essay about heart disease

116 Heart Disease Essay Topic Ideas & Examples

🏆 best heart disease topic ideas & essay examples, 👍 good essay topics on heart disease, ⭐ simple & easy heart disease essay titles.

• Types of Cardiac Arrhythmia Resulting From Centrifugal Acceleration In the context of an airplane, these factors tend to reproduce the weight of the unit mass of the persons in the jet.
• Pathophysiology of Congestive Heart Failure Cardiac output and stroke volume is lowered due to vasoconstriction. It causes pressure overload, which leads to congestion.
• Left-Sided Heart Failure and Nursing Intervention Thus left-sided heart failure or left ventricular failure refers to a condition where the left part of the heart is unable to propel adequate oxygenated blood from the pulmonary transmission to the body through the […]
• Hypertension and Congestive Heart Failure In conclusion, the patient experiences a range of issues related to hypertension, which is likely to cause left-sided congestive heart failure since it is the most common in the population.
• Heart Diseases in Florida: Cardiology The Centers for Disease Control in Florida encourages the management of heart ailments and dementia in all the regions and Districts of Florida.
• Heart Attack: Cellular Functions and Problems The story describes the symptoms and processes in the body of a man who suffered a heart attack. A heart attack directly impacts the cellular processes in the organism.
• Coronary Heart Disease Caused by Stress It is essential to study the degree of influence of stress on the development of coronary heart disease since, in this way, it will be possible to prevent it more successfully.
• Antioxidants: The Role in Preventing Cancer and Heart Disease Some of antioxidants are more widely known as vitamins E, C, and carotenoids, and have a reputation of preventing cardiovascular diseases and cancer.
• Obesity and Coronary Heart Disease As shown in Table 1, the researchers have collected data about the rate of obesity and CHD in the chosen group.
• COPD, Valvular Disease, and CHF: Risk of Heart Disease Under these conditions, it is possible to analyze the case regarding the high risks of chronic obstructive pulmonary disease, valvular disease, and congestive heart failure.
• Epidemiology of Heart Disease Among Canadians At the end of the study, the connection between heart disease epidemiological evidence, community strategies, and internal and external impacts will be revealed to contribute to a better application of knowledge.
• Vitamin E for Prevention of Heart Diseases As experiments on the benefits of vitamin E show, ‘swimming’ is not always the key to a completely healthy life, in which the risk of a heart attack is reduced to a minimum.
• Heart Failure and Chronic Obstructive Pulmonary Disease Respiratory: The patient is diagnosed with COPD and continues to smoke up to two packs a day. Psychosocial: The patient is conscious and able to communicate with the staff, informing them of his state of […]
• Congestive Heart Failure Treatment Innovations The relevance of the problem of this disease for health care is conditioned by the prevalence of pathology and the high economic costs of its treatment.
• Plan for Management of Patient with Schizophrenia and Heart Disease About 1% of the world’s population suffers from schizophrenia About 0. 7% of the UK population suffers from schizophrenia Schizophrenia can manifest any time from early adulthood onwards, but rarely when a person is below […]
• Myocardial Infarction and Heart Attack The prolonged oxygen deprivation to the myocardium can lead to necrosis and death of the myocardial cell. Therefore, myocardial infarction is a dangerous condition caused by the lack of blood flow to the heart.
• Preventing Heart Failure: Case Study In addition to the signs of heart failure, Mrs. The use of oxygen through nasal cannulas reduces the load on the heart, and it is rational.
• Importance of Dashboard in Heart Failure Preventing Thorough testing of the heart failure dashboard is essential to ensure its successful work and contribute to the reduction of the risk of hospitalization for heart failure.
• Nutrition in Relation to Heart Diseases in African Americans While the causes of such an occurrence are varied, dietary and nutrition-based difficulties are one of the factors that can increase the risk of cardiovascular diseases among African Americans.
• Analysis of Heart Failure: Diagnosis and Treatment The current paper examines the two types of HF – systolic and diastolic – and explains the differences between the varieties based on the case study.
• Video Consultations Between Patients and Clinicians in Diabetes, Cancer, and Heart Failure Services For example, during one of my interactions with the patient, I was asked whether the hospital had the policy to avoid face-to-face interaction during the pandemic with the help of video examinations.
• Diets to Prevent Heart Disease, Cancer, and Diabetes In order to prevent heart disease, cancer, and diabetes, people are required to adhere to strict routines, including in terms of diet. Additionally, people wanting to prevent heart disease, cancer, and diabetes also need to […]
• Reducing Risks of Heart Diseases In recent years, the health of US citizens has been especially alarming: obesity and heart disease top the list of the most common causes of death, and the situation needs to be changed radically.
• Critiquing Research: Fatigue in the Presence of Coronary Heart Disease Fatigue is a common and debilitating symptom linked to a number of acute and chronic conditions such as chronic heart failure and acute myocardial infarction. Fatigue has not been analyzed in regards to patients with stable coronary heart disease (CHD), despite the fact that it might factor into new onsets or progression of CHD. Therefore, […]
• Hypertension and Risk of Heart Failure Therefore, it is essential to reduce the circulating volume with the help of diuretics, a low-sodium diet, and ACE inhibitors that block the activation of the RAAS.
• Cardiomyopathy Types, Treatment, and Consequences Cardiomyopathy is a disease associated with a gradual increase in the volume of the left ventricle and, as a consequence, resulting in the formation of heart failure.
• Impact of Cognitive Dysfunctions on Patients With Heart Failure Based on the statement, which has been the initial assumption, impaired cognitive functions correlate with a lack of participation in the treatment of heart failure. The frame in which the structural concepts of the research […]
• Dietary Approaches to Heart Disease and Hypertension Zachary should observe the following recommendations to improve his diet: He should drink water or soda water to avoid drinks rich in sugar like Pepsi and orange juice.
• American Heart Association on Coronary Artery Disease Coronary artery disease is a type of disease during which plaque accumulates in the blood vessels, restricting blood flow to the heart.
• Heart Failure: Prevent Readmissions and Noncompliance With Chronic Management The Heart failure (HF) is a rising healthcare burden which is common among many admitted patients. The project will introduce preventive interventions and measures for HF.
• Congestive Heart Failure: Diagnosis and Treatment Congestive Heart Failure is a condition characterized by decreasing pumping capacity of the heart muscles of a person resulting in the congestion of the body.
• Heart Disease: Population Affected- Brooklyn Brooklyn leads in morbidity of heart diseases in comparison to the rest of New York and the United States in general.
• IoT-Based Heart Attack Detection and Alert System The patient’s chest pain complaint mirrored against the prevailing hypertensive state, the elevated cholesterol levels, the chronic tobacco smoking, a high sodium diet, and inadequate physical activity.
• Heart Failure: Diagnosis and Pharmacologic Treatment In addition, due attention should be paid to effective strategies for the prevention of symptoms and treatment of concomitant diseases to improve the quality of life of patients with heart failure.
• The Different Types of Heart Failure Right-sided heart failure occurs when the right chamber of the heart has not enough power to pump blood to the lungs. The role of a nurse is to assess and educate a patient with heart […]
• Lecithin, Trimethylamine Oxide, and Heart Diseases Lecithin is a dietary phospholipid that is associated cardiovascular diseases. Trimethylamine oxide is a metabolite of lecithin that causes heart diseases.
• Congestive Heart Failure (CHF): Causes, Treatment and Prevention Congestive Heart Failure is a condition that occurs when the heart is unable to pump enough blood to meet the needs of the entire body.
• Aspirin and Heart Attacks Relations Research studies have demonstrated aspirin is the recommended drug for secondary prevention of heart attack and other cardiovascular diseases. 2Research studies have demonstrated that aspirin is effective in the secondary prevention of cardiovascular diseases.
• Health Issues of Heart Failure and Pediatric Diabetes As for the population, which is intended to participate in the research, I am convinced that there is the need to specify the patients who should be examined and monitored.
• Systolic and Diastolic Heart Failure Second, the high sinus rhythm indicates the man’s irregular heartbeat, which is the result of the emergence of the specified event, and it is referred to as cardiac arrhythmias.
• Chronic Obstructive Pulmonary Disease, Hypertension, and Heart Failure: The Case Study The most likely cause of the symptom is fluid accumulation and congestion in the pulmonary system due to the failed heart that reduces the kidneys’ perfusion, thus causing an increase in the production of renin.
• Prevention of Heart Failure Hospital Readmissions This paper describes on improving patient’s health literacy and providing specialized nursing care will prevent heart failure hospital readmissions.
• Readmission in Hypertension and Heart Failure Patients In research, the independent variables are presented by CHF interventions, mortality rates, and population size, whereas the dependent variable is the possible results of their use for people with PH.
• Heart Disease Among Hispanic and Latino Population Hispanics and Latinos have the highest propensity for heart related diseases in the society. They are at a very high risk of developing diabetes, obesity, and hypertension.
• The Role of Education in the Treatment of Congestive Heart Failure Home treatment plan is critical for the treatment and management of congestive heart failure, which is experienced by Mr.P. Hence, comprehensive education is central to the treatment and management of the congestive heart failure in […]
• Hospital Readmission and Health Related Quality of Life in Patients With Heart Failure The article analyzes the treatment of patients and the bettering of care. And the third is the discharge itself and the plans that organize its carrying out.
• Cardiology: Women and Heart Diseases Myocardial infarctions, also referred to as heart attacks, are some of the most dangerous cardiovascular diseases making a significant contribution to the mortality of the American population and imposing a great financial burden on the […]
• Heart Disease and Stroke in Sarasota County Adults in Sarasota County must be informed of healthy lifestyles that reduce the risk of contracting cardiovascular diseases such as heart disease and stroke.
• Chronic Heart Failure: Symptoms and Self-Management Finally, the other cause of CHF includes endocarditis or myocarditis, a condition that affects the heart valves or the muscles of the heart.
• Coronary Heart Disease: Review One of the major concerns worth considering is the issue of aspirin failure. In summary, aspirin failure is a symbol of increased risk to coronary heart diseases.
• Risk Factors Involving People with Ischaemic Heart Disease: In-Depth Interview In the following account of research on ischaemic heart disease, the researcher conducts qualitative research and qualitative analysis of the data obtained to determine the cause of the disease.
• Congestive Heart Failure – One of the Most Devastating Diseases Based on the guideline, the study will be focused on all aspects in the management of CHF. This is a very efficient theory in addressing nursing issues and more precisely the management of CHF.
• Home Health Care vs. Telemonitoring: Reducing Hospital Readmissions for Patients With Heart Failure In the United States, chronic heart failure is regarded as the number one cause of both the hospitalization and readmission of patients.
• Coronary Heart Disease Aggravated by Type 2 Diabetes and Age In the case, the patient shows multiple signs associated with the coronary heart disease, which is associated with shortness of breath, irregular heartbeats, faster heartbeats, fatigue, and hypertension. A possible backward failure in the right […]
• Heart Disease in New York State For those residing in New York, one of the most populous and metropolitan states in the United States, the cardiovascular disease presents one of the most serious threats.
• Why the Elders Delay Responding to Heart Failure Symptoms The paper would discuss the reasons the elderly delay in responding to the symptoms of heart failure. It incorporates the history of the problem and seeks to use the current technology to solve the problem.
• Heart Disease and Low Carbohydrate Diets My opinion about the connection between heart diseases and low-carb diets is based on the article written by Sacks and his team for the Journal of the American Medical Association in 2014 where the authors […]
• Heart Disease: Cell Death During Myocardial Infarction This process is known as the non-reversible cell injury because of the changes in the cell structure and functions when the cell membrane is damaged, and the cell dies.
• Intervention of Heart Diseases in Children The resources that are necessary for the program include the human resources: the governing body of the school, several teachers and parents willing to promote the program, health consultants.
• Remote Care Costs for Congestive Heart Failure Various aspects of the article including the significance of the chosen problem, methods, and approaches, the reliability of results and the articles structure will be discussed and evaluated.
• Identification and Assessment of Heart Disease Heart diseases have always been of primary concern for the population of the United States of America. The identification of heart diseases in the elderly can be rather a challenge due to the variety of […]
• Heart Disease Among Hispanic & Latino Population One of the causes of the rise in the case of heart diseases in Westminster is the literacy rate of the Hispanic/Latinos in the county.
• Heart Failure: Prevention of the Disease Heart failure is now occurring in younger people and it is vital to make them cautious and have a healthy lifestyle to prevent the disease. The purpose of the leaflet is to draw people’s attention […]
• Prevention of Heart Disease and Stroke in Collier County According to the statistical data, presented by the Health Planning Council of Southwest Florida, these health problems are among the leading causes of death in this particular community. This strategy is helpful for understanding various […]
• Understanding Cardiomyopathy in the Elderly There are different types of cardiomyopathy diseases, but the one that prevails among the elderly is restrictive cardiomyopathy, according to the National Institutes of Health. Dilated cardiomyopathy is most prevalent in Africa, mainly due to […]
• Cardiomyopathy in the Elderly Patients Lack of flexibility of the ventricles due to stiffening affects the ventricle’s role of pumping blood out of the heart to other parts of the body or lungs.
• Congestive Heart Failure Etiology and Treatment Introduction Congestive heart failure (CHF) is a “progressive and debilitating disease” that is characterized by the congestion of body tissues (Nair & Peate, 2013, p. 237). Five percent of all medical admissions in hospitals are due to CHF. When an individual has this disease, his or her heart is not able to pump adequate blood […]
• Pharmacokinetics and Pharmacodynamics: Coronary Heart Disease Consequently, an increase in the doze of the drug followed, which was quite a predictable step for the healthcare specialist to take, and a sharp rise in Tina’s blood pressure ensued.
• Congestive Heart Failure Case Management Program A multidisciplinary strategy can be observed and applied to the outpatient’s supervision of the CHF conditions with the attempt to facilitate the functionality and to bring down the statistics of readmission of the CHF patients […]
• Therapeutic Properties of Fish Oil: Reduction of Heart Diseases The sudden reduction in deaths resulting from cardiac diseases led to the increased interest in the potential anti-arrhythmic properties of fish oil. The researchers hypothesized that the use of fish oil causes a significant reduction […]
• Cardiomegaly: Symptoms, Types, Diagnosis, Treating The enlargement is caused by the extra job that the heart has to do to pump blood to the whole body. Mild cardiomegaly is described as a slight increase in the size of the heart.
• Heart Attack: Causes and Prevention There is actually a way to escape the effect of this much dreaded disease and yet every year it claims the lives of thousands of people in the United States alone.
• Social Determinants of the Heart Disease Cardiovascular diseases are injuries of the heart, blood vessels and the system of the blood vessels, the major reason for this is the accumulation of fats in blood vessels which interferes with the normal rate […]
• Heart Hemodynamics and Cardiomyopathy The heart is the main organ responsible for the transport of blood, which in turn is carrying nutrients and other essential things that are needed in order for the body to function perfectly.
• Cardiovascular Physiology: Interval Training in a Mouse Model of Diabetic Cardiomyopathy The abstract does not describe the study and the results accurately. The authors did not give enough details of the study in the abstract.
• Heart Attack: Health Education and Intervention Methodologies According to the National Heart Lung and Blood Institute, “A heart attack occurs when blood flow to a section of the heart muscle becomes blocked.
• Breathlessness as an Element of Congestive or Chronic Heart Failure It was done in order to preserve the focus of the analysis on the factor of breathlessness itself. The article allows nurses and other medical specialists to gain a more in-depth understanding of breathlessness among […]
• The Syndrome of Chronic Heart Failure Chronic heart failure is a syndrome of various diseases of the cardiovascular system, leading to a decrease in the pumping function of the heart, chronic hyperactivation of neurohormonal systems.
• Obstructive Sleep Apnea and Heart Diseases In children with Down syndrome, incidence rates of hypertension and sleepiness are high, and the problem is compounded in the presence of OSA.
• Measures to Avoid Re-Hospitalization of Patients With Congestive Heart Failure The idea of this project is to print out a supplement for the hospital’s 28-page guide in English and Spanish, which will have the essential recommendations and references to page numbers.
• Patient Education: Congestive Heart Failure These statistics suggest that hospitals have a substantial number of patients with CHF, and adjusting their practice and guidelines to suit the requirements of these patients is a necessity.
• Heart Diseases: History, Risks and Prevention This may be attributed to the fact that most of the risk factors are as a result of our day to day activities.
• Nutrition for People With Hearth Disease Studies have shown that the soluble fiber lowers cholesterol and decreases dietary fat absorption in the intestines. 13 mm Hg and in diastolic blood pressure of 1.
• Congestive Heart Failure and Coronary Artery Disease The overall result of this is the development of a clump of fatty material covered by a smooth muscle and fibrous tissue on the inside of the artery; this is known as an atherosclerotic plaque.
• Alcohol Consumption and Cardiovascular Diseases This is necessary to examine the relationship between individual experience of disease and consumption, and, in the population, is essential to the calculation of attributable risk.
• Heart Diseases and Their Pathophysiology The primary pacemaker of the heart is the sinus node, a group of specialized cells located in the sulcus terminalis of the high right atrium, between the superior vena cava and the base of the […]
• Chronic Diseases: Heart Failure and Cancer The first article examines the role of genetic testing of molecular markers that determine the occurrence and progression of cancer in individuals. The article recommends oncology nurses to keep abreast of advances in genomics for […]
• Heart and Lung Diseases: Health History and Assessment J’s case that may lead to a heart attack include the following: Past heart attack. The patient was already administered to the intensive care unit with a decompensated heart failure.
• Examining Pathophysiological Processes: Heart Failure & Chronic Kidney Disease Research conducted by Sahle concludes that the prevalence of HF in Australia is 1%-2%, which is similar to the statistics of the developed countries.
• Combating Heart Disease in the African American Community of Kings County, NY Accordingly, people should be aware of the optimal parameters of a healthy person, and the popularization of physical activity, along with the correction of eating habits, can be a valuable way to achieve positive results.
• Heart Attack: Health Information Patient Handout Heart attacks can be listed among the most dangerous health issues due to their ability to stop the work of the heart muscle.
• Heart Disease from Medical and Social Viewpoint Through the recording of all activities in the cardiovascular system, such testing quickly discloses the existing problems that could be the basis of trouble or might show that the muscles of the heart have been […]
• Sampling Methods in Nursing Study on Heart Failure In systematic sampling, the arrangement of the people was done in the order of their increase in age and selection using the same order.
• Heart Disease, Risk Factors and Emotional Support As such, the objective of the study was to determine the effects of anger, anxiety, and depression on the development of cardiovascular diseases.
• Chronic Heart Failure: Symptoms, Diagnosis, and Treatment The diagnosis of the condition is made when signs and symptoms of congestion along with reduced tissue perfusion are documented in the presence of abnormal systolic or diastolic cardiac function. When it comes to the […]
• Heart Disease Reverse: Dr. Esselstyn’s Impact Esselstyn’s approach to improving the condition of a human heart and to reduce the number of heart attacks will be analyzed to develop several independent assertions about heart disease and rules to avoid coronary disease […]
• Heart Disease: Causal Effects of Cardiovascular Risk Factors The process of cause and effect can be described as a relationship between issues where one is the outcome of the other.
• Heart Disease and Alzheimer’s in Adult Women Education and Employment History: The patient reported she is a college graduate and has a master’s degree in Victorian Literature. The patient is currently working full-time as a Literature professor at UC Berkeley, in a […]
• Women with Heart Disease: Risk of Depression The presence of heart disease can often lead to depression, as the person has to worry about his life and health every day, knowing that their heart is not as reliable as it used to […]
• Can Aspirin Prevent a Person From Having a Heart Attack? Regardless of the effectiveness of aspirin, there is a significant drawback related to its influence on a human organism: in order to guarantee its regularity and continuity, it is recommended to avoid making pauses in […]
• Heart Failure: Health and Physical Assessment DJ has a bad sleeping pattern, and no remitting factors were found. DJ has no medication intolerances.
• Heart Failure: Risk Factors and Treatment A comprehension of the risk aspects for heart failure is crucial for the generation of effective interventions that seek to prevent the occurrence of the condition.
• Heart Failure: Cardiology and Treatment The patients suffering from the left-sided heart failure persistently wake up several times at night because of the shortness of breath and gain weight significantly.
• Heart Failure Among Older Adult Males The purpose of this paper is to evaluate the problem of heart failure in adult males of 65 years of age and older, identify risk factors, pathophysiology, typical lab, and diagnostic health data, and goals […]
• Heart Disease Prevention in Postmenopausal Women The article “Coronary Heart Disease Mortality and Hormone Therapy Before and After the Women’s Health Initiative” offers new insights that can be used to prevent cardiovascular diseases in postmenopausal women. The HRT approach can be […]
• Coronary Heart Attack and Health Determinants Smoking predisposes one to the risk of contracting coronary heart attack especially if the victim is an active user of the substance.
• Heart Disease in African Americans: Intervention According to the tests carried out among the target denizens of the population, 78% of the African Americans were in the risk area due to their unhealthy lifestyles, particularly improper dieting.
• What Influences Physical Activity in People With Heart Failure When the literature on related research was reviewed, it was noted that all of the previous research that had been done on the issue of physical activities for people with heart failure conditions had centered […]
• Coronary Heart Diseases in African Americans: Intervention Plan The lack of patients and community involvement in the development of prevention strategies hinders the fight against coronary heart diseases in African Americans.
• Obesity, Diabetes and Heart Disease Chronic diseases such as obesity, diabetes and heart disease have become endemic and as such calls into question what processes can be implemented among members of the local population so as to prevent the spread […]
• Core Functions of Public Health in the Context of Smoking and Heart Disease In the relation to our problem, heart attacks and smoking, it is important to gather the information devoted to the number of people who suffered from heart attacks and indicate the percentage rate of those […]
• Medical, Social and Diet Changes and Heart Disease in Middle-Aged Men The questions seek to establish the relationship between the potential causes of heart disease and the occurrence of the disease in the surveyed population.
• Heart Disease: Nutrition Assessment As such, it is important for the patients to increase their consumption of whole grains, vegetables, legumes and fruits that are rich in trans-fatty acids and saturated fatty acids.
• Congestive Heart Failure in Older Adults The research will narrow down to the readmission and admission rates for the period between January 2010 and March 2011 as well as the relevant data that will facilitate the development of a case management […]
• Resource Identification, Evaluation and Selection: Congestive Heart Failure Below is modification of search terms that were most resourceful Heart failure OR congestive heart failure Congestive heart failure AND re-admission Heart failure+ causes and symptoms Congestive heart failure AND edema Congestive heart failure AND […]
• Chicago (A-D)
• Chicago (N-B)

