Cardiovascular disease (CVD) is a catch-all term that describes a group of disorders that affect your heart and blood vessels. Among these, coronary artery disease (CAD) is the most common type of heart disease.
Cardiovascular diseases include:
Aortic disease: affects the aorta, the main blood vessel that carries blood from the heart to the body
Cerebrovascular disease: affects the blood vessels that supply blood to the brain
Congenital heart disease: abnormal heart structures that form during pregnancy
Coronary heart disease: affects the blood vessels that supply blood to the heart
Deep vein thrombosis and pulmonary embolism: clots that form in the veins of the leg, and if dislodged, can travel to the heart and lungs and cause blockages
Heart attack or failure: occurs when the blood supply to the heart is disrupted or cut off
Peripheral arterial disease: affects the blood vessels that supply blood to the arms and legs
Rheumatic heart disease: damage to the heart muscle or valves caused by rheumatic fever
Stroke: occurs when the blood supply to the brain is disrupted
Other cardiovascular diseases include arrhythmias (abnormal heart rhythms), heart or blood vessel tumors, heart muscle or valve disorders, and disorders that affect the lining of the heart itself.
Many CVDs do not develop quickly. For example, strokes and heart attacks can come on suddenly, but the cause is typically a build-up of fatty deposits that slowly form inside the arteries (atherosclerosis) over a period of years. Eventually, these deposits cause a blockage that prevents sufficient blood flow to the heart or brain.
The development of CVD has many components, and a variety of interconnected factors contribute to increases or decreases in CVD risk. These factors can be divided into two groups: modifiable and nonmodifiable.
There are four main nonmodifiable risk factors for CVD:
Genetics or family history
Race or ethnicity
Men have a greater CVD risk than do women, and their risk begins to increase at a younger age (45 for males, 55 for females). CVD risk is also associated with certain racial or ethnic backgrounds. While some of this risk may have a genetic component (nonmodifiable), social and environmental determinants of health are also contributing factors (modifiable).
Lastly, family history can also contribute to risk. If members of your family have a history of CVD, this may increase your risk profile.
There are many different types of modifiable lifestyle factors that you can alter to help decrease your overall risk for developing CVD. However, although many of these factors are modifiable, they can coexist with a nonmodifiable component such an increased risk of blood pressure due to your genetics.
Many of these factors can be modified by focusing on diet quality and consistently getting enough exercise. For example, diet and exercise can significantly influence your blood pressure, diabetes, LDL-C, sleep, stress, and weight.
Additionally, smoking and excessive alcohol intake are key contributing risk factors for CVD.
Access free and confidential coaching via QuitLine (1-800-QUIT-NOW).
Quickly sign up for a free texting-based program at SmokeFreeTXT
Use the mobile app quitSTART
A good place to start is the NIAAA Alcohol Treatment Navigator.
You can find support at the US SAMHSA’s National Helpline — a free, confidential, 24/7, year-round treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.
You can also call the SAMHSA’s hotline at 1-800-662-HELP (4357) or TTY 1-800-487-4889.
LDL-C levels are a modifiable metric of interest because they can contribute to plaque formation and build-up in the arteries (atherosclerosis). Heart disease is most commonly the result of atherosclerosis, which occurs when LDL particles penetrate the arterial walls, become oxidized, and are attacked by white blood cells.
The greater the number of LDL particles in the blood (LDL-P), the more likely it is that some will pass into the artery walls, become oxidized, and kickstart plaque formation. Good evidence shows that reducing LDL-C is associated with a lower CVD risk.
Although total cholesterol, HDL-C, and triglycerides are also related to CVD risk, the American Heart Association has reported that diet-related changes in HDL-C are no longer thought to be directly associated with changes in CVD. Similarly, triglyceride levels alone may not be a reliable predictor of CVD risk.
How CVD presents can vary from person to person and by the specific type of CVD. Sometimes, symptoms may not manifest for years. Below are some of the possible symptoms that can occur in the more common types of CVD.
|CVD DISORDER||POSSIBLE SYMPTOMS|
A “fluttering” feeling in the chest (palpitations)
Chest pain, discomfort, or pressure
A persistent wheezing or cough
The most common symptoms are a sudden weakness of the face, arm, or leg (typically on only one side of the body), facial drooping, and slurred speech. If you experience these symptoms, call 9-1-1 immediately. Other symptoms include:
Diagnosing your exact type of CVD can require various specific tests or specialized testing. Obtaining an exact diagnosis can involve one or more rounds of testing in coordination with your healthcare provider(s).
Below are some tests that may be performed to determine a diagnosis. The test can be noninvasive or invasive. Invasive procedures usually require some form of cutting or inserting of a medical instrument into the body.
