Introduction Cardiovascular disease rates in the UK have been steadily declining over the past 50 years, mainly due to improvements in risk factors. This paper focuses on the behavioural risk factors and aims to document trends from 1961 to the present.

Methods We searched the peer-reviewed and grey literature from comparable estimates of prevalence of smoking, poor diet, alcohol consumption, physical inactivity and overweight and obesity, within the UK between 1961 and 2011.

Results Trends in heavy drinking showed no real increase since the '70s for either men or women. 40–50 years ago, average BMI was within the “normal” range of 20–25, but now it is above this range for most age groups. Childhood overweight and obesity has also dramatically increased since the '70s. Smoking rates have declined with four times less tobacco available in the UK now since 1961. The quality of the UK diet has improved, with reductions in saturated fat and sugar intake, and increases in fruit consumption. Long term trends in physical activity levels were unclear.

Conclusion Falls in cardiovascular disease are due to the improvements in smoking and diet—two of the major risk factors. Trends in heavy drinking have remained fairly constant, but the striking increases in average BMI and childhood obesity threaten to slow or even reverse the declines in cardiovascular mortality, a condition which in 2009 killed a third of the UK population.