In the last decades we have accumulated substantial knowledge about the risk factors that lead to cardiovascular disease. Despite this progress, in this issue of BMC Public Health we learn that little improvement has been made towards reducing inequalities in these risk factors in the UK. Characterizing changes over time can help understanding the mechanisms that underpin health inequalities. These pathways are complex and operate at different levels, from the individual to the context where someone lives. In this commentary I highlight some of the issues and uncertainties that may arise when individual and area level measures are used indistinctively.