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• Strategies to prevent heart disease

You can help prevent heart disease by following a heart-healthy lifestyle. Here are strategies to help you protect your heart.

Heart disease is a leading cause of death. You can't change some risk factors for it, such as family history, sex at birth or age. But you can take plenty of other steps to lower your risk of heart disease.

Get started with these eight tips to boost your heart health:

1. Don't smoke or use tobacco

One of the best things you can do for your heart is to stop smoking or using smokeless tobacco. Even if you're not a smoker, be sure to stay away from secondhand smoke.

Chemicals in tobacco can damage the heart and blood vessels. Cigarette smoke lowers the oxygen in the blood, which raises blood pressure and heart rate. That's because the heart has to work harder to supply enough oxygen to the body and brain.

There's good news though. The risk of heart disease starts to drop in as little as a day after quitting. After a year without cigarettes, the risk of heart disease drops to about half that of a smoker. No matter how long or how much you smoked, you'll start reaping rewards as soon as you quit.

2. Get moving: Aim for at least 30 to 60 minutes of activity daily

Regular, daily physical activity can lower the risk of heart disease. Physical activity helps control your weight. It also lowers the chances of getting other conditions that may put a strain on the heart. These include high blood pressure, high cholesterol and type 2 diabetes.

If you haven't been active for a while, you may need to slowly work your way up to these goals. But in general, you should aim for at least:

• 150 minutes a week of moderate aerobic exercise, such as walking at a brisk pace.
• 75 minutes a week of vigorous aerobic activity, such as running.
• Two or more strength training sessions a week.

