Analysis: drug treatment and CVD mortality rates

Twice as many people in the UK now live with cardiovascular disease (CVD) than with cancer and Alzheimer’s disease combined, according to the British Heart Foundation (BHF). In part, the large number of people living with CVD reflects a dramatic fall in deaths from heart disease. In 1961, CVD caused half of UK deaths, but since then, age-standardised CVD mortality has declined by three-quarters.

Between 1981 and 2000 alone, mortality from coronary heart disease (CHD) in people aged 25 to 84 years old in England and Wales fell by 62% in men and by 45% among women. Treatment accounted for 42% of this fall. For instance, heart failure treatments (13% of the decrease), secondary prevention (11%) and antihypertensives (3%) made important contributions. Reductions in population risk factors underlie the remainder – for example, reduced smoking alone accounted for 48% of the decrease.¹

Risk factors combine

Risk factors, however, accumulate. Dutch researchers followed 12,616 patients for, on average, 8.0 years. Compared with controls, patients with a single risk factor were 65% more likely to develop a major CVD event (myocardial infarction, stroke and vascular mortality) or die from any cause.

The likelihood was 3-4 times higher in those with two (hazard ratio [HR] 2.61), three (HR 3.25) and four (HR 3.74) risk factors.² UK adults with three risky behaviours (physically inactive, poor fruit and vegetable intake, and high alcohol intake) were 25.18 times more likely to have CVD than those with two risky behaviours (physically inactive and poor fruit/vegetable intake).³

Blood pressure and obesity

Nevertheless, systolic blood pressure (SBP) and non-high density lipoprotein cholesterol (non-HDL-C) levels in older adults with obesity are “increasingly similar” to those with a healthy body mass index (BMI). Researchers analysed data from 978,425 participants aged 20-79 years between 1990 to 2024 from seven countries: England, the US, Japan, South Korea, Taiwan, Thailand and Finland.⁴

During the 1990s, obese adults generally had higher SBP and non-HDL-C levels than people with a healthy BMI. Since 1990, in five countries, including England, SBP and non-HDL-C fell more steeply among those aged 40-79 years old with obesity and overweight than among those with normal BMI.

So, the gap narrowed. (Taiwan and Thailand showed less marked convergences.⁴)

Indeed, in England and the US, adults aged 60-79 years with obesity, especially those with severe obesity (at least 35kg/m²), had similar or lower SBP and non-HDL-C than older adults with normal BMI. “This finding might be partly because older people with obesity use more antihypertensive and lipid-lowering medicines than those with normal BMI,” the authors comment.

For example, in England and the US, 70-72% of men aged 60-79 years with severe obesity took cholesterol-lowering medication by the early 2020s, compared with 40-48% of those with healthy BMIs.⁴

No cause for complacency

Adults younger than 40 years old showed little or no narrowing of the gap in SBP and non-HDL-C between those with obesity and those with a healthy BMI. However, relatively few people of this age use cholesterol-lowering medication, antihypertensives or both. This supports suggestions that medication drives the gap reduction in older adults.⁴

“While good news for older adults with obesity, our results suggest that cardiovascular health risks remain higher for adults under 40 than for their counterparts with a normal BMI,” adds Ysé d’Ailhaud de Brisis of Imperial. “Early lifestyle interventions, screening and, when appropriate, medication in this younger group should be considered to prevent long-term cardiovascular complications linked to obesity.”

There is no place for clinical complacency – CVD is still responsible for 26% of UK deaths and risk factors remain common. Hypertension, the UK’s leading modifiable CVD risk factor, is linked with about half of heart attacks and strokes. High levels of low density cholesterol are associated with 1 in 5 CVD deaths in the UK, the BHF estimates. High BMI is associated with 1 in 9 CVD deaths and increases the risk of diabetes, renal and hepatic diseases, and certain cancers.

Nevertheless, remarkable progress has been made against CVD. As Jain notes, the improvements in the study reflect “a significant public health success story and one we should not lose sight of as new weight-loss medications enter the picture.”

References

1. Circulation. 2004; 109:1101-1107
2. Global Heart. 2021; 16:85
3. Scientific Reports. 2022; 12:17349
4. Lancet. 2026; DOI: 10.1016/s0140-6736(26)00758-0