If you’re like most people, you think that heart disease is a problem for other folks. But heart disease is the number one killer in the U.S. It is also a major cause of disability. There are many different forms of heart disease. The most common cause of heart disease is narrowing or blockage of the coronary arteries, the blood vessels that supply blood to the heart itself. This is called coronary artery disease and happens slowly over time. It’s the major reason people have heart attacks.

Other kinds of heart problems may happen to the valves in the heart, or the heart may not pump well and cause heart failure. Some people are born with heart disease.

Heart disease is the leading cause of the death in the U.S. Over one quarter of all deaths are from heart disease. It is also a major cause of disability. The risk of heart disease increases as you age. You have a greater risk of heart disease if you are a man over age 45 or a woman over age 55. You also are at greater risk if you have a close family member who had heart disease at an early age.

Fortunately, there are many things you can do reduce your chances of getting heart disease. You should

• Know your blood pressure and keep it under control
• Exercise regularly
• Don’t smoke
• Get tested for diabetes and if you have it, keep it under control
• Know your cholesterol and triglyceride levels and keep them under control
• Eat a lot of fruits and vegetables
• Maintain a healthy weight

The vascular system is the body’s network of blood vessels. It includes the arteries, veins and capillaries that carry blood to and from the heart. Problems of the vascular system are common and can be serious. Arteries can become thick and stiff, a problem called arteriosclerosis. Blood clots can clog vessels and block blood flow to the heart or brain. Weakened blood vessels can burst, causing bleeding inside the body.

You are more likely to have vascular disease as you get older. Other factors that make vascular disease more likely include

• Family history of vascular or heart diseases
• Pregnancy
• Illness or injury
• Long periods of sitting or standing still
• Any condition that affects the heart and blood vessels, such as diabetes or high cholesterol
• Smoking
• Obesity

Losing weight, eating healthy foods, being active and not smoking can help vascular disease. Other treatments include medicines and surgery.

Heart Disease Risk Factors

This video—presented by the National Heart, Lung, and Blood Institute, part of the National Institutes of Health—discusses the risk factors for heart disease. You can control many heart disease risk factors, but some you cannot. Taking steps to prevent heart disease is key. For example, don’t smoke or quit smoking; aim for a healthy weight; be physically active; eat for heart health; know your cholesterol, blood pressure, and blood glucose numbers; and know your family’s medical history.

For more information, visit the Health Topics Coronary Heart Disease Risk Factors and Heart Disease in Women articles.

What Is Coronary Heart Disease?

Coronary heart disease (CHD), also called coronary artery disease, is a condition in which plaque (pronounced: plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart muscle.

Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. When plaque builds up in the arteries, the condition is called atherosclerosis. The buildup of plaque occurs over many years.

Atherosclerosis

Over time, plaque hardens and narrows your coronary arteries. This limits the flow of oxygen-rich blood to your heart muscle.mEventually, an area of plaque can rupture (break open). This causes a blood clot to form on the surface of the plaque. If the clot becomes large enough, it can mostly or completely block blood flow through a coronary artery.

Overview

If the flow of oxygen-rich blood to your heart muscle is reduced or blocked, angina or a heart attack may occur.

Angina is chest pain or discomfort. It may feel like pressure or squeezing in your chest. The pain also may occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion.

A heart attack occurs if the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked. If blood flow isn’t restored quickly, the section of heart muscle begins to die. Without quick treatment, a heart attack can lead to serious problems and even death.

Over time, CHD can weaken the heart muscle and lead to heart failure and arrhythmias. Heart failure is a condition in which your heart can’t pump enough blood to meet your body’s needs. Arrhythmias are problems with the rate or rhythm of the heartbeat.

Outlook

CHD is the most common type of heart disease. In the United States, CHD is the #1 cause of death for both men and women. Lifestyle changes, medicines, and medical procedures can help prevent or treat CHD and may reduce the risk of related health problems.