Even shorter bouts of activity offer heart benefits. So if you can't meet those guidelines, don't give up. Just five minutes of moving can help. Activities such as gardening, housekeeping, taking the stairs and walking the dog all count toward your total. You don't have to exercise hard to benefit. But you can see bigger benefits if you boost the intensity, length and frequency of your workouts.

3. Eat a heart-healthy diet

A healthy diet can help protect the heart, improve blood pressure and cholesterol, and lower the risk of type 2 diabetes. A heart-healthy eating plan includes:

• Vegetables and fruits.
• Beans or other legumes.
• Lean meats and fish.
• Low-fat or fat-free dairy foods.
• Whole grains.
• Healthy fats such as olive oil and avocado.

Two examples of heart-healthy food plans include the Dietary Approaches to Stop Hypertension (DASH) eating plan and the Mediterranean diet.

Take in less of the following:

• Salt or high-sodium meals.
• Sugar or sweetened beverages.
• Highly refined carbohydrates.
• Highly processed food, such as processed meats.
• Saturated fat, which is found in red meat, full-fat dairy products, palm oil and coconut oil.
• Trans fat, which is found in some fried fast food, chips and baked goods.

4. Maintain a healthy weight

Being overweight — especially around the middle of the body — raises the risk of heart disease. Extra weight can lead to conditions that raise the chances of getting heart disease. These conditions include high blood pressure, high cholesterol and type 2 diabetes.

The body mass index (BMI) uses height and weight to find out whether a person is overweight or obese. A BMI of 25 or higher is considered overweight. In general, it's linked with higher cholesterol, higher blood pressure, and an increased risk of heart disease and stroke.

Waist circumference also can be a useful tool to measure how much belly fat you have. The risk of heart disease is higher if the waist measurement is greater than:

• 40 inches (101.6 centimeters, or cm) for men.
• 35 inches (88.9 cm) for women.

Even a small weight loss can be good for you. Reducing weight by just 3% to 5% can help lower certain fats in the blood called triglycerides. It can lower blood sugar, also called glucose. And it can cut the risk of type 2 diabetes. Losing even more helps lower blood pressure and blood cholesterol levels.

5. Get quality sleep

People who don't get enough sleep have a higher risk of obesity, high blood pressure, heart attack, diabetes and depression.

Most adults need at least seven hours of sleep each night. Children usually need more. So make sure you get enough rest. Set a sleep schedule and stick to it. To do that, go to bed and wake up at the same times each day. Keep your bedroom dark and quiet too, so it's easier to sleep.

Talk to a member of your health care team if you feel like you get enough sleep but you're still tired throughout the day. Ask if you need to be evaluated for obstructive sleep apnea. It's a condition that can raise your risk of heart disease. Symptoms of obstructive sleep apnea include loud snoring, stopping breathing for short times during sleep and waking up gasping for air. Treatment for obstructive sleep apnea may involve losing weight if you're overweight. It also might involve using a device that keeps your airway open while you sleep. This is called a continuous positive airway pressure (CPAP) device.

6. Manage stress

Ongoing stress can play a role in higher blood pressure and other risk factors for heart disease. Some people also cope with stress in unhealthy ways. For example, they may overeat, drink or smoke. You can boost your health by finding other ways to manage stress. Healthy tactics include physical activity, relaxation exercises, mindfulness, yoga and meditation.

If stress becomes overwhelming, get a health care checkup. Ongoing stress may be linked with mental health conditions such as anxiety and depression. These conditions also are tied to heart disease risk factors, including higher blood pressure and less blow flow to the heart. If you think you might have depression or anxiety, it's important to get treatment.

7. Get regular health screening tests

High blood pressure and high cholesterol can damage the heart and blood vessels. But if you don't get checked for these conditions, you likely won't know whether you have them. Regular screening tests can tell you what your numbers are and whether you need to take action.

Blood pressure. Regular blood pressure screenings usually start in childhood. Starting at age 18, blood pressure should be measured at least once every two years. This checks for high blood pressure as a risk factor for heart disease and stroke.

If you're between 18 and 39 and have risk factors for high blood pressure, you'll likely be screened once a year. People age 40 and older also are given a blood pressure test yearly.

• Cholesterol levels. The National Heart, Lung, and Blood Institute (NHLBI) recommends that cholesterol screenings start between the ages of 9 and 11. Earlier testing may be recommended if you have other risk factors, such as a family history of early-onset heart disease. After the first cholesterol test, screenings should be repeated every five years. Then the timing changes with age. The NHLBI recommends that women ages 55 to 65 and men ages 45 to 65 get screened every 1 to 2 years. People over 65 should get their cholesterol tested once a year.
• Type 2 diabetes screening. Diabetes involves ongoing high blood sugar levels. It raises the chances of getting heart disease. Risk factors for diabetes include being overweight and having a family history of diabetes. If you have any of the risk factors, your health care team may recommend early screening. If not, screening is recommended starting at age 45. Then you get your blood sugar levels tested again every three years.

If you have a condition such as high cholesterol, high blood pressure or diabetes, talk with your health care team. Your doctor may prescribe medicines and recommend lifestyle changes. Make sure to take your medicines exactly as prescribed, and follow a healthy-lifestyle plan.

8. Take steps to prevent infections

Certain infections may lead to heart problems. For instance, gum disease may be a risk factor for heart and blood vessel diseases. So brush and floss daily. Get regular dental checkups too.

Other illnesses caused by infections can make existing heart problems worse. Vaccines help protect against infectious diseases. So stay up to date on the following shots:

• Yearly flu vaccine.
• COVID-19 vaccine, which lowers the chances of getting very sick.
• Pneumococcal vaccine, which reduces the risk of certain illnesses caused by bacteria.
• Tdap vaccine, which protects against tetanus, diphtheria and pertussis.

Ask your health care professional if you need any other vaccines too.

There is a problem with information submitted for this request. Review/update the information highlighted below and resubmit the form.

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• Know your risk for heart disease. Centers for Disease Control and Prevention. https://www.cdc.gov/heartdisease/risk_factors.htm. Accessed May 15, 2023.
• Heart disease facts. Centers for Disease Control and Prevention. https://www.cdc.gov/heartdisease/facts.htm. Accessed May 15, 2023.
• Hennekens CH. Overview of primary prevention of coronary heart disease and stroke. https://www.uptodate.com/contents/search. Accessed May 15, 2023.
• How to prevent heart disease at any age. American Heart Association. https://www.heart.org/en/healthy-living/healthy-lifestyle/how-to-help-prevent-heart-disease-at-any-age. Accessed May 15, 2023.
• Heart-healthy lifestyle changes. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/heart-healthy-lifestyle-changes. Accessed May 15, 2023.
• Smokeless tobacco: Health effects. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/smokeless/health_effects/index.htm. Accessed May 15, 2023.
• How smoking affects heart health. U.S. Food and Drug Administration. https://www.fda.gov/tobacco-products/health-information/how-smoking-affects-heart-health. Accessed May 15, 2023.
• Benefits of quitting. American Lung Association. https://www.lung.org/stop-smoking/i-want-to-quit/benefits-of-quitting.html. Accessed May 15, 2023.
• Physical Activity Guidelines for Americans. 2nd ed. U.S. Department of Health and Human Services. https://health.gov/our-work/physical-activity/current-guidelines. Accessed May 15, 2023.
• How does sleep affect your heart health? Centers for Disease Control and Prevention. https://www.cdc.gov/bloodpressure/sleep.htm. Accessed May 15, 2023.
• Sleep apnea. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/sleep-apnea. Accessed May 15, 2023.
• AskMayoExpert. Screening, immunization, and prevention (child). Mayo Clinic; 2022.
• AskMayoExpert. Screening, immunization, and prevention (adult). Mayo Clinic; 2022.
• Sleep and chronic disease. https://www.cdc.gov/sleep/about_sleep/chronic_disease.html. Accessed May 15, 2023.
• AskMayoExpert. Hypertension (adult). Mayo Clinic; 2023.
• Lopez-Jimenez F (expert opinion). June 19, 2023.
• Stress and heart health. American Heart Association. https://www.heart.org/en/healthy-living/healthy-lifestyle/stress-management/stress-and-heart-health. Accessed June 20, 2023.
• Blood cholesterol: Diagnosis. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health/blood-cholesterol/diagnosis. June 20, 2023.
• Wilder RS, et al. Overview of gingivitis and periodontitis in adults. https://www.uptodate.com/contents/search. Accessed June 20, 2023.
• What vaccines are recommended for you? Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/adults/rec-vac/index.html. Accessed June 20, 2023.

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Preventing Heart Disease

When heart experts talk about prevention, they usually refer to one of three types: secondary, primary and primordial prevention. [1] All three have similar elements, but different starting times and different effects.

• Secondary prevention. These efforts are started after someone has a heart attack or stroke , undergoes angioplasty or bypass surgery, or develops some other form of heart disease. It involves taking medications like aspirin and/or a cholesterol-lowering statin, quitting smoking and losing weight if needed, exercising more , and following a healthy diet. Although secondary prevention may sound like “closing the barn door after the horse has gone,” it isn’t. These steps can prevent a second heart attack or stroke, halt the progression of heart disease, and prevent early death. It may be obvious, but the number one killer of individuals who survive a first heart attack is a second heart attack.
• Primary prevention. Primary prevention aims to keep an individual at risk of heart disease from having a first heart attack or stroke, needing angioplasty or surgery, or developing some other form of heart disease . Primary prevention is usually aimed at people who already have developed cardiovascular risk factors, such as high blood pressure or high cholesterol. As with secondary prevention, primary prevention focuses on controlling these risk factors by making healthy lifestyle changes and, if needed, taking medications. That said, the appearance of worrisome cardiovascular risk factors means that inflammation, atherosclerosis, and/or endothelial dysfunction are already at work and, in most cases, aren’t reversible.
• Primordial prevention. The word “primordial” means existing from the beginning. Primordial prevention involves working to prevent inflammation, atherosclerosis, and endothelial dysfunction from taking hold, and thus prevent risk factors such as high blood pressure, high cholesterol, excess weight, and ultimately cardiovascular events. Once rarely discussed, primordial prevention is now the cornerstone of the American Heart Association’s definition of ideal heart health and efforts to help people achieve it. [1] As its name implies, the sooner you can start practicing primordial prevention—ideally from childhood on—the more likely you are to achieve it and protect yourself from heart disease.

Steps for the primordial prevention of heart disease

Five key lifestyle steps can dramatically reduce your chances of developing cardiovascular risk factors and ultimately heart disease:

1. Not smoking

In fact, researchers examining the relationship between cigarette smoking and smoking cessation on mortality during a decades-long perspective study of over 100,000 women found that approximately 64% of deaths among current smokers and 28% of deaths among former smokers were attributable to cigarette smoking. [2]

• This study also reported that much of the excess risk due to smoking may be drastically lowered after quitting. Additionally, the excess risk for all-cause mortality—that is, death from any cause—decreases to the level of a “never-smoker” 20 years after quitting.

The nicotine that tobacco products deliver is one of the most addictive substances around. That makes tobacco use one of the toughest unhealthy habits to break. But don’t get discouraged; many smokers do quit! In fact, in the United States today there are more ex-smokers than smokers. [3] Learn more about the hazards of smoking, the benefits of quitting, and tips for quitting from the Centers for Disease Control and Prevention .

2. Maintaining a healthy weight

In a study of over one million women, body-mass index (BMI) was a strong risk factor for coronary heart disease. The incidence of coronary heart disease increases progressively with BMI. [7]

In the Nurses’ Health Study and the Health Professionals Follow-Up Study, middle-aged women and men who gained 11 to 22 pounds after age 20 were up to three times more likely to develop heart disease, high blood pressure, type 2 diabetes, and gallstones than those who gained five pounds or fewer.

• Those who gained more than 22 pounds had an even greater risk of developing these diseases. [4,8-11]

Weight and height go hand-in-hand. The taller you are, the more you weigh. That’s why researchers have devised several measures that account for both weight and height. The one most commonly used is BMI .

