Heart disease remains the UK’s biggest killer — yet many of the risks that matter most in our 50s, 60s and 70s aren’t the ones most commonly discussed.

Most people know about high cholesterol, smoking and blood pressure.

But newer UK studies — particularly from the UK Biobank — reveal several quieter, less-recognised factors that gradually increase cardiovascular risk long before symptoms appear.

These risks are also highly modifiable, even later in life.

Below are the hidden factors worth paying attention to — and the small, practical steps that can make a real difference.

Before We Begin: A Free NHS Heart Check You May Be Entitled To

If you’re aged 40–74 in England, you’re eligible for a free NHS Health Check every five years.

It measures:

• Blood pressure

• Cholesterol

• Diabetes risk

• Kidney function

• BMI

• Your overall cardiovascular risk score

This is one of the most effective ways to detect issues early. You can arrange one through your GP practice.

1. Low-Grade Inflammation

A major cardiovascular risk — even when cholesterol looks normal.

UK Biobank research shows that chronic, low-grade inflammation is associated with higher risk of heart disease, stroke and early mortality — even in people who appear healthy.

Inflammation can be quietly elevated for years due to:

• Poor sleep

• Chronic stress

• Inactivity

• Visceral fat

• Diets low in fibre and omega-3 fats

• Low vitamin D levels (very common in UK adults over 60)

Inflammatory markers include CRP (C-reactive protein), one of the key biomarkers used in UK Biobank studies.

What helps:

• Eating 30g fibre/day

• Regular oily fish consumption

• Daily movement

• Improving sleep consistency

• Vitamin D supplementation during autumn–winter (as recommended by the UK government)

  
  

2. Undiagnosed or “Masked” High Blood Pressure

Half of people over 60 — especially those over 65 — live with raised blood pressure.

The NHS estimates that around one in two adults over 65 have hypertension. Yet many remain undiagnosed because readings are taken infrequently.

A growing concern is masked hypertension — normal readings in the clinic but higher at home. Research suggests it may affect a significant proportion of adults, making home monitoring important.

Why it matters:

Persistent high blood pressure is a leading cause of heart attacks, heart failure and vascular dementia.

What helps:

• NHS-approved home blood pressure monitors

• Reducing salt intake

• Regular physical activity

• Limiting alcohol

• Weight management

• Sleep improvement

If your home readings are consistently high, share them with your GP.

3. Low Omega-3 Levels

A widespread nutritional gap after midlife.

Intake of oily fish declines with age, and conversion of plant omega-3 (ALA) into EPA/DHA is inefficient at all ages — generally under 10%.

Low EPA/DHA levels are associated with:

• Higher triglycerides

• Stiffer arteries

• Increased inflammatory activity

What helps:

• Eating oily fish twice weekly (salmon, mackerel, sardines)

• Including plant sources (walnuts, flax, chia) where helpful

• Maintaining consistent weekly intake

4. Sedentary Time — Even If You Exercise

Long sitting periods independently increase cardiovascular risk.

UK Biobank data shows that sitting for long periods raises cardiovascular risk even in people who meet NHS exercise guidelines.

Why? Because sedentary time affects:

• Blood flow

• Insulin sensitivity

• Inflammatory pathways

What helps:

• Standing or walking for 1–2 minutes every 30–45 minutes during long sitting periods

• Avoiding long stretches of evening inactivity

• Adding frequent “movement snacks” into your day

5. Poor Sleep Quality

An under-recognised cardiovascular risk after midlife.

Poor sleep becomes more common with age, and large-scale UK studies link short sleep (<6 hours), irregular sleep patterns and sleep apnoea with increased cardiovascular risk.

Why it matters:

Sleep affects:

• Blood pressure regulation

• Glucose metabolism

• Cortisol levels

• Inflammatory markers

What helps:

• Consistent sleep and wake times

• Limiting caffeine after lunchtime

• Early daylight exposure

• A wind-down routine before bed

6. Gum Disease & Dental Plaque

A surprisingly significant — and often overlooked — heart risk.

Evidence from the British Heart Foundation, the NHS and cohort studies shows that gum disease (periodontitis) is linked with higher rates of heart disease and stroke.

This doesn't mean gum disease directly causes heart disease - the relationship is associative rather than definitively causal - but the biological mechanism is plausible:

Inflamed gums allow bacteria to enter the bloodstream, and these bacteria are thought to contribute to arterial inflammation. In addition, gum disease raises whole-body inflammatory markers such as CRP.

Age-related gum recession makes plaque harder to control, increasing the importance of dental care.

What helps (NHS guidance):

• Daily flossing or interdental brushing

• Twice-daily brushing with fluoride toothpaste

• Routine dental check-ups

• Managing dry mouth

• Reducing sugary snacks

7. Social Isolation & Loneliness

A quiet but powerful heart risk backed by UK evidence.

This is one of the most genuinely “hidden” cardiovascular risks — and one of the most relevant for adults over 50.

UK Biobank studies show that social isolation increases heart disease risk by around 30–40%.

Mechanisms include:

• Chronic stress and elevated cortisol

• Increased inflammation

• Poorer sleep

• Less consistent health behaviours

• Reduced motivation for activity or good nutrition

The UK government has even appointed a Minister for Loneliness, highlighting the scale of the issue.

What helps:

• Regular contact with family or friends

• Joining community groups or classes

• Volunteering

• Walking groups or social exercise

• Video calls if mobility is limited

Even modest increases in meaningful social interaction can significantly improve overall wellbeing.

When to See a GP

Lifestyle changes are powerful, but it’s important to seek medical advice if you experience:

• Persistent chest discomfort or tightness

• Unexplained breathlessness

• Irregular heartbeat or palpitations

• Swelling in the legs or ankles

• Persistent fatigue unrelated to sleep

• Home blood pressure readings consistently above NHS thresholds

These symptoms warrant professional assessment.

Putting It All Together

Heart health is shaped by more than cholesterol. A modern, evidence-based view includes:

• Inflammation (including vitamin D status)

• Blood pressure patterns

• Omega-3 levels

• Sedentary time

• Sleep quality

• Gum and dental health

• Social connection

These areas are all modifiable — and improving even one can support better cardiovascular health.