What Causes Coronary Heart Disease?

Research suggests that coronary heart disease (CHD) starts when certain factors damage the inner layers of the coronary arteries. These factors include:

• Smoking
• High levels of certain fats and cholesterol in the blood
• High blood pressure
• High levels of sugar in the blood due to insulin resistance or diabetes

When damage occurs, your body starts a healing process. The healing may cause plaque to build up where the arteries are damaged.

The buildup of plaque in the coronary arteries may start in childhood. Over time, plaque can narrow or block some of your coronary arteries. This reduces the flow of oxygen-rich blood to your heart muscle.

Eventually, an area of plaque can rupture (break open). If this happens, blood cell fragments called platelets (PLATE-lets) will stick to the site of the injury and may clump together to form blood clots. Blood clots narrow the coronary arteries even more and worsen angina or cause a heart attack.

Who Is at Risk for Coronary Heart Disease?

In the United States, coronary heart disease (CHD) is the #1 cause of death for both men and women. Each year, more than half a million Americans die from CHD.

Certain traits, conditions, or habits—known as risk factors—may raise your risk for CHD. The more risk factors you have, the more likely you are to develop the disease.

You can control many risk factors, which may help prevent or delay CHD.

Major Risk Factors

• Unhealthy blood cholesterol levels. This includes high LDL cholesterol (sometimes called “bad” cholesterol) and low HDL cholesterol (sometimes called “good” cholesterol).
• High blood pressure. Blood pressure is considered high if it stays at or above 140/90 mmHg over time. If you have diabetes or chronic kidney disease, high blood pressure is defined as 130/80 mmHg or higher. (The mmHg is millimeters of mercury—the units used to measure blood pressure.)
• Smoking. Smoking can damage and tighten blood vessels, lead to unhealthy cholesterol levels, and raise blood pressure. Smoking also can limit how much oxygen reaches the body’s tissues.
• Insulin resistance. This condition occurs if the body can’t use its own insulin properly. Insulin is a hormone that helps move blood sugar into cells where it’s used as an energy source. Insulin resistance may lead to diabetes.
• Diabetes. With this disease, the body’s blood sugar level is too high because the body doesn’t make enough insulin or doesn’t use its insulin properly.
• Overweight or obesity. The terms “overweight” and “obesity” refer to body weight that’s greater than what is considered healthy for a certain height.
• Metabolic syndrome. Metabolic syndrome is the name for a group of risk factors that raises your risk for CHD and other health problems, such as diabetes and stroke.
• Lack of physical activity. Lack of physical activity can worsen other risk factors for CHD, such as unhealthy blood cholesterol levels, high blood pressure, diabetes, and overweight or obesity.
• Unhealthy diet. An unhealthy diet can raise your risk for CHD. Foods that are high in saturated and trans fats, cholesterol, sodium (salt), and sugar can worsen other risk factors for CHD.
• Older age. As you get older, your risk for CHD increases. Genetic or lifestyle factors cause plaque to build up in your arteries as you age. By the time you’re middle-aged or older, enough plaque has built up to cause signs or symptoms.
  • In men, the risk for CHD increases after age 45.
  • In women, the risk for CHD increases after age 55.
• Family history of early heart disease. Your risk increases if your father or a brother was diagnosed with CHD before 55 years of age, or if your mother or a sister was diagnosed with CHD before 65 years of age.

Although older age and a family history of early heart disease are risk factors, it doesn’t mean that you’ll develop CHD if you have one or both. Controlling other risk factors often can lessen genetic influences and prevent CHD, even in older adults.

Emerging Risk Factors

Researchers continue to study other possible risk factors for CHD:

• High levels of a protein called C-reactive protein (CRP) in the blood may raise the risk for CHD and heart attack. High levels of CRP are a sign of inflammation in the body.
• Inflammation is the body’s response to injury or infection. Damage to the arteries’ inner walls may trigger inflammation and help plaque grow.