• You can calculate your BMI by dividing your weight in kilograms by your height in meters squared (kg/m 2 ). You can also use an online BMI calculator or BMI table .
• A healthy BMI is under 25 kg/m 2 . Overweight is defined as a BMI of 25 to 29.9 kg/m 2 , and obesity is defined as a BMI of 30 kg/m 2
• Waist size matters , too. In people who are not overweight, waist size may be an even more telling warning sign of increased health risks than BMI. [12] An expert panel convened by the National Institutes of Health identified these useful benchmarks: Men should aim for a waist size below 40 inches (102 cm) and women should aim for a waist size below 35 inches (88 cm). [13]

3. Exercising

• Getting regular physical activity is one of the best things you can do for your health. It lowers the risk of heart disease, diabetes, stroke, high blood pressure, osteoporosis, and certain cancers, and it can also help control stress, improve sleep, boost mood, keep weight in check, and reduce the risk of falling and improve cognitive function in older adults.
• It doesn’t take marathon training to see real health gains. A 30-minute brisk walk five days of the week will provide important benefits for most people. Getting any amount of exercise is better than none.
• Exercise and physical activity benefit the body, while a sedentary lifestyle does the opposite—increasing the chances of becoming overweight and developing a number of chronic diseases.
• Research shows that people who spend more time each day watching television, sitting, or riding in cars have a greater chance of dying early than people who are more active. [17-19] A 2013 study showed that, among women ages 50-79 with no cardiovascular disease at the start of study, prolonged sitting time was associated with increased heart disease risk regardless of the amount of time spent in leisure-time physical activity. [16]

4. Following a healthy diet

• The best diet for preventing heart disease is one that is full of fruits and vegetables, whole grains, nuts, fish, poultry, and vegetable oils; includes alcohol in moderation, if at all; and goes easy on red and processed meats, refined carbohydrates, foods and beverages with added sugar, sodium, and foods with trans fat.
• People with diets consistent with this dietary pattern had a 31% lower risk of heart disease, a 33% lower risk of diabetes, and a 20% lower risk of stroke. [20]
• This study highlighted that low-fat diets are not beneficial to heart health, and that incorporating healthy fats – such as those included in the Mediterranean diet –  can improve heart health and weight loss.
• There isn’t one exact Mediterranean diet, as this eating style takes into account the different foods, eating patterns, and lifestyles in multiple countries that border the Mediterranean Sea. However, there are similarities that define a Mediterranean eating pattern, including: high intake of olive oil, nuts, vegetables, fruits, and cereals; moderate intake of fish and poultry; low intake of dairy products, red meat, processed meats, and sweets; and wine in moderation, consumed with meals. [21]
• The study found that those who adhered most to healthy eating patterns had a 14% to 21% lower risk of cardiovascular disease when compared with those who adhered least. The findings also showed that these different healthy eating patterns were similarly effective at lowering risk across racial and ethnic groups and other subgroups studied, and that they were statistically significantly associated with lower risk of both coronary heart disease and stroke. [22]
• Sodium and potassium are two interrelated minerals that play major roles in regulating blood pressure and a healthy heart. Eating less salty foods and more potassium-rich foods may significantly lower the risk of cardiovascular disease. [29]  Potassium is found in many foods, especially fruits, vegetables, legumes, and low-fat dairy. But the reverse of eating a lot of sodium-rich foods especially from processed breads, packaged snacks, canned goods, and fast-food meals while skimping on potassium can increase cardiovascular disease risk.

5. Improving sleep health

• Sleeping for too short or too long a stretch is associated with heart disease and can negatively affect other heart-related risk factors like dietary intake, exercise, weight, blood pressure, and inflammation. [30]
• There are various reasons causing poor sleep, including clinical sleep disorders, working overnight shifts, or poor sleep hygiene. Talk with your doctor if you have frequent restless nights or do not feel adequately rested during the day. Improving sleep habits can make a difference. Examples include setting a sleep schedule and sticking to it, having a calming bedtime ritual like doing stretches or meditating, getting regular exercise, stopping use of electronic devices an hour before bedtime, and avoiding heavy meals, caffeine, and alcohol several hours before bed.

Other factors to consider

Along with these five practices, the American Heart Association recommends controlling cholesterol, managing blood sugar, and managing blood pressure as additional factors for improving and maintaining cardiovascular health. Learn more at the American Heart Association’s “Life’s Essential 8.”

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Putting it all together

You can help prevent heart disease by doing five key things and making them into habits:

• Don’t smoke (or quit if you do)
• Maintain a healthy weight
• Exercise; be active
• Follow a healthy diet
• Improve sleep health

Strong studies make it possible to link reductions in risk to these habits. Following a healthy lifestyle may prevent over 80% of cases of coronary artery disease, [24, 25] 50% of ischemic strokes, [26] 80% of sudden cardiac deaths, [27] and 72% of premature deaths related to heart disease. [28] In other words, a healthy lifestyle is a good investment in a longer, healthier life.

• Lloyd-Jones DM, Hong Y, Labarthe D, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation . 2010;121:586-613.
• Kenfield SA, Stampfer MJ, Rosner BA, Colditz GA. Smoking and smoking cessation in relation to mortality in women. JAMA . 2008;299:2037-47.
• Babb S, Malarcher A, Schauer G, Asman K, Jamal A. Quitting Smoking Among Adults – United States, 2000-2015. MMWR. Morbidity and mortality weekly report . 2017;65:1457-64.
• Willett WC, Manson JE, Stampfer MJ, et al. Weight, weight change, and coronary heart disease in women. Risk within the ‘normal’ weight range. JAMA .  1995;273:461-5.
• Bogers RP, Bemelmans WJ, Hoogenveen RT, et al. Association of overweight with increased risk of coronary heart disease partly independent of blood pressure and cholesterol levels: a meta-analysis of 21 cohort studies including more than 300 000 persons. Archives of internal medicine . 2007;167:1720-8.
• Berrington de Gonzalez A, Hartge P, Cerhan JR, et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med . 2010;363:2211-9.
• Canoy D, Cairns BJ, Balkwill A, et al. Body mass index and incident coronary heart disease in women: a population-based prospective study. BMC Med . 2013;11:87.
• Rimm EB, Stampfer MJ, Giovannucci E, et al. Body size and fat distribution as predictors of coronary heart disease among middle-aged and older US men. American journal of epidemiology . 1995;141:1117-27.
• Colditz GA, Willett WC, Rotnitzky A, Manson JE. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med . 1995;122:481-6.
• Huang Z, Willett WC, Manson JE, et al. Body weight, weight change, and risk for hypertension in women. Ann Intern Med . 1998;128:81-8.
• Maclure KM, Hayes KC, Colditz GA, Stampfer MJ, Speizer FE, Willett WC. Weight, diet, and the risk of symptomatic gallstones in middle-aged women. N Engl J Med . 1989;321:563-9.
• Zhang C, Rexrode KM, van Dam RM, Li TY, Hu FB. Abdominal obesity and the risk of all-cause, cardiovascular, and cancer mortality: sixteen years of follow-up in US women. Circulation . 2008;117:1658-67.
• National Heart, Lung, and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report . Bethesda, MD; 1998.
• Ford ES, Caspersen CJ. Sedentary behaviour and cardiovascular disease: a review of prospective studies. International journal of epidemiology . 2012;41:1338-53.
• Matthews CE, George SM, Moore SC, et al. Amount of time spent in sedentary behaviors and cause-specific mortality in US adults. The American journal of clinical nutrition . 2012;95:437-45.
• Chomistek AK, Manson JE, Stefanick ML, et al. Relationship of sedentary behavior and physical activity to incident cardiovascular disease: results from the Women’s Health Initiative. Journal of the American College of Cardiology . 2013;61:2346-54.
• Dunstan DW, Barr EL, Healy GN, et al. Television viewing time and mortality: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Circulation . 2010;121:384-91.
• Patel AV, Bernstein L, Deka A, et al. Leisure time spent sitting in relation to total mortality in a prospective cohort of US adults. American journal of epidemiology . 2010;172:419-29.
• Warren TY, Barry V, Hooker SP, Sui X, Church TS, Blair SN. Sedentary behaviors increase risk of cardiovascular disease mortality in men. Med Sci Sports Exerc . 2010;42:879-85.
• Chiuve SE, Fung TT, Rimm EB, et al. Alternative dietary indices both strongly predict risk of chronic disease. The Journal of nutrition . 2012;142:1009-18.
• Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a mediterranean diet supplemented with extra-virgin olive oil or nuts. New England Journal of Medicine. 2018 Jun 13.
• Shan Z, Li Y, Baden MY, Bhupathiraju SN, Wang DD, Sun Q, Rexrode KM, Rimm EB, Qi L, Willett WC, Manson JE, Qi Q, Hu FB. Association Between Healthy Eating Patterns and Risk of Cardiovascular Disease. JAMA Intern Med . Published online June 15, 2020.
• Yu E, Malik VS, Hu FB. Cardiovascular Disease Prevention by Diet Modification: JACC Health Promotion Series. Journal of the American College of Cardiology . 2018 Aug 21;72(8):914-26.
• Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med . 2000;343:16-22.
• Chiuve SE, McCullough ML, Sacks FM, Rimm EB. Healthy lifestyle factors in the primary prevention of coronary heart disease among men: benefits among users and nonusers of lipid-lowering and antihypertensive medications. Circulation . 2006;114:160-7.
• Chiuve SE, Rexrode KM, D. S, Logroscino G, Manson JE, Rimm EB. Primary prevention of stroke by healthy lifestyle.  Circulation . 2008;118:947-54.
• Chiuve SE, Fung TT, Rexrode KM, et al. Adherence to a low-risk, healthy lifestyle and risk of sudden cardiac death among women. JAMA .  2011;306:62-9.
• van Dam RM, Li T, Spiegelman D, Franco OH, Hu FB. Combined impact of lifestyle factors on mortality: prospective cohort study in US women. BMJ . 2008;337:a1440.
• Ma Y, He FJ, Sun Q, Yuan C, Kieneker LM, Curhan GC, MacGregor GA, Bakker SJ, Campbell NR, Wang M, Rimm EB. 24-Hour Urinary Sodium and Potassium Excretion and Cardiovascular Risk.  New England Journal of Medicine . 2021 Nov 13.
• Lloyd-Jones DM, Allen NB, Anderson CAM, Black T, Brewer LC, Foraker RE, Grandner MA, Lavretsky H, Perak AM, Sharma G, Rosamond W; American Heart Association. Life’s Essential 8: Updating and Enhancing the American Heart Association’s Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association. Circulation . 2022 Jun 29:101161CIR0000000000001078.

Last reviewed August 2022

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Coronary Heart Disease Research

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For almost 75 years, the NHLBI has been at the forefront of improving the nation’s health and reducing the burden of  heart and vascular diseases . Heart disease, including coronary heart disease, remains the leading cause of death in the United States. However, the rate of heart disease deaths has declined by 70% over the past 50 years, thanks in part to NHLBI-funded research. Many current studies funded by the NHLBI focus on discovering genetic associations and finding new ways to prevent and treat the onset of coronary heart disease and associated medical conditions.

NHLBI research that really made a difference

The NHLBI supports a wide range of long-term studies to understand the risk factors of coronary heart disease. These ongoing studies, among others, have led to many discoveries that have increased our understanding of the causes of cardiovascular disease among different populations, helping to shape evidence-based clinical practice guidelines.

