Cardiovascular prevention means lowering the likelihood of a heart attack, a stroke or cardiac death by acting on modifiable risk factors: smoking, high blood pressure, cholesterol, diabetes, excess weight, physical inactivity, diet and alcohol. Age, sex and heredity cannot be changed, but they set how intensive prevention needs to be.
What is cardiovascular prevention and why does it matter?
Cardiovascular prevention covers the measures that prevent or delay diseases of the heart and arteries, either before any event (primary prevention) or after a first event to avoid recurrence (secondary prevention). This article deals with primary prevention, in adults with no known cardiovascular disease.
According to the WHO, 19.8 million people died of cardiovascular disease worldwide in 2022, or about 32% of all deaths, and “most cardiovascular diseases can be prevented by addressing behavioural and environmental risk factors” (fact sheet of July 31, 2025). In France, Santé publique France, the French public health agency, ranks them as the second leading cause of death after cancers, responsible for about one death in five and about one million hospitalizations each year. The French Cardiology Federation (FFC) speaks of “400 deaths per day” and points out that these diseases “remain the leading cause of death in women.”
These diseases develop silently, through atherosclerosis: the gradual buildup of plaque in the artery walls, fueled for decades by risk factors. This long lead time is what gives prevention its full value.
What are the 7 cardiovascular risk factors?
The list of “7 cardiovascular risk factors” generally combines three non-modifiable factors (age, sex and family history) with four major modifiable factors (smoking, high blood pressure, high cholesterol and diabetes). Official French sources count more: the FFC lists six main modifiable factors, and French National Health Insurance (Assurance Maladie) an even longer list.
| Non-modifiable (Assurance Maladie) | Main modifiable factors (FFC) | Other factors and modifiers (Assurance Maladie, Santé publique France) |
|---|---|---|
| Age: the likelihood of an event rises sharply after 50 in men and 60 in women | Smoking, “the leading cause of cardiovascular death in France” | Overweight (BMI above 25) and obesity (BMI above 30); waist circumference of 80 cm or more in women, 94 cm or more in men |
| Sex: women are relatively protected until menopause; after 60, their risk catches up with men’s | High blood pressure (140/90 mmHg or higher) | Metabolic syndrome, high triglycerides |
| Family history: heart attack or sudden death before 55 in a male parent, before 65 in a female parent; stroke before 45 | High cholesterol | Alcohol, stress, depression, sleep disorders, drug use |
| Diabetes | Air pollution, chronic kidney disease, pregnancy complications | |
| Physical inactivity (less than 30 minutes of activity per day) | ||
| Stress |
One sentence from French National Health Insurance sums it up: “cardiovascular risk factors do not simply add up; they amplify one another.” Two moderate factors often weigh more than a single severe one. The international INTERHEART study (Yusuf et al., The Lancet, 2004), conducted in 52 countries among 15,152 people who had had a heart attack and 14,820 controls, showed that nine factors (smoking, high blood pressure, diabetes, abdominal obesity, diet, physical activity, alcohol, blood apolipoproteins and psychosocial factors) together accounted for 90% of the attributable risk of heart attack in men and 94% in women. Nearly all of the risk therefore comes from factors that can be acted on.
How can you find out your level of risk before taking action?
Risk level is measured with a validated score: SCORE2 for people aged 40–69 and SCORE2-OP for those aged 70–89, published in 2021 by the European Society of Cardiology (ESC). They estimate the 10-year probability of a fatal or non-fatal cardiovascular event from five data points: age, sex, smoking, systolic blood pressure and non-HDL cholesterol. France uses the tables for the low-risk region.
Three measurements feed the calculation: a recent blood pressure reading, a lipid panel and, as a complement, fasting blood sugar. The 2021 European guidelines then classify risk as “low to moderate,” “high” or “very high,” with thresholds that depend on age, and consider people who already have cardiovascular disease, diabetes, chronic kidney disease or familial hypercholesterolemia to be at high or very high risk from the outset. They also invite doctors to take into account “risk modifiers” not included in the score, such as psychosocial stress or certain inflammatory diseases. The calculation method, thresholds and their limits are detailed in our article on 10-year cardiovascular risk.
Which cardiovascular prevention strategies are proven, and how effective are they?
Six levers have a demonstrated effect on cardiovascular events: quitting smoking, physical activity, a Mediterranean-style diet, moderating alcohol, controlling blood pressure and cholesterol, and preventing or properly controlling diabetes. The orders of magnitude below come from official sources or published trials; they describe populations, not your individual case.