Research is under way to find out whether reducing inflammation and lowering CRP levels also can reduce the risk for CHD and heart attack.

• High levels of triglycerides in the blood also may raise the risk for CHD, especially in women. Triglycerides are a type of fat.

Other Risks Related to Coronary Heart Disease

Other conditions and factors also may contribute to CHD, including:

• Sleep apnea. Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep. Untreated sleep apnea can increase your risk for high blood pressure, diabetes, and even a heart attack or stroke.
• Stress. Research shows that the most commonly reported “trigger” for a heart attack is an emotionally upsetting event, especially one involving anger.
• Alcohol. Heavy drinking can damage the heart muscle and worsen other risk factors for CHD. Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day.
• Preeclampsia. This condition can develop during pregnancy. The two main signs of preeclampsia are a rise in blood pressure and excess protein in the urine. Preeclampsia is linked to an increased lifetime risk of heart disease, including CHD, heart attack, heart failure, and high blood pressure.

What Are the Signs and Symptoms of Coronary Heart Disease?

A common symptom of coronary heart disease (CHD) is angina. Angina is chest pain or discomfort that occurs if an area of your heart muscle doesn’t get enough oxygen-rich blood.

Angina may feel like pressure or squeezing in your chest. You also may feel it in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. The pain tends to get worse with activity and go away with rest. Emotional stress also can trigger the pain.

Another common symptom of CHD is shortness of breath. This symptom happens if CHD causes heart failure. When you have heart failure, your heart can’t pump enough blood to meet your body’s needs. Fluid builds up in your lungs, making it hard to breathe.

The severity of these symptoms varies. They may get more severe as the buildup of plaque continues to narrow the coronary arteries.

Signs and Symptoms of Heart Problems Related to Coronary Heart Disease

Some people who have CHD have no signs or symptoms, a condition called silent CHD. The disease may not be diagnosed until a person has signs or symptoms of a heart attack, heart failure, or an arrhythmia (an irregular heartbeat).

Heart Attack

Each year over a million people in the U.S. have a heart attack. About half of them die. Many people have permanent heart damage or die because they don’t get help immediately. It’s important to know the symptoms of a heart attack and call 9-1-1 if someone is having them. Those symptoms include

• Chest discomfort—pressure, squeezing, or pain
• Shortness of breath
• Discomfort in the upper body—arms, shoulder, neck, back
• Nausea, vomiting, dizziness, lightheadedness, sweating

These symptoms can sometimes be different in women.

What exactly is a heart attack? Most heart attacks happen when a clot in the coronary artery blocks the supply of blood and oxygen to the heart. Often this leads to an irregular heartbeat—called an arrhythmia—that causes a severe decrease in the pumping function of the heart. A blockage that is not treated within a few hours causes the affected heart muscle to die.

Heart With Muscle Damage and a Blocked Artery

The most common heart attack symptom is chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest that often lasts for more than a few minutes or goes away and comes back.

The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. The feeling can be mild or severe. Heart attack pain sometimes feels like indigestion or heartburn.

The symptoms of angina can be similar to the symptoms of a heart attack. Angina pain usually lasts for only a few minutes and goes away with rest.

Chest pain or discomfort that doesn’t go away or changes from its usual pattern (for example, occurs more often or while you’re resting) can be a sign of a heart attack. If you don’t know whether your chest pain is angina or a heart attack, call 911.

All chest pain should be checked by a doctor.

Other common signs and symptoms of a heart attack include:

• Upper body discomfort in one or both arms, the back, neck, jaw, or upper part of the stomach
• Shortness of breath, which may occur with or before chest discomfort
• Nausea (feeling sick to your stomach), vomiting, light-headedness or fainting, or breaking out in a cold sweat
• Sleep problems, fatigue (tiredness), or lack of energy

Heart Failure

Heart failure is a condition in which your heart can’t pump enough blood to meet your body’s needs. Heart failure doesn’t mean that your heart has stopped or is about to stop working.