• Risk factors that can be changed:  The NHLBI  Framingham Heart Study (FHS)  revealed that cardiovascular disease is caused by modifiable risk factors such as smoking,  high blood pressure ,  obesity , high  cholesterol  levels, and physical inactivity. It is why, in routine physicals, healthcare providers check for high blood pressure, high cholesterol, unhealthy eating patterns, smoking, physical inactivity, and unhealthy weight. The FHS found that cigarette smoking increases the risk of heart disease. Researchers also showed that cardiovascular disease can affect people differently depending on sex or race, underscoring the need to address health disparities. 
• Risk factors for Hispanic/Latino adults:  The  Hispanic Community Health Study/Study of Latinos (HCHS/SOL)  found that heart disease risk factors are widespread among Hispanic/Latino adults in the United States , with 80% of men and 71% of women having at least one risk factor. Researchers also used HCHS/SOL genetic data to explore genes linked with central adiposity (the tendency to have excess body fat around the waist) in Hispanic/Latino adults. Before this study, genes linked with central adiposity, a risk factor for coronary heart disease, had been identified in people of European ancestry. These results showed that those genes also predict central adiposity for Hispanic/Latino communities. Some of the genes identified were more common among people with Mexican or Central/South American ancestry, while others were more common among people of Caribbean ancestry.
• Risk factors for African Americans:  The  Jackson Heart Study (JHS) began in 1997 and includes more than 5,300 African American men and women in Jackson, Mississippi. It has studied genetic and environmental factors that raise the risk of heart problems, especially high blood pressure, coronary heart disease,  heart failure ,  stroke , and  peripheral artery disease (PAD) . Researchers discovered a gene variant in African American individuals that doubles the risk of heart disease. They also found that even small spikes in blood pressure can lead to a higher risk of death. A community engagement component of the JHS is putting 20 years of the study’s findings into action by turning traditional gathering places, such as barbershops and churches, into health information hubs.
• Risk factors for American Indians:  The NHLBI actively supports the  Strong Heart Study , a long-term study that began in 1988 to examine cardiovascular disease and its risk factors among American Indian men and women. The Strong Heart Study is one of the largest epidemiological studies of American Indian people ever undertaken. It involves a partnership with 12 Tribal Nations and has followed more than 8,000 participants, many of whom live in low-income rural areas of Arizona, Oklahoma, and the Dakotas. Cardiovascular disease remains the leading cause of death for American Indian people. Yet the prevalence and severity of cardiovascular disease among American Indian people has been challenging to study because of the small sizes of the communities, as well as the relatively young age, cultural diversity, and wide geographic distribution of the population. In 2019, the NHLBI renewed its commitment to the Strong Heart Study with a new study phase that includes more funding for community-driven pilot projects and a continued emphasis on training and development. Read more about the  goals and key findings  of the Strong Heart Study.

Current research funded by the NHLBI

Within our  Division of Cardiovascular Sciences , the Atherothrombosis and Coronary Artery Disease Branch of its  Adult and Pediatric Cardiac Research Program and the  Center for Translation Research and Implementation Science  oversee much of our funded research on coronary heart disease.

Research funding  

Find  funding opportunities  and  program contacts for research on coronary heart disease. 

Current research on preventing coronary heart disease

• Blood cholesterol and coronary heart disease: The NHLBI supports new research into lowering the risk of coronary heart disease by reducing levels of cholesterol in the blood. High levels of blood cholesterol, especially a type called low-density lipoprotein (LDL) cholesterol, raise the risk of coronary heart disease. However, even with medicine that lowers LDL cholesterol, there is still a risk of coronary heart disease due to other proteins, called triglyceride-rich ApoB-containing lipoproteins (ApoBCLs), that circulate in the blood. Researchers are working to find innovative ways to reduce the levels of ApoBCLs, which may help prevent coronary heart disease and other cardiovascular conditions.
• Pregnancy, preeclampsia, and coronary heart disease risk: NHLBI-supported researchers are investigating the link between developing preeclampsia during pregnancy and an increased risk for heart disease over the lifespan . This project uses “omics” data – such as genomics, proteomics, and other research areas – from three different cohorts of women to define and assess preeclampsia biomarkers associated with cardiovascular health outcomes. Researchers have determined that high blood pressure during pregnancy and low birth weight are predictors of atherosclerotic cardiovascular disease in women . Ultimately, these findings can inform new preventive strategies to lower the risk of coronary heart disease.
• Community-level efforts to lower heart disease risk among African American people: The NHLBI is funding initiatives to partner with churches in order to engage with African American communities and lower disparities in heart health . Studies have found that church-led interventions reduce risk factors for coronary heart disease and other cardiovascular conditions. NHLBI-supported researchers assessed data from more than 17,000 participants across multiple studies and determined that these community-based approaches are effective in lowering heart disease risk factors .

Find more NHLBI-funded studies on  preventing coronary heart disease  on the NIH RePORTER.

Learn about the impact of COVID-19 on your risk of coronary heart disease.

Current research on understanding the causes of coronary heart disease

• Pregnancy and long-term heart disease:  NHLBI researchers are continuing the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b)   study to understand the relationship between pregnancy-related problems, such as gestational hypertension, and heart problems. The study also looks at how problems during pregnancy may increase risk factors for heart disease later in life. NuMoM2b launched in 2010, and long-term studies are ongoing, with the goal of collecting high-quality data and understanding how heart disease develops in women after pregnancy.
• How coronary artery disease affects heart attack risk: NHLBI-funded researchers are investigating why some people with coronary artery disease are more at risk for heart attacks than others. Researchers have found that people with coronary artery disease who have high-risk coronary plaques are more likely to have serious cardiac events, including heart attacks. However, we do not know why some people develop high-risk coronary plaques and others do not. Researchers hope that this study will help providers better identify which people are most at risk of heart attacks before they occur.
• Genetics of coronary heart disease:  The NHLBI supports studies to identify genetic variants associated with coronary heart disease . Researchers are investigating how genes affect important molecular cascades involved in the development of coronary heart disease . This deeper understanding of the underlying causes for plaque buildup and damage to the blood vessels can inform prevention strategies and help healthcare providers develop personalized treatment for people with coronary heart disease caused by specific genetic mutations.

Find more NHLBI-funded studies on understanding the  causes of coronary heart disease  on the NIH RePORTER.

Recent findings suggest that cholesterol-lowering treatment can lower the risk of heart disease complications in people with HIV.

Current research on treatments for coronary heart disease

• Insight into new molecular targets for treatment: NHLBI-supported researchers are investigating the role of high-density lipoprotein (HDL) cholesterol in coronary heart disease and other medical conditions . Understanding how the molecular pathways of cholesterol affect the disease mechanism for atherosclerosis and plaque buildup in the blood vessels of the heart can lead to new therapeutic approaches for the treatment of coronary heart disease. Researchers have found evidence that treatments that boost HDL function can lower systemic inflammation and slow down plaque buildup . This mechanism could be targeted to develop a new treatment approach for coronary heart disease.
• Long-term studies of treatment effectiveness: The NHLBI is supporting the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial EXTENDed Follow-up (EXTEND) , which compares the long-term outcomes of an initial invasive versus conservative strategy for more than 5,000 surviving participants of the original ISCHEMIA trial. Researchers have found no difference in mortality outcomes between invasive and conservative management strategies for patients with chronic coronary heart disease after more than 3 years. They will continue to follow up with participants for up to 10 years. Researchers are also assessing the impact of nonfatal events on long-term heart disease and mortality. A more accurate heart disease risk score will be constructed to help healthcare providers deliver more precise care for their patients.
• Evaluating a new therapy for protecting new mothers: The NHLBI is supporting the Randomized Evaluation of Bromocriptine In Myocardial Recovery Therapy for Peripartum Cardiomyopathy (REBIRTH) , for determining the role of bromocriptine as a treatment for peripartum cardiomyopathy (PPCM). Previous research suggests that prolactin, a hormone that stimulates the production of milk for breastfeeding, may contribute to the development of cardiomyopathy late in pregnancy or the first several months postpartum. Bromocriptine, once commonly used in the United States to stop milk production, has shown promising results in studies conducted in South Africa and Germany. Researchers will enroll approximately 200 women across North America who have been diagnosed with PPCM and assess their heart function after 6 months. 
• Impact of mental health on response to treatment:  NHLBI-supported researchers are investigating how mental health conditions can affect treatment effectiveness for people with coronary heart disease. Studies show that depression is linked to a higher risk for negative outcomes from coronary heart disease. Researchers found that having depression is associated with poor adherence to medical treatment for coronary heart disease . This means that people with depression are less likely to follow through with their heart disease treatment plans, possibly contributing to their chances of experiencing worse outcomes. Researchers are also studying new ways to treat depression in patients with coronary heart disease .

Find more NHLBI-funded studies on  treating coronary heart disease  on the NIH RePORTER.  

Researchers have found no clear difference in patient survival or heart attack risk between managing heart disease through medication and lifestyle changes compared with invasive procedures. 

Coronary heart disease research labs at the NHLBI

• Laboratory of Cardiac Physiology
• Laboratory of Cardiovascular Biology
• Minority Health and Health Disparities Population Laboratory
• Social Determinants of Obesity and Cardiovascular Risk Laboratory
• Laboratory for Cardiovascular Epidemiology and Genomics
• Laboratory for Hemostasis and Platelet Biology

Related coronary heart disease programs

• In 2002, the NHLBI launched  The Heart Truth® ,  the first federally sponsored national health education program designed to raise awareness about heart disease as the leading cause of death in women. The NHLBI and  The Heart Truth®  supported the creation of the Red Dress® as the national symbol for awareness about women and heart disease, and also coordinate  National Wear Red Day ® and  American Heart Month  each February. 
• The  Biologic Specimen and Data Repository Information Coordinating Center (BioLINCC)  facilitates access to and maximizes the scientific value of NHLBI biospecimen and data collections. A main goal is to promote the use of these scientific resources by the broader research community. BioLINCC serves to coordinate searches across data and biospecimen collections and provide an electronic means for requesting additional information and submitting requests for collections. Researchers wanting to submit biospecimen collections to the NHLBI Biorepository to share with qualified investigators may also use the website to initiate the application process. 
• Our  Trans-Omics for Precision Medicine (TOPMed) Program  studies the ways genetic information, along with information about health status, lifestyle, and the environment, can be used to predict the best ways to prevent and treat heart, lung, blood, and sleep disorders. TOPMed specifically supports NHLBI’s  Precision Medicine Activities. 
• NHLBI  population and epidemiology studies  in different groups of people, including the  Atherosclerosis Risk in Communities (ARIC) Study , the  Multi-Ethnic Study of Atherosclerosis (MESA) , and the  Cardiovascular Health Study (CHS) , have made major contributions to understanding the causes and prevention of heart and vascular diseases, including coronary heart disease.
• The  Cardiothoracic Surgical Trials Network (CTSN)  is an international clinical research enterprise that studies  heart valve disease ,  arrhythmias , heart failure, coronary heart disease, and surgical complications. The trials span all phases of development, from early translation to completion, and have more than 14,000 participants. The trials include six completed randomized clinical trials, three large observational studies, and many other smaller studies.

Learn how heart disease may be different for women than for men.

Explore more NHLBI research on coronary heart disease

The sections above provide you with the highlights of NHLBI-supported research on coronary heart disease. You can explore the full list of NHLBI-funded studies on the NIH RePORTER .

To find more studies:

• Type your search words into the  Quick Search  box and press enter. 
• Check  Active Projects  if you want current research.
• Select the  Agencies  arrow, then the  NIH  arrow, then check  NHLBI .

If you want to sort the projects by budget size — from the biggest to the smallest — click on the  FY Total Cost by IC  column heading.

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• About Stroke
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Preventing Heart Disease

You can choose healthy habits to help prevent heart disease.

• Take charge of your medical conditions to lower your risk for heart disease.

By living a healthy lifestyle, you can help keep your blood pressure, cholesterol, and blood sugar levels normal and lower your risk for heart disease and heart attack.

Choose healthy habits

Choose healthy food and drinks.

Choose healthy meals and snacks to help prevent heart disease and its complications. Be sure to eat plenty of fresh fruits and vegetables and fewer processed foods.

• Eating lots of foods high in saturated fat and trans fat may contribute to heart disease.
• Eating foods high in fiber and low in saturated fats, trans fat, and cholesterol can help prevent high cholesterol.
• Limiting salt (sodium) in your diet can also lower your blood pressure.
• Limiting sugar in your diet can lower your blood sugar level to prevent or help control diabetes.
• Do not drink too much alcohol, which can raise your blood pressure.

Keep a healthy weight

People with overweight or obesity have a higher risk for heart disease. Carrying extra weight can put extra stress on the heart and blood vessels.

To find out if your weight is in a healthy range, you can calculate your Body Mass Index (BMI).

Get regular physical activity

Physical activity can help you maintain a healthy weight and lower your blood pressure, blood cholesterol, and blood sugar levels. For adults, the Surgeon General recommends 2 hours and 30 minutes of moderate-intensity exercise, like brisk walking or bicycling, every week. Children and adolescents should get 1 hour of physical activity every day.