Lipid profile (i.e., total cholesterol, HDL-C, LDL-C, and triglycerides)
Cardiac catheterization with coronary angiography (a catheter is inserted into a blood vessel to help diagnose or treat heart disease)
Treatments for CVD can be divided into two main categories:
Primary prevention: intended for people at risk for developing CVD
Secondary prevention: intended for people who already have CVD
Primary prevention is mostly focused on altering modifiable lifestyle factors but may also include some drug therapies. Secondary prevention also focuses on modifiable lifestyle factors but may include more aggressive drug therapy treatment.
Fish oil, cocoa, garlic, nitrates, and fiber may help with overall heart health, and folic acid (aka Vitamin B9) and B-complex vitamins have moderate-quality evidence for decreasing the risk of stroke.
The table below displays an analysis of human studies and indicates how supplements may affect cardiovascular disease.
Consuming more than three servings of fruits and vegetables per day can lower triglycerides by approximately 0.10 mmol/L (9 mg/dL) and diastolic blood pressure by approximately 2 mmHg on average when compared to consuming three servings or less. Clinically, even a small 2 to 5 mmHg decrease can noticeably reduce cardiovascular disease and total mortality.
Including specific foods such as nuts, soybeans, whole grains, and fish — as well adopting healthy dietary patterns such as the Dietary Approaches to Stop Hypertension (DASH) diet and the Mediterranean diet — may additionally benefit triglycerides and raise HDL-C levels. The Mediterranean diet and the Dietary Approaches to Stop Hypertension diet are among the more well-studied diet patterns for prevention of cardiovascular disease.
But what about fat in the diet? A network meta-analysis of 54 RCTs (lasting 3 to 27 weeks) and 2,065 participants found that oils higher in poly- and monounsaturated fats had more favorable effects on LDL-C and total cholesterol compared to those with a higher saturated fat content.
Specifically for LDL-C (which plays a role in the development of CVD), safflower, rapeseed, and sunflower oil were associated with reducing LDL-C., and therefore, these oils may help to reduce CVD risk. In contrast, butter, lard, and coconut oil were associated with increasing LDL-C.
For those recovering from CVD — particularly heart attacks, failure, or CAD — cardiac rehabilitation may be recommended.
These treatments are typically 3-month supervised programs that include a multidisciplinary medical team (e.g., doctors, nurses, pharmacists, dietitians, physical therapists) to target many different factors that could speed recovery and prevent a second incident.
Physical activity training (recovery from CVD may require specialized exercise instructions to ensure safety)
Various physical exams and tests that track recovery
Education about healthy eating patterns
Stress reduction and mental health counseling
Smoking cessation programs or alcohol use counseling, if needed
A variety of drugs are available from depending on which CVD risk factor is targeted. Below are the common classes of drugs typically used for CVD treatment.
Angiotensin-II receptor blockers (ARBs) (to treat high blood pressure)
Angiotensin-converting enzyme (ACE) inhibitors (to treat high blood pressure)
Antiplatelet therapy (blood thinners)
Beta-blockers (to prevent angina and treat high blood pressure)
Calcium-channel blockers (to decrease blood pressure)
Diuretics (to remove excess water and salt via urine)
Nitrates (to widen blood vessels)
Statins (cholesterol-lowering medicine)
In certain situations, minor or major surgical procedures may be needed to treat CVD.
Coronary angioplasty (aka percutaneous coronary intervention (PCI), percutaneous transluminal coronary angioplasty (PTCA), and balloon angioplasty). A small balloon is inserted into the artery and inflated to “push” the fatty tissue blockage out of the way. In some cases, a metal stent (a mesh wire tube) is inserted to hold the artery open. These stents can also contain drugs that are released into the artery to prevent future blockages.
Coronary artery bypass grafting (CABG, aka bypass surgery). This procedure is used when an artery supplying blood to the heart is narrowed or completely blocked. A healthy blood vessel is taken from another part of the body and connected to the blood vessel above and below the problematic artery, creating a “bypass” for normal blood flow to resume.
Heart valve repair or replacement. This procedure is used when the valves in the heart that keep blood flowing in the right direction are not functioning properly. In some cases, a valve can be repaired, but in other cases, it may need to be entirely replaced.
Arrhythmias. These cases are usually treated with medication first, but if the drug treatment is insufficient, a pacemaker or implantable cardioverter-defibrillator (ICD) may be implanted. A pacemaker sits just under the skin near the heart and helps to control the heart rhythm. An ICD is similarly placed under the skin and monitors the heartbeat for dangerous abnormalities. If detected, it sends an electric shock to help restore a normal heart rhythm.
Heart transplants. Transplants may be required in more severe cases in which the heart is too damaged to be repaired. In these cases, a donor heart may be surgically transplanted.