The most common signs and symptoms of heart failure are shortness of breath or trouble breathing; fatigue; and swelling in the ankles, feet, legs, stomach, and veins in the neck.

All of these symptoms are the result of fluid buildup in your body. When symptoms start, you may feel tired and short of breath after routine physical effort, like climbing stairs.

Arrhythmia

An arrhythmia is a problem with the rate or rhythm of the heartbeat. When you have an arrhythmia, you may notice that your heart is skipping beats or beating too fast.

Some people describe arrhythmias as a fluttering feeling in the chest. These feelings are called palpitations. Some arrhythmias can cause your heart to suddenly stop beating. This condition is called sudden cardiac arrest (SCA). SCA usually causes death if it’s not treated within minutes.

How Can Coronary Heart Disease Be Prevented or Delayed?

Taking action to control your risk factors can help prevent or delay coronary heart disease (CHD). Your risk for CHD increases with the number of risk factors you have.

• One step you can take is to adopt a healthy lifestyle. Following a healthy diet is an important part of a healthy lifestyle.
• A healthy diet includes a variety of fruits, vegetables, and whole grains. It also includes lean meats, poultry, fish, beans, and fat-free or low-fat milk or milk products. A healthy diet is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugar.
• If you’re overweight or obese, work with your doctor to create a reasonable weight-loss plan. Controlling your weight helps you control CHD risk factors.
• Be as physically active as you can. Physical activity can improve your fitness level and your health. Talk with your doctor about what types of activity are safe for you.
• If you smoke, quit. Smoking can damage and tighten blood vessels and raise your risk for CHD. Talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke.
• Know your family history of health problems related to CHD. If you or someone in your family has CHD, be sure to tell your doctor.
• If lifestyle changes aren’t enough, you also may need medicines to control your CHD risk factors. Take all of your medicines as prescribed.

Angina

Angina is chest pain or discomfort you get when your heart muscle does not get enough blood. It may feel like pressure or a squeezing pain in your chest. It may feel like indigestion. You may also feel pain in your shoulders, arms, neck, jaw or back.

Angina is a symptom of coronary artery disease (CAD), the most common heart disease. CAD happens when a sticky substance called plaque builds up in the arteries that supply blood to the heart, reducing blood flow.

There are three types of angina: stable, unstable, and variant. Unstable angina is the most dangerous. It does not follow a pattern and can happen without physical exertion. It does not go away with rest or medicine. It is a sign that you could have a heart attack soon.

Not all chest pain or discomfort is angina. If you have chest pain, you should see your health care provider.

Congestive heart failure

Heart failure is a condition in which the heart can’t pump enough blood throughout the body. Heart failure does not mean that your heart has stopped or is about to stop working. It means that your heart is not able to pump blood the way it should.

The weakening of the heart’s pumping ability causes

• Blood and fluid to back up into the lungs
• The buildup of fluid in the feet, ankles and legs—called edema
• Tiredness and shortness of breath

The leading causes of heart failure are coronary artery disease, high blood pressure, and diabetes.

Treatment includes treating the underlying cause of your heart failure, medicines, and heart transplantation if other treatments fail.

Heart failure is a serious condition. About 5 million people in the U.S. have heart failure. It contributes to 300,000 deaths each year.

Congenital heart disorders

A congenital heart defect is a problem with the structure of the heart. It is present at birth. Congenital heart defects are the most common type of major birth defect.

A baby’s heart begins to develop shortly after conception. During development, structural defects can occur. These defects can involve the walls of the heart, the valves of the heart and the arteries and veins near the heart. Congenital heart defects can disrupt the normal flow of blood through the heart. The blood flow can

• Slow down
• Go in the wrong direction or to the wrong place
• Be blocked completely

Treatment for the defect can include medicines, surgery and other medical procedures and heart transplants. The treatment depends on the type and severity of the defect and a child’s age, size and general health. Today, many children born with complex heart defects grow to adulthood and lead productive lives.