Don't smoke

Cigarette smoking greatly increases your risk for heart disease. If you don't smoke, don't start. If you do smoke, quitting will lower your risk for heart disease. Your doctor can suggest ways to help you quit.

For more information about tobacco use and quitting, see CDC's Smoking & Tobacco Use website .

Take charge of your medical conditions

If you have high cholesterol, high blood pressure, or diabetes, you can take steps to lower your risk for heart disease.

Check your cholesterol

Your health care team should test your blood levels of cholesterol at least once every 4 to 6 years. If you have already been diagnosed with high cholesterol or have a family history of the condition, you may need to have your cholesterol checked more often. Talk with your health care team about this simple blood test. If you have high cholesterol, medicines and lifestyle changes can help reduce your risk for heart disease.

Control your blood pressure

High blood pressure usually has no symptoms, so have it checked on a regular basis. Your health care team should measure your blood pressure at least once every 2 years if you have never had high blood pressure or other risk factors for heart disease.

If you have been diagnosed with high blood pressure, also called hypertension, your health care team will measure your blood pressure more often to make sure you have the condition under control. Talk with your health care team about how often you should check your blood pressure. You can check it at a doctor's office, at a pharmacy, or at home.

If you have high blood pressure, your health care team might recommend some changes in your lifestyle, such as lowering the sodium in your diet. Your doctor may also prescribe medicine to help lower your blood pressure.

Manage your diabetes

If you have diabetes, monitor your blood sugar levels carefully. Talk with your health care team about treatment options. Your doctor may recommend certain lifestyle changes to help keep your blood sugar under control. These actions will help reduce your risk for heart disease.

Take your medicines as directed

If you take medicine to treat high blood cholesterol, high blood pressure, or diabetes, follow your doctor’s instructions carefully. Always ask questions if you don’t understand something. Never stop taking your medicine without first talking to your doctor, nurse, or pharmacist.

Work with your health care team

You and your health care team can work together to prevent or treat the medical conditions that lead to heart disease. Discuss your treatment plan regularly, and bring a list of questions to your appointments. Talk with your health care team about how heart disease and mental health disorders are related .

If you've already had a heart attack , your health care team will work with you to prevent another one. Your treatment plan may include medicines or surgery and lifestyle changes to reduce your risk. Be sure to take your medicines as directed and follow your doctor's instructions.

• Million Hearts ® ABCS of Heart Health
• USDA Center for Nutrition Policy and Promotion – Dietary Guidelines

Heart Disease

Heart disease is the leading cause of death in the United States.

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• Essay on Health

Essay On Heart Disease

Type of paper: Essay

Topic: Health , Medicine , Disease , Heart , Cardiology , Heart Disease , Blood , Lifestyle

Words: 1100

Published: 03/30/2023

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Heart disease, otherwise known as coronary artery disease, is a name given to a side array of conditions that impact the heart. These disease include arrhythmias, congenital heart defects, and. At times, heart disease has been called cardiovascular disease as if the two refer to the same issue. While they both involved the heart and human body, they are not the same. Heart disease refers to the aforementioned issues, among others, while cardiovascular disease refers to blocked, clogged, or narrowing blood vessels. Cardiovascular disease can often lead to an angina, a heart attack, general chest pain, or even a stroke. Currently, heart disease does not have a cure, but it can be treated and prevented by lifestyle changes. In addition to the perils of heart disease in itself, it is important to understand the symptoms of the disease. Unfortunately, one can only know the symptoms if one understands there are several different types of heart disease. For example, heart disease cause by an arrhythmia, or abnormal heartbeat, will be characterized by tachycardia or brachycardia, chest pain, a fluttering feeling in one’s chest, dizziness, and even fainting. In contrast, valvular heart disease only shares fainting, irregular heartbeat, and chest pain as a symptom. Other symptoms include fatigue and the swelling of feet or ankles. Atherosclerotic heart disease presents with an angina, or chest pain, and shortness of breath. However, one will also feel pain in their extremities, jaw, back, upper abdomen, and throat. The legs may also feel weak. If heart disease if caused by a congenital defect, the individual’s skin will become gray or blue, and swelling may be experienced in the lower extremities, as well as around the eyes. It is important to know the various symptoms and when one is at risk for which variant of the disease. Most importantly, however, is to understand when to see a doctor, characterized by when an individual faints, experiences irregular breathing, or angina. While much is known about the symptoms of heart disease in its various forms, it appears even more is known about the various things that cause damage to each mechanism in the heart, leading to heart disease. Cardiovascular heart disease, for instance, is caused by a continuous build-up of fatty plaques that damage the arteries. These plaques cause the arteries to stiffen, making blood flow difficult. Obesity and smoking also contribute to this form of heart disease. Arrhythmia’s, in contrast, are often caused by coronary artery disease, a defect one is born with, high blood pressure, drug use, stress, and a variety of other issues in one’s life that can place unnecessary stress on the body. Congenital heart defects leading to heart disease develop in-utero as the heart develops. The lifestyle of the mother may play a role in congenital defects. Valvular heart disease, another among many variances of the disease, can be caused by an infection or a disorder within the heart’s connective tissue. Over time, researchers have found risk factors in accordance with heart disease based on who is more likely to develop it. Using these factors, they have been able to develop ways for individuals to prevent the disease in many cases, or treat it if the disease develops. Age is unavoidable, but as one ages, the arteries weaken and one is more at risk for developing the disease. Eating healthy and exercising regularly can help this. Males are more likely to experience the disease. After women experience menopause, the likelihood is equalized, and there is not yet any research that yields preventative measures against this. Smoking restricts blood vessels significantly, disallowing blood flow. It also weakens the inner lining of vessels, leaving one susceptible to a heart attack. It is widely recommended individuals to not smoke to prevent the disease, or stop in order to treat it. Family history can increase an individual’s susceptibility, increasing the demand for a healthy lifestyle. High cholesterol and blood pressure also harden the vessels and weaken the heart. This is often due to high stress levels and poor diet, making it essential for an individual to eat healthy and have a relaxation routine in order to avoid the disease if possible. Other issues, such as obesity, physical inactivity, and even poor hygiene increase one’s chances of experiencing heart disease. These three risk factors make it crucial, once more, to eat healthy, stay active within a safe range for your age and body, and keep a good hygiene routine in order to remain healthy. If lifestyle changes are impossible, or the individual is in need of a quicker form of treatment, other options are available. Medications can be prescribed based on the particular type of heart disease one has. Beta Blockers, for example, are preliminary for individuals who have experienced a heart attack or any hardening of blood vessels. Something as simple as baby aspirin may be prescribed, as well. Surgery may also become an option depending on the severity of the disease, as well as the type. Specific lifestyle changes that are typically recommended include regularly checking one’s cholesterol and blood pressure, managing stress and any existing mental illnesses such as depression, and exercising regularly. While there is no cure for heart disease, much is known about it. Enough research has been gathered to help the population prevent the disease from happening if they adhere to a relatively healthy lifestyle. Lifestyle changes are also available in order to treat the various forms of the disease and if these are not enough, medication and surgical options are available. Research has also discovered multiple forms of heart disease exist, allowing us to assess our bodies for the different symptoms coinciding with each one. We are fortunate to live in a time wherein we are able to have all of this knowledge, assess our bodies, and create preventative plans based on our lifestyles in order to avoid such a tremendous health catastrophe.

Anderson, L., & Taylor, T. (2014). Cardiac rehabilitation for people with heart disease: An overview of Cochrane systematic reviews. International Journal of Cardiology, 348-361. Dawber, T. R., Moore, F. E., & Mann, G. V. (2016). Coronary Heart Disease in the Framingham Study. International Journal of Epidemiology, 1767-1780. Mann, D., Zipes, D., Libby, P., & Bonow, R. (2014). Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. New York: Elselvier Health Sciences.

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How Daily Stress Affects your Heart Health

This essay about the impact of stress on heart health explores how chronic stress triggers hormonal changes that adversely affect cardiovascular function. It highlights the direct consequences of prolonged stress, such as increased blood pressure and atherosclerosis, which elevate the risk of heart disease. Additionally, the essay discusses how stress influences lifestyle choices that can further harm heart health, like poor diet, smoking, and lack of exercise. It also touches on the role of chronic inflammation under stress, which contributes to the deterioration of arterial health. Solutions for managing stress, such as regular exercise, mindfulness practices, and maintaining strong social connections, are outlined as effective strategies to mitigate these risks. Overall, the essay emphasizes the importance of managing stress to protect heart health, suggesting practical ways to alleviate stress and its harmful impacts on the cardiovascular system.

How it works

It’s no secret that the fast pace of modern life often brings a fair share of stress. Whether it’s the hustle of meeting tight deadlines, managing household responsibilities, or navigating complex social relationships, stress seems to shadow much of our daily routines. What might not be so apparent, however, is the profound impact this stress can have on our heart health.

When we’re stressed, our body reacts by releasing hormones like adrenaline and cortisol. These hormones kick-start the body’s ‘fight or flight’ response, gearing us up for immediate action.

This natural survival mechanism can be lifesaving in acute situations, but when triggered too often—thanks to chronic stress—it can wear down our body, particularly our cardiovascular system.

Chronic stress leads to continuous high levels of cortisol and adrenaline, which are tough on the heart and arteries. Consistently high blood pressure from prolonged stress can damage the arterial walls, which may lead to heart disease. As these walls thicken and harden, conditions like atherosclerosis decrease arterial flexibility, dramatically increasing the risk of heart attacks and strokes.

Stress doesn’t just wreak havoc on our bodies directly. It also influences our lifestyle choices. For many, stress is a gateway to picking up or continuing unhealthy habits—smoking, reaching for a drink, or indulging in junk food. While these may offer temporary relief, they come with a host of health issues, including weight gain, higher cholesterol levels, and increased blood sugar levels, all of which stress the heart even more.

Furthermore, chronic stress affects the way our body handles inflammation, a leading player in heart disease. Under stress, inflammatory responses can go into overdrive, accelerating the buildup of plaque in our arteries. Moreover, the constant rush of stress hormones can make the heart pump faster and harder, which over time can change the heart muscle itself.

Thankfully, there are effective ways to mitigate the impact of stress on our heart. Exercise, for example, is a fantastic stress reliever. It not only helps control weight and reduce blood pressure but also triggers the release of endorphins, chemicals in the brain that act as mood lifters and painkillers.

Mindfulness practices like yoga, meditation, and deep-breathing exercises can also help calm the mind and reduce stress. These activities help shift the body from stress responses to relaxation responses, lowering heart rate and blood pressure, and promoting overall heart health.

Social connections also play a crucial role in stress management. A robust social network can offer emotional support, reduce loneliness, and help manage stress more effectively. Keeping in touch with friends and family, participating in community activities, or even getting professional counseling can provide the support needed to manage stress.

To wrap it up, while stress is a natural part of life, managing it effectively is key to maintaining a healthy heart. By understanding how stress affects heart health and adopting strategies to cope, we can protect ourselves from the serious risks associated with heart disease. Taking active steps to reduce stress is not merely about feeling better—it’s about fostering a healthier, stronger heart.

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The impact of social determinants on cardiovascular disease

Catherine kreatsoulas.

1 McMaster University;

Sonia S Anand

Cardiovascular disease is the leading cause of death among high-income countries and is projected to be the leading cause of death worldwide by 2030. Much of the current research efforts have been aimed toward the identification, modification and treatment of individual-level risk factors. Despite significant advancements, gross inequalities continue to persist over space and time. Although increasing at different rates worldwide, the magnitude of increase in the prevalence of various cardiovascular risk factors has shifted research efforts to study the causes of the risk factors (ie, the ‘causes of the causes’), which include the social determinants of health. The social determinants of health reflect the impact of the social environment on health among people sharing a particular community. Imbalances in the social determinants of health have been attributed to the inequities in health observed between and within countries. The present article reviews the role of the social determinants of health on a global level, describing the epidemiological transition and the persistent trend known as the ‘inverse social gradient’. The impact of social determinants in Canada will also be examined, including data from ethnic and Aboriginal communities. Possible solutions and future directions to reduce the impact of social factors on cardiovascular health are proposed.