| Lever | Practical benchmark | Sourced order of magnitude |
|---|---|---|
| Quitting smoking | Nicotine replacement therapy, support (Tabac info service, France’s national smoking cessation service; a tobacco cessation specialist) | “After one year without tobacco, the risk of myocardial infarction is cut in half”; the risk of stroke “returns to that of a nonsmoker” (Assurance Maladie) |
| Physical activity | At least 150 minutes per week of moderate intensity (WHO); 150 to 300 minutes according to the 2021 ESC guidelines; “at least the equivalent of half an hour of brisk walking per day” (Assurance Maladie) | 31% of adults worldwide were inactive in 2022 (WHO) |
| Diet | At least 5 servings of fruits and vegetables per day, fish at least twice a week, processed meats limited to 150 g per week, less salt (Assurance Maladie); Mediterranean diet recommended by the ESC | PREDIMED trial (Estruch et al., NEJM, 2018): 7,447 participants aged 55 to 80, median follow-up 4.8 years; major cardiovascular events reduced, hazard ratio 0.69 with extra-virgin olive oil and 0.72 with nuts |
| Alcohol | No more than 10 standard drinks per week and no more than 2 per day (Assurance Maladie) | — |
| Blood pressure | High blood pressure from 140/90 mmHg (Assurance Maladie); home blood pressure monitoring; treatment based on overall risk (ESC 2021) | Individualized targets, not given here |
| Cholesterol | Lipid panel; LDL targets that are lower the higher the risk (ESC 2021) | Targets to discuss with your doctor, not given here |
| Diabetes | Fasting blood sugar after 45 if a risk factor is present (French National Authority for Health, HAS) | In the Diabetes Prevention Program (Knowler et al., NEJM, 2002), a lifestyle intervention reduced the incidence of diabetes by 58% at 2.8 years in high-risk adults |
| Weight, stress, sleep | Waist circumference, stress management, good-quality sleep (FFC, Assurance Maladie) | — |
Smoking is the fastest lever, as we explain in our article on quitting smoking; physical activity is the most wide-ranging, because it acts on blood pressure, cholesterol, blood sugar, weight, sleep and mood (see physical activity for prevention). Cholesterol has its own article on cholesterol and lipoproteins, and diabetes another on type 2 diabetes prevention.
What can the prevention check-up at ages 45–50 offer?
The prevention check-up offered between ages 45 and 50 inclusive is the natural time to take stock of your cardiovascular risk: preventing cardiovascular disease is one of its official themes, and at this age risk factors are often established but still reversible.
It is a 30- to 45-minute consultation with a doctor, nurse, pharmacist or midwife, fully covered (100%) by French National Health Insurance, with no upfront payment. A self-assessment questionnaire completed before the appointment reviews smoking, alcohol, diet, physical activity, sleep, stress and medical history; the consultation sets one or two priority topics in a Personalized Prevention Plan (PPP), which is sent to your regular doctor (médecin traitant) unless you object. The check-up does not include a blood draw, but the professional refers you to your regular doctor for the blood pressure measurement, lipid panel and blood sugar test needed to calculate SCORE2. The full process is described in the prevention check-up at ages 45–50, and the program in our guide to the prevention check-up.
What can a precision test such as metabolomics add?
A nuclear magnetic resonance (NMR) metabolomics panel measures 249 biomarkers from a single sample: lipoproteins by class and size, fatty acids, amino acids and inflammation (GlycA). It does not replace SCORE2; it breaks down what the score sums up in a single non-HDL cholesterol figure.
In the UK Biobank cohort, these biomarkers have been linked to more than 700 diseases in 118,461 participants (Julkunen et al., Nature Communications, 2023), and a metabolomic profile improved 10-year prediction of several common diseases, including heart failure, compared with clinical variables (Buergel et al., Nature Medicine, 2022). These results apply at the scale of a research population; to date, no guideline incorporates metabolomics into individual risk calculation. Its value, discussed with your doctor, lies in cases where risk is intermediate or in tracking the effect of the changes you have made. We detail the technique in NMR metabolomics and the markers in our guide to blood biomarkers.
When should you see a doctor?
If you have no symptoms, see a doctor to take stock at ages 45–50, and earlier if you smoke, are overweight, have never had your blood pressure or blood sugar measured, or if a close relative had a heart attack or sudden death before 55 (men) or 65 (women), or a stroke before 45. Women who had high blood pressure or diabetes during a pregnancy should also talk to their doctor about it: Santé publique France lists these complications among the risk factors. Having your blood pressure measured regularly is the simplest preventive step there is.
In an emergency, severe chest pain, sudden shortness of breath, or signs of stroke (drooping face, arm weakness, speech difficulty) require you to call 15 (SAMU, the French emergency medical service) immediately. No test and no score should ever delay that call.
Key takeaways
- Cardiovascular disease is the leading cause of death worldwide (19.8 million deaths in 2022, WHO) and the second in France; most of it can be prevented by acting on risk factors.
- Three factors cannot be changed (age, sex, heredity); smoking, high blood pressure, cholesterol, diabetes, inactivity, excess weight, diet, alcohol and stress can, and they “amplify one another” rather than simply adding up.
- The proven levers have measured effects: heart attack risk halved one year after quitting smoking (Assurance Maladie), cardiovascular events reduced on a Mediterranean diet (PREDIMED), at least 150 minutes of moderate activity per week (WHO).
- The prevention check-up at ages 45–50, fully covered (100%), helps identify risk factors and obtain the measurements needed to calculate SCORE2; metabolomics can refine the picture without replacing the score.
- Chest pain or signs of stroke: call 15 without delay.
What Sokrate lets you do
The Sokrate service is built into the prevention check-up that is fully covered (100%) by French National Health Insurance, with no upfront payment. The Sokrate 360 adaptive questionnaire, completed online before your appointment, explores nine dimensions of your health; a doctor signs your Personalized Prevention Plan and sends it to your regular doctor, unless you object. In agreement with your doctor, a metabolomics panel of 249 biomarkers can complement the standard lipid panel. Join the waitlist.