Stroke

A stroke is a medical emergency. Strokes happen when blood flow to your brain stops. Within minutes, brain cells begin to die. There are two kinds of stroke. The more common kind, called ischemic stroke, is caused by a blood clot that blocks or plugs a blood vessel in the brain. The other kind, called hemorrhagic stroke, is caused by a blood vessel that breaks and bleeds into the brain. “Mini-strokes” or transient ischemic attacks (TIAs), occur when the blood supply to the brain is briefly interrupted.

Symptoms of stroke are

• Sudden numbness or weakness of the face, arm or leg (especially on one side of the body)
• Sudden confusion, trouble speaking or understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

If you have any of these symptoms, you must get to a hospital quickly to begin treatment. Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot or by stopping the bleeding. Post-stroke rehabilitation helps individuals overcome disabilities that result from stroke damage. Drug therapy with blood thinners is the most common treatment for stroke.

Incidence of Stroke

Every 40 seconds, someone in the United States has a stroke. In 2008 alone, more than 133,000 Americans died from stroke—or one person every four minutes—making it the fourth leading cause of death in the United States.

A stroke, sometimes called a brain attack, occurs when a blockage stops the flow of blood to the brain or when a blood vessel in or around the brain bursts. Although many people think of stroke as a condition that affects only older adults, strokes can and do occur in people of all ages. In fact, nearly a quarter of all strokes occur in people younger than age 65.

Each year, almost 800,000 strokes occur in the United States. Strokes often lead to serious, life-changing complications that include:

• Paralysis or weakness on one side of the body.
• Problems with thinking, awareness, attention, learning, judgment, and memory.
• Problems understanding or forming speech.
• Difficulty controlling or expressing emotions.
• Numbness or strange sensations.
• Pain in the hands and feet.
• Depression.

To help protect yourself and your loved ones, learn what steps you can take to prevent a stroke and how to spot a stroke if one occurs.

Lowering Your Risk for Stroke

Demographic factors such as family history, age, sex, and race/ethnicity can all play a role in an individual’s stroke risk. Regardless of your background, however, there are several things you can do to lower your chances of having a stroke.

For example, cigarette smoking contributes to one in every five strokes in the United States. Smoking—and even exposure to second-hand smoke—can thicken the blood and make it more likely to clot. Thicker blood flow can lead to increased plaque buildup in your arteries and damage to the blood vessels leading to the brain, which can cause or worsen a stroke. So, quit smoking—or better yet, don’t start.

In 2011, the Department of Health and Human Services launched the Million Hearts™ initiative to prevent a million heart attacks and strokes by 2017. A primary focus is on the ABCS to prevent cardiovascular disease, including stroke, and contribute to overall health

• Appropriate Aspirin therapy
  • Ask your doctor if taking aspirin is right for you.
• Blood pressure control
  • Keeping your blood pressure under control reduces your risk of heart attack and stroke. More than half of the world’s stroke deaths are caused by elevated blood pressure levels.
• Cholesterol management
  • Get your cholesterol checked regularly and manage it with diet and physical activity or with medication, if needed.
• Smoking cessation
• Exercise regularly.
• Eat a healthy diet that’s low in sodium.
• Maintain a healthy weight.
• Prevent or control diabetes.
• Limit your alcohol intake (fewer than two drinks per day for men, or one drink per day for women).

Recognizing the Signs of Stroke

When responding to a stroke, every minute counts. The sooner a patient receives medical treatment, the lower the risk for death or disability. If you or someone you know exhibits the following signs or symptoms, call 9-1-1 immediately:

• Numbness or weakness of the face, arm, or leg, especially on one side of the body
• Confusion, trouble speaking, or difficulty understanding
• Trouble seeing in one or both eyes
• Trouble walking, dizziness, or loss of balance and coordination
• Severe headache with no known cause