La maladie cardiovasculaire est la principale cause de mortalité dans les pays à revenus élevés et on s’attend à ce qu’elle devienne la principale cause de mortalité dans le monde d’ici 2030. Une bonne part de la recherche actuelle s’est attardée à la reconnaissance, à la modification et au traitement des facteurs de risque à l’échelon individuel. Or, malgré des progrès significatifs, d’importantes disparités persistent dans l’espace et le temps. Même si elle croît à un rythme différent selon les régions du monde, la prévalence de divers facteurs de risque cardiovasculaires force maintenant les chercheurs à étudier désormais l’origine des facteurs de risque eux-mêmes (c.à-d., « la cause des causes »), ce qui inclut les déterminants sociaux de la santé. Les déterminants sociaux de la santé témoignent de l’impact de l’environnement social sur la santé des personnes d’une communauté donnée. Les disparités quant aux déterminants sociaux de la santé ont été attribuées aux inégalités en matière de santé observées à l’intérieur des pays et entre eux. Le présent article fait le point sur le rôle des déterminants sociaux de la santé d’un point de vue mondial en décrivant l’évolution de l’épidémiologie et la tendance persistante connue sous le nom de « gradient social inverse ». L’impact des déterminants sociaux au Canada fera l’objet d’une analyse qui portera entre autres sur les données provenant des communautés ethniques et autochtones. On propose des solutions et des orientations qui pourraient éventuellement réduire l’impact des déterminants sociaux sur la santé cardiovasculaire.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among high-income countries of the industrialized world, accounting for more than one-third of total deaths ( 1 , 2 ). CVD is the leading cause of noncommunicable morbidity and mortality among low- and middle-income countries, accounting for almost 25% of total deaths ( 3 ) and, by the year 2030, is projected to be the leading cause of death worldwide ( 1 , 2 ). One of the most important advances in cardiovascular research of the 20th century was the identification of risk factors associated with CVD, with subsequent treatments developed and rigorously tested to modify these risk factors with the goal of preventing CVD. The INTERHEART study ( 4 ) examined more than 27,000 cases and controls from 52 countries and found that more than 90% of the population-attributable risk for myocardial infarction can be explained by nine potentially modifiable risk factors: apolipoprotein B/apolipoprotein A ratio, smoking, diabetes, hypertension, abdominal obesity, psychosocial factors, fruit/vegetable consumption, physical activity and alcohol consumption; thus, it is reasonable to believe that modification of these individual risk factors will significantly improve cardiovascular health. However, despite advances in the primary and secondary prevention of CVD, there are still gross inequalities in cardiovascular health care across space and time ( 5 – 7 ). To date, epidemiological studies have focused on identifying, modifying and treating individual risk factors; however, many cardiovascular risk factors have been increasing at different rates worldwide. Efforts to narrow the persistent health gap has spurred recent interest in developing approaches to study the causes of risk factors (ie, the ‘causes of the causes’), which include the social determinants of health.

The term ‘social determinants of health’ is used to describe the health impact of the social environment on people living in a particular community ( 8 ). Specifically, they include the conditions in which people are born, grow, live, work and age, and are shaped by the distribution of money, power and resources at global, national and local levels ( 9 ). The social determinants of health (including the health care system) are mostly responsible for health inequities between and within countries ( 9 ). Historical research has significantly established the impact of economic development and social organization on health ( 10 ). Because the prevalence of some cardiovascular risk factors (eg, obesity, hypertension and diabetes) is rising worldwide ( 2 , 10 , 11 ), it is necessary to focus efforts on understanding the role of the ‘causes of the causes’ (ie, the social determinants of health) to help bridge the current gap in equality. For the purpose of the present article, the social determinants of health as they pertain to CVD will first be explored on a global level and, second, within Canada, including data from ethnic and Aboriginal communities. Possible solutions to reduce the impact of social factors on CVD are also proposed.

THE GLOBAL BURDEN OF DISEASE

The World Bank and the WHO commissioned the Global Burden of Disease study ( 1 , 2 ) to quantify mortality, morbidity and the health effects of selected diseases, injuries and risk factors for the world as a whole and within specific regions. Among worldwide noncommunicable causes of death, CVD accounts for more than one-half ( 1 ); this finding has been consistently projected to remain unchanged across multiple models for at least the next 20 years in countries of both the developed and developing world ( 1 , 2 , 11 ). This finding is at odds with the popular perception that noncommunicable disease, such as CVD, are ‘diseases of affluence’ whereby related risk factors are perceived to be more prevalent in high-income countries and not present among low-income countries ( 12 ). However, this apparent paradox of substantial noncommunicable death in adults of the developing world has insidiously been established without attracting global attention or local action ( 12 , 13 ). The magnitude of this problem has been greatly overlooked because more than 80% of CVD deaths worldwide currently occur in low- and middle-income countries ( 13 ). By the year 2020, CVD is expected to surpass infectious disease as the world’s leading cause of death and disability ( 3 ), increasing from 25% in 1990 to 40% in 2020, illustrating the scale of this epidemic ( 13 ). Several factors are likely driving the worldwide increase in CVD, including the projected increase of 60% in the global population between 1990 and 2020, the increasing average life expectancy (due to a multitude of factors including improvements in nutrition, public health and medical care, while decreasing the rates of communicable diseases) and the economic, social and cultural changes that have led to increases in CVD risk factors including tobacco use, obesity, hypertension and diabetes ( 3 ). To put this into perspective, smoking, for example, is projected to kill 50% more people in 2015 than HIV/AIDS, and will be responsible for 10% of all deaths globally ( 11 ).

The epidemiological transition

Global patterns of death and disability have been observed over time. As societies become increasingly urban and industrialized, infant mortality declines, and the major causes of death and disability shift from nutritional deficiencies and infectious disease to degenerative or noncommunicable diseases such as CVD, resulting in an increasing average life expectancy. This shift has come to be known as the ‘epidemiological transition’ ( 3 , 14 ). Originally, three main transition states were identified ( 15 ); however, recently, up to five transition states have been described and characterize the total rates of CVD change ( 3 , 10 , 16 ) as illustrated in Figure 1 . Briefly, the first stage, known as ‘the age of pestilence and famine’, is indicative of countries in the earliest stage of development, in which death from CVD accounts for less than 10%, predominantly as rheumatic heart disease and cardiomyopathies due to infection and malnutrition ( 3 , 10 ). Geographical regions currently experiencing this transition state include sub-Saharan Africa and rural areas of South America and Asia. During the second stage, known as ‘the age of receding pandemics’, infectious disease burdens are reduced, nutrition improves and, correspondingly, deaths attributed to CVD increase to up to 35%, manifesting mostly as rheumatic heart disease, hypertension, coronary artery disease and stroke ( 3 , 10 , 16 ). Geographical regions currently experiencing this transition state include China and other Asian countries. In the third stage – ‘the age of degenerative and man-made diseases’ – life expectancy continues to improve, diets include higher fat content, cigarette smoking becomes more prevalent and sedentary lifestyles become more common ( 10 ). Not surprisingly, deaths attributed to CVD continue to rise, accounting for 35% to 65% of total deaths, primarily manifesting as atherosclerosis, coronary artery disease and stroke, often at ages younger than 50 years ( 10 ). Regions currently experiencing this stage include urban India, Latin America and former socialist European eastern block countries. In the developed world, most countries are in the fourth stage of transition referred to as ‘the age of delayed degenerative diseases’, in which up to 50% of deaths are attributed to CVD and typically present as coronary artery disease, stroke or congestive heart failure at more advanced ages ( 3 , 10 , 16 ). More recently, a fifth stage has been identified – ‘the age of health regression and social upheaval’ – which is used to describe conditions of social upheaval or war, resulting in a breakdown of the health system in which there is a resurgence of diseases seen in transition states one and two (eg, rheumatic heart disease), while the CVD diseases common in the third and fourth stage (eg, atherosclerosis) continue to persist ( 10 ). In total, approximately 35% to 55% of deaths are attributed to CVD, with a lower average life expectancy similar to what is currently experienced in Russia ( 10 ).

The epidemiological transition states of cardiovascular disease (CVD). CHD Coronary heart disease. Reproduced with permission from reference 10

Epidemiological transition states occur on a macro level, affecting specific countries or regions; however, they may also occur on a micro level within a country, including affluent countries. A country or a region can enter an epidemiological transition state at any time, with the progression from one state to another closely associated with parallel economic, demographic and nutritional ‘transitions’. From an economic perspective, progression through the transition states is often accompanied by an increase in per capita income; a social transition to industrialization, shifting from predominately rural to urban life; and the establishment of a public health infrastructure including wider access to health care ( 3 ). At the same time, a demographic transition occurs in which fertility and age-adjusted mortality decline, leading to an increase in average life expectancy and an aging population ( 3 ). As life expectancy increases, a shift in nutrition also occurs and populations are exposed to more cardiovascular risk factors including ‘Westernized’ diets (higher animal products and fat), sedentary behaviours and low physical activity, which lead to an elevation in blood pressure, body weight, blood sugar levels and lipid concentrations ( 13 ). This pattern has been repeatedly observed in many developing countries. For example, body mass index and blood cholesterol levels have dramatically increased in the Chinese population, likely due to a sharp increase in fat consumption; it is expected that China will soon experience a rapid escalation of coronary artery disease, surpassing the current one-third of total lives that it claims each year ( 13 , 17 ). Even with China’s booming economic growth, health care costs are currently unsustainable – the impact of which has been detrimental to the poor. Health care is less accessible while the health care system is inundated, having to cope with the double burden of infectious and chronic disease in an excessively large population ( 13 , 17 ).

The epidemiological transition has been observed to occur within countries. Affluent regions are typically affected first and, as the epidemic matures, the socioeconomically disadvantaged groups become increasingly more vulnerable, widening the health inequality gap in a phenomenon widely known as ‘the inverse social gradient’ ( 13 ). The socioeconomically disadvantaged groups have a greater exposure to cardiovascular risk factors such as smoking, increasing incidence of atherosclerotic risk factors (eg, obesity, diabetes, dyslipidemia and hypertension), poor working and living conditions, stress, lower rates of formal education, and reduced access to health care and health education ( 3 , 5 , 13 , 17 ). As research continues to emerge, evidence is mounting, indicating that epidemiological transition is a poor and incomplete model to understand how the social determinants of health interact with cardiovascular health because education, occupation, social norms, culture, geography, policy, economic factors and environment are considered to be independent individual risk factors. A comprehensive understanding of the social determinants of health must consider their dynamic nature, which inevitably includes a temporal component of early life and childhood exposures impacting adult health. The life course perspective is a methodological approach that takes into account the cross-sectional relationship of social circumstances from the early stages of life that may later be accompanied by similar social advantage/disadvantage in other spheres of adult life ( 5 , 18 ) ( Figure 2 ). For example, a longitudinal study ( 19 ) from Scotland found that social disadvantage, defined by a father’s occupation and neighbourhood (postal code of residence), contributed to CVD even after controlling for CVD risk factors. An increasing number of longitudinal epidemiological studies have demonstrated the importance of early-life socioeconomic circumstances with respect to future development of cardiovascular risk factors and CVD in later life ( 20 ).

Socioeconomic influences on cardiovascular disease (CVD) from a lifecourse perspective. Reproduced with permission from reference 18

CARDIOVASCULAR RISK FACTORS AND SOCIAL DETERMINANTS IN CANADA

CVD is the leading cause of death in Canada, accounting for one-third of total deaths ( 21 , 22 ). Despite the decline in CVD-related deaths over time in Canada, there are wide regional variations in death rates and risk factors ( 22 ). For example, the overall Canadian age-standardized CVD mortality rate (ASMR) from 1995 to 1997 was 245.8 per 100,000 population ( 22 ). Within Canada, there are significant differences in the ASMR from CVD, with Newfoundland and Labrador having the highest CVD mortality rate at 320.6 per 100,000 population, and the Northwest Territories having the lowest at 196.9 per 100,000. An east to west gradient in CVD mortality has been described, in which provinces in eastern Canada have higher CVD-related ASMR, with mortality rates generally decreasing westward, where the province of British Columbia has the lowest ASMR from CVD. However, the Territories have the lowest CVD ASMR in the country ( 22 ). In addition to between province/territory variation, variability within provinces has been observed. In a study using cross-sectional data from the National Population Health Survey of 1994, in combination with the Canadian Community Health Survey of 2005, Lee et al ( 21 ) compared temporal trends in the prevalence of cardiovascular risk factors across Canada. Over a 10-year study period, the prevalence of diabetes and obesity significantly increased, the prevalence of hypertension nearly doubled while smoking rates significantly declined ( 21 ). The prevalence of risk factors, when analyzed according to age and sex, indicates that they are increasing in both sexes and in all age groups among Canadians, particularly among the younger population groups ( 21 ). Such trends have important short- and long-term implications because the early presence of risk factors predisposes people to earlier onset of CVD, incurring greater health resource consumption and a greater potential for life-years lost ( 21 , 23 , 24 ).

