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Most cardiovascular events avoidable with modest blood pressure and cholesterol reductions

Risk Factors and Prevention

Paris, France – 2 Sept 2019: The majority of heart attacks, strokes, and deaths from heart disease can be prevented with modest and sustained decreases in blood pressure and cholesterol. The late breaking results are presented in a Hot Line Session today at ESC Congress 2019 together with the World Congress of Cardiology(1) and published in the Journal of the American Medical Association.(2)

Principal investigator Professor Brian Ference of the University of Cambridge, UK said: “Healthy eating and physical activity are effective ways to improve cardiovascular health. The best diet or exercise programme differs for each person. It is the one that produces the greatest reductions in both blood pressure and cholesterol for that person AND to which he or she can adhere because the benefits of the reductions accrue overtime.”

The study found that long-term exposure to the combination of both lower low-density lipoprotein cholesterol (LDL-C) and lower systolic blood pressure (SBP) was linked with independent and additive reductions in the lifetime risk of cardiovascular disease.

The relationship was dose-dependent, meaning that any combination of lower LDL-C and lower SBP was associated with a corresponding reduction in lifetime risk. 

The study shows that even small declines in LDL-C and SBP can substantially diminish the likelihood of ever having a heart attack or stroke. For example, the combination of 0.3 mmol/L (14 mg/dL) lower LDL-C and 5 mmHg lower SBP was associated with a 50% lower lifetime risk of cardiovascular disease.

Prof Ference said: “These small modifications in LDL-C and SBP are the kind of changes that can be achieved by eating healthily such as the DASH diet3 or similar diets.”

Larger reductions in LDL-C and SBP with more aggressive lifestyle changes or other therapies to achieve the combination of 1 mmol/L (38.67 mg/dL) lower LDL-C and 10 mmHg lower SBP can reduce lifetime risk of cardiovascular disease by 80% and reduce lifetime risk of cardiovascular death by more than two-thirds (68%).  

The study included 438,952 participants of the UK Biobank who experienced a total of 24,980 major coronary events (defined as the first occurrence of non-fatal heart attack, ischaemic stroke, or coronary death).  The average age was 65.2 years (range: 40.4 to 80.0) and 54% were female.

The researchers used genetic variants linked with lower LDL-C and SBP as instruments to randomly divide participants into groups with lifetime exposure to lower LDL-C, lower SBP, or both as compared to a reference group using a 2x2 factorial design. They then compared the differences in plasma LDL-C, SBP and cardiovascular event rates between the groups to estimate associations with lifetime risk of cardiovascular disease.

Prof Ference said: “It is important to encourage patients and populations to invest in their future health.  Maintaining even small reductions in both LDL-C and SBP for prolonged periods of time can pay very big health dividends by dramatically reducing the lifetime risk of cardiovascular disease.”


Notes to editor

Notes to editors

Authors: ESC Press Office 
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Funding: Prof Ference is supported by the National Institute for Health Research Cambridge Biomedical Research Centre at the Cambridge University Hospitals NHS Foundation Trust. Additional funding was provided by the British Heart Foundation and U.K. Medical Research Council (MRC). 

Disclosures: Prof Ference reports receiving grants, Amgen, Merck & Co., Novartis and Esperion Therapeutics; and consulting or advisory board fees from Amgen, Regeneron, Sanofi, Merck & Co., Pfizer, CiVi BioPhama, and KrKA Phamaceuticals, and grants from Merck & Co., Amgen, Novartis, Novo Nordisk, Regeneron, Sanofi, Pfizer, Eli Lilly, Mylan, Ionis, dalCOR, Silence Therapeutics, Integral Therapeutics, CiVi Pharma, KrKa Phamaceuticals, American College of Cardiology, European Atherosclerosis Society, and European Society of Cardiology.

References and notes

(1) Combined effect of lower LDL-C and lower SBP on the lifetime risk of cardiovascular disease will be discussed during:

(2) The full paper will be available during Congress from

(3) The Dietary Approaches to Stop Hypertension (DASH) diet is a lifelong approach to healthy eating designed to help treat or prevent high blood pressure.


About ESC Congress

ESC Congress is the world’s largest gathering of cardiovascular professionals contributing to global awareness of the latest clinical trials and breakthrough discoveries. ESC Congress 2019 together with the World Congress of Cardiology takes place from 31 August to 4 September at the Expo Porte de Versailles in Paris, France. Explore the scientific programme.

About the European Society of Cardiology 

The European Society of Cardiology brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.