Heart Disease

What heart disease is

"Heart disease" is an umbrella term. It overlaps with cardiovascular disease, which also includes stroke and diseases of blood vessels elsewhere in the body. When people say heart disease, they usually mean coronary artery disease, but there are several distinct types.

Types of heart disease

How coronary artery disease develops

Cholesterol-rich plaque builds up in artery walls over decades, a process called atherosclerosis. Narrowed arteries can cause chest pain when the heart works harder (angina). If a plaque cracks, a clot forms on it and can block the artery suddenly, causing a heart attack. Damage from heart attacks and long-term high blood pressure is the commonest route to heart failure.

Heart disease symptoms

Many people have no symptoms until a heart attack, cardiac arrest or stroke. When symptoms occur, they include:

• Chest pain or discomfort: pressure, squeezing, heaviness or burning, often brought on by exertion, cold or stress and eased by rest
• Pain elsewhere: arms (especially the left), jaw, neck, upper back or upper belly
• Shortness of breath with activity or lying flat
• Fatigue and reduced ability to exercise
• Palpitations: a racing, pounding or irregular heartbeat
• Swelling of the ankles, legs or belly, and sudden weight gain
• Dizziness or fainting

Heart disease symptoms in women

Women more often have heart attacks without classic crushing chest pain. They are more likely to report shortness of breath, nausea or vomiting, pain in the back, jaw or neck, indigestion-like discomfort and unusual tiredness in the days or weeks before. Women also more often have disease of the tiny heart arteries (coronary microvascular disease), which standard angiograms can miss. Pregnancy complications such as preeclampsia and gestational diabetes, early menopause and autoimmune diseases raise later heart risk.

Early signs of heart disease

Early warning signs are often subtle: getting breathless on stairs you used to manage, chest tightness with exertion that goes away with rest, or new swelling of the ankles. The earliest "signs" are usually found on tests rather than felt: high blood pressure, high cholesterol, high blood sugar and a raised coronary calcium score.

Causes and risk factors

Risk factors you can change

• High blood pressure
• High LDL cholesterol and other lipid problems (high cholesterol)
• Smoking and vaping, and secondhand smoke
• Diabetes and prediabetes
• Obesity, especially around the waist
• Physical inactivity and an unhealthy diet high in salt, saturated fat and processed food
• Too much alcohol, poor sleep and chronic stress

Risk factors you cannot change

• Age: risk rises after 45 in men and 55 in women
• Family history of early heart disease
• Inherited conditions such as familial hypercholesterolemia and high lipoprotein(a)
• Chronic kidney disease, rheumatoid arthritis, lupus, HIV and previous cancer treatment with chest radiation or some chemotherapy drugs

How heart disease is diagnosed

Your doctor will ask about symptoms, what brings them on, family history and lifestyle, then listen to the heart and lungs and check pulse, blood pressure and swelling. Tests are chosen to answer specific questions:

For people without symptoms, doctors estimate 10-year risk of heart attack and stroke with a risk calculator based on age, sex, cholesterol, blood pressure, diabetes and smoking. This guides decisions about statins and blood pressure treatment.

Treatment

Lifestyle

• Stop smoking: risk falls within a year and keeps falling.
• Aim for at least 150 minutes a week of moderate activity, such as brisk walking.
• Eat a Mediterranean or DASH-style diet: vegetables, fruit, whole grains, beans, nuts, fish and olive oil, with less salt, red and processed meat and sugar.
• Lose weight if needed. Even 5 to 10% makes a measurable difference to blood pressure and sugar.
• Limit alcohol and aim for 7 to 9 hours of sleep.

Medicines

• Statins and other cholesterol-lowering drugs reduce heart attacks and strokes.
• Blood pressure medicines such as ACE inhibitors, ARBs, calcium channel blockers and diuretics.
• Antiplatelet medicines, such as low-dose aspirin, for people who already have coronary disease or stents. Aspirin is no longer routinely recommended to prevent a first heart attack in most older adults, so do not start it without asking your doctor.
• Beta-blockers and nitrates to relieve angina.
• Heart failure medicines that lengthen life, including SGLT2 inhibitors.
• Anticoagulants to prevent stroke in atrial fibrillation.

Procedures and surgery

• Angioplasty and stents to open narrowed arteries, urgently during a heart attack
• Coronary artery bypass surgery for extensive disease
• Valve repair or replacement, including keyhole catheter procedures such as TAVR
• Ablation, pacemakers and implantable defibrillators for rhythm problems
• Cardiac rehabilitation, a supervised exercise and education program after a heart event that lowers the risk of another

Complications

Heart attack, heart failure, stroke, sudden cardiac arrest, peripheral artery disease and kidney damage are the main complications. Depression is common after a heart event and is worth treating, since it affects recovery.

Preventing heart disease

The American Heart Association's Life's Essential 8 sums up prevention: eat better, be more active, quit tobacco, get healthy sleep, manage weight, and control cholesterol, blood sugar and blood pressure. Know your numbers: have blood pressure checked at least yearly, and cholesterol and blood sugar checked as advised by your doctor.

Frequently asked questions

What are the early signs of heart disease?

Often there are none. When early signs appear, they include breathlessness or chest tightness on exertion that eases with rest, unusual fatigue, palpitations and ankle swelling. Many people learn they are at risk from routine checks showing high blood pressure, cholesterol or blood sugar, which is why regular screening matters.

What are the symptoms of heart disease in women?

Women can have chest pain, but are more likely than men to have shortness of breath, nausea, jaw, neck or back pain, indigestion-like discomfort and extreme tiredness. Symptoms may come on during rest or stress rather than exertion. Women should not dismiss these symptoms or delay calling 911.

Can heart disease be reversed?

Plaque does not disappear, but intensive cholesterol lowering, quitting smoking, exercise and blood pressure control can stabilize it and sometimes shrink it slightly. More importantly, these steps markedly reduce the chance of heart attack and death. Some heart failure and rhythm problems improve greatly with treatment.

Is heart disease genetic?

Partly. A parent or sibling with early heart disease raises your risk, and some inherited conditions, such as familial hypercholesterolemia, high lipoprotein(a) and inherited cardiomyopathies, run strongly in families. Genes load the dice, but lifestyle and treatment of risk factors still change the outcome substantially.

What is the difference between heart disease and cardiovascular disease?

Heart disease refers to conditions of the heart itself, such as coronary artery disease, heart failure and valve or rhythm problems. Cardiovascular disease is broader and also includes stroke and disease of arteries and veins elsewhere. The terms are often used loosely as if they meant the same thing.

How can I lower my risk of heart disease?

Do not smoke, stay active most days, eat mainly plants, whole grains, fish and healthy fats, keep a healthy weight, sleep well, and get blood pressure, cholesterol and blood sugar checked and treated. People with high calculated risk often benefit from a statin.