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Atherosclerotic cardiovascular disease (CVD) remains the leading cause of premature morbidity and mortality in the world today, and is on course to cost the global economy > US$1 trillion by 2030. Although the clinical manifestations of CVD are seldom seen prior to middle-age, current evidence points to a decades-long subclinical period of the disease prior to the appearance of overt complications. While the exact physiological processes underlying this evolution are still poorly understood, it has been estimated that virtually all of the population attributable risk for CVD can be attributed to just nine lifestyle-related (and therefore modifiable) risk factors: namely abnormal lipids; smoking; hypertension; diabetes; abdominal obesity; psychosocial factors; low consumption of fruits and vegetables; and lack of regular physical activity. Timely prevention strategies to alter lifestyle behaviours and reduce these risk factors are therefore likely to offer the greatest benefits to cardiovascular health and longevity at a population level.

Physical activity and cardiovascular risk: No such thing as ‘Too little, too late’