arteries while showing a low short-term risk.
Yet NHS HealthCheck data (Patel/Deanfield, more than 5 million people aged 40 to 74) show that 70% have at least one major cardiovascular risk factor at a high level. Lee's study (JACC 2025) confirms the almost universal presence of at least one non-optimal risk factor before any disease, arguing for "primordial" prevention.
The multiplied gain of early cardiovascular prevention
Acting early on the arteries offers a "leveraged gain". The same modifiable risk factors feed several diseases of ageing. Reducing exposure to them opens a "golden decade": years in good health, active and productive.
One striking example comes from the mouth. Treating periodontitis improves endothelial function, an early marker of vascular ageing (D'Aiuto/Deanfield, Lancet Diab Endocrinol 2018). The body works as a whole, and small levers can have large effects.
From screening to action in the field
Geoffrey Rose's paradox clarifies the strategy: modestly lowering risk across the whole population prevents more events than aggressive treatment reserved for those at highest risk. Hence the value of new tools, such as personalised risk and benefit calculators (Ference, Nat Rev Cardiol 2024), which make prevention "investable".
In practice, this translates simply: move regularly, do not smoke, monitor blood pressure, blood sugar and LDL, and do so without waiting for symptoms. Anti-smoking measures confirm it: smoke-free legislation in Scotland rapidly reduced hospital admissions for acute coronary syndrome (Pell, NEJM 2008).
In conclusion, cardiovascular prevention is never too early. As Professor Deanfield puts it, "for lifelong prevention, you can never start too early". Every step taken young protects the heart and arteries over the long term.