Evidence of the inverse social gradient in Canada

When analyzing CVD mortality and risk factor prevalence rates according to income group, it is alarming to realize that despite affluence in Canada, individuals of lower socioeconomic status are more vulnerable to CVD than those of higher socioeconomic status ( 3 , 25 ). Evidence of the inverse social gradient and inequity gap reveals that mortality is highest among those in the poorest income group and, as income increases, the mortality rate decreases ( 3 , 25 ). Not surprisingly, these trends are also consistent with CVD risk factor prevalence rates in which individuals in a lower income group, especially in urban areas, have a greater exposure to risk factors (such as smoking and atherosclerosis) that manifest as obesity, diabetes, dyslipidemia and hypertension ( 21 , 22 ). Alarmingly, the inverse social gradient and inequity gap not only persisted but grew when the prevalence of cardiovascular risk factors according to income category over time were considered. Specifically, heart disease, hypertension, diabetes, smoking and obesity increased as income decreased in 1994. This trend was exaggerated when individual risk factors were compared between decades and within income group, with the exception of smoking ( 21 ). What is remarkable about these trends in a country such as Canada, is that they are persisting despite the availability and universality of health care. The presence and persistence of an inverse social gradient related to CVD mortality and associated risk factors is especially concerning because the inequity gap is widening between the highest and lowest income groups, and this trend is worsening with time ( 21 ).

It is likely that multiple factors contribute to the persistence of the inverse social gradient. Consistent with trends observed in the epidemiological transition state, the concurrent decline in malnutrition and communicable disease while CVD risk factors increase typically occur in privileged groups first, soon followed by higher rates of CVD including ischemic heart disease and stroke. This trend is likely responsible for the popular perception that CVD is a ‘disease of affluence’ ( 1 , 13 ). However, as the middle class expands and the epidemiological transition spreads to a broader population, individuals with the lowest socioeconomic status tend to acquire the harmful risk factors last, mostly due to their financial situation and the heavy physical activity usually associated with their work ( 3 , 17 ). At the same time, the socioeconomically disadvantaged are also less likely to have access to advanced health services, treatments and information for risk factor modification and, as a result, CVD mortality rates are slower to decline in this group ( 3 , 17 ). For example, of the percentage of the population living in poverty in Canada, two-parent families comprise the highest income group whereas female lone-parent families comprise the lowest-income group – a trend that has remained consistent over time ( Figure 3 ). Socioeconomic status has been widely acknowledged as the most powerful social determinant of health; however, there are a multitude of factors that intersect with socioeconomic status, including systematic inequalities due to ethnicity and sex.

Canadian poverty rates over time, 1984 to 2004. Reproduced with permission from reference 28

The inverse social gradient and Aboriginals in Canada

Ethnicity is a construct that embodies both genetic and cultural differences including language, religion and diet, to name a few. The construct of ethnicity is intertwined with variations in lifestyle, geography, socioeconomic position and education. Differences in morbidity and mortality among various ethnic groups are well documented within Canada. The Study of Health Assessment and Risk in Ethnic groups (SHARE) ( 26 ) used a population-based approach and confirmed differences in risk factor prevalence rates among three ethnic groups in Canada ( 26 ). This is an important finding because the overall prevalence of CVD is declining in Canada; however, CVD was observed to be rising within some ethnic groups. There are a number of explanations proposed for these differences including the concept of social exclusion, differences in risk factor frequency, access to screening/prevention, differences in treatment and adherence to treatment ( 26 ). Specifically, Aboriginals in Canada have been identified as the population group with the shortest life expectancy ( 25 , 27 ), averaging five to 14 years less than their fellow Canadians ( 28 ) despite a decline in infectious disease deaths. Aboriginal infant mortality rates that are 1.5 to four times greater than the Canadian rate contributed to the shorter life expectancy ( 29 ).

Not surprisingly, CVD health among Aboriginals is also poor. It has been demonstrated that Aboriginals have a higher prevalence of CVD and a greater burden of atherosclerosis than Canadians of European ancestry ( 27 ). Correspondingly, they also have a higher prevalence of conventional risk factors including higher rates of smoking, diabetes, obesity, abdominal obesity, hypertension, cholesterol and family history, which likely account for observed ethnic group differences ( 27 ). However, Aboriginals have also been identified to have an excess of social disparities including environmental dispossession – a term used to refer to the processes through which Aboriginal Peoples’ access to the resources of their traditional environments are greatly reduced ( 30 ) – and high levels of poverty ( 27 ). Consistent with trends among other disadvantaged groups, there is evidence of an inverse social gradient; however, the social gradient is strikingly pronounced among Aboriginals when compared with their European-Canadian counterparts of similar income. In The Study of Health Assessment and Risk Evaluation in Aboriginal Peoples (SHARE-AP) ( 27 ), both Aboriginals and European-Canadians had the highest prevalence of CVD; however, even among individuals in the lowest income group (less than $20,000 household income), the absolute rate of CVD was significantly higher among Aboriginals than among European-Canadians of all income ranges ( 27 ), as illustrated in Figure 4 . Consistent with this trend (and equally as shocking!), the burden of CVD risk factors (more than three CVD risk factors) was greatest among people in the lowest income group in both Aboriginals and European-Canadians; however, the absolute rate of CVD risk factor burden was at least twice as high in Aboriginals compared with European-Canadians within each income level group ( 27 ) ( Figure 5 ). The social disadvantage index score was developed to incorporate social and economic exposures into a single continuous measure, and found that increased social disadvantage is associated with an increased burden of some – but not all – cardiovascular risk factors independently associated with CVD ( 31 ). Specifically, social disadvantage was found to increase with age, was higher among women than men and varied greatly according to ethnic group, in which the highest risk for CVD was among Aboriginal men ( Figure 6 ) ( 31 ).

Socioeconomic gradient and cardiovascular disease (CVD) among Aboriginal Peoples and European descendants in Canada. Reproduced with permission from reference 27

Cardiovascular disease (CVD) risk factor prevalence and income among Aboriginal Peoples and European descendants in Canada. Reproduced with permission from reference 27

Risk of cardiovascular disease and social disadvantage. Reproduced with permission from reference 31

THE TREATMENT GAP

In addition to the health inequities examined, both on a global and national level, the ‘10/90 gap’ has been recognized as a serious limitation to the improvement of health care, citing that less than 10% of global health research spending is devoted to diseases that account for 90% of the global disease burden ( 32 ). Globalization may negatively affect countries in a lower epidemiological transition state by accelerating the transition of Western products and behaviours to non-Western cultures ( 13 ). At the same time, globalization can also offer opportunities to facilitate the prevention of CVD through risk factor modification, applying evidence of effective interventions and promoting health behaviour through mass media ( 13 ). Despite this, current effective therapies for secondary prevention, such as treatment with acetylsalicylic acid, blood pressure-lowering drugs and statins, are highly undersused. For example, a study conducted in rural India ( 13 ), where CVD is the leading cause of death, reported that less than one-sixth of the patients who experienced a previous CVD event acknowledged taking antiplatelet therapy.

The reasons for the treatment gap are complex. Several proposed explanations include the following: incomplete guidelines for physicians, health care systems and policy; the cost of therapy relative to wages; cultural barriers such as the stigma of taking long-term medication; urban versus rural accessibility to health care; and international neglect, for which low- and middle-income countries account for one-third of the world’s population but only receive 2% of global health resources ( 17 ). Even within affluent countries such as Canada and the United States, a ‘5/95 gap’ is used to describe the ratio of resources devoted to prevention versus treatment ( 33 ).

To help address issues related to health inequities occurring at both a global and local level, the Centre for Urban Health – commissioned by the WHO – created a document titled ‘The Solid Facts’ to “promote awareness, informed debate and above all, action…a valuable tool for broadening the understanding of stimulating debate and action on the social determinants of health” ( 8 ). The Solid Facts document identifies 10 social determinants of health: social gradient, stress, early life, social exclusion, work, unemployment, social support, addiction, food and transport ( 8 ). This document is widely available, and every member state of the European Union (EU) has currently made efforts to integrate it into their health care agendas. Among the objectives for generating this document was to encourage other countries outside the EU to use it as a model/template for their health care agendas ( 8 ). However, current health models and dissemination of health information to the public from various government and health bodies have been strongly and individually oriented, and take the position that individuals can control the factors that determine their health, as exemplified in the ‘Traditional 10 tips for better health’ ( 29 ) depicted in Table 1 . However, these conceptualizations have been recently refined to incorporate the information established from research on the social determinants of health using a socially oriented perspective, which assumes that the most important determinants of health are beyond the control of most individuals. The traditional 10 tips can be contrasted with the ‘Social determinants 10 tips for better health’ presented in Table 2 ( 29 ).

The traditional 10 tips for better health

Reproduced with permission from reference 29

The social determinants 10 tips for better health

Because CVD is increasing globally, it is crucial that we understand the social and economic forces that promote the development of risk factors affecting who is screened and who is treated. The dissemination of knowledge and the application of effective strategies are essential. The social determinants of health are tools to help illuminate how social processes interact with CVD health on a global, national and individual level. Specifically, if disadvantaged groups can be identified, intervention strategies can then be tailored at an early age before the individual exhibits the conventional risk factors thereby improving population health and reducing the burden placed on health care resources. It is critical that people – including the scientific community – advocate, educate, organize, lobby and convince policy makers that minimizing social and economic inequities will diminish the social gradients of cardiovascular risk factors and CVD.

Improvements to implement change must be made on many levels. Currently, there is an international plea to improve national health monitoring and surveillance systems ( 34 , 35 ). Advances in statistical linkage techniques (eg, geocoding and area-based socioeconomic measures), in addition to multilevel hierarchical analysis frameworks, have contributed to assessing public health outcomes to identify disadvantaged groups ( 35 ). In particular, these techniques have aided researchers and policy makers to study risk factors such as smoking ( 36 ) and physical activity level ( 37 ) at the neighbourhood-of-residence level so that new approaches to develop community-level interventions can be targeted ( 36 ). For example, clean indoor air legislation prohibiting smoking in the workplace has aided in reducing overall cigarette consumption ( 38 , 39 ). Similarly, a study ( 40 ) using hierarchical regression analysis techniques suggested that greater social cohesion, which seeks to capture the presence of strong social bonds and the absence of latent social conflict, was found to be directly associated with more general physical activity in Chicago (United States) neighbourhoods, independent of previous participation in recreational programs and other neighbourhood- and individual-level covariates. To increase the promotion of physical activity in this urban population, the authors recommended that efforts should target neighbourhood-level social and psychosocial processes that influence social cohesion ( 37 ). These examples highlight that an understanding of the community and household determinants of the major cardiovascular risk factors, which may vary by geographical region and cultural background, is required to develop prevention strategies. Finally, such context-dependent strategies must be evaluated to ensure that they are efficacious.

CONFLICTS OF INTEREST: The authors have no financial disclosures or conflicts of interest to declare.

The slowly evolving truth about heart disease and women

A century ago, so little was known about heart disease that people who had it resigned themselves to years of bed rest or, worse, an early death. Even less was known about how heart disease affected women—because nobody thought it did.

Heart disease was considered a man's disease. If women had a role to play, it was in taking care of the men in their lives. Even the American Heart Association hosted a conference in the 1960s themed "How Can I Help My Husband Cope with Heart Disease?" and published a nutrition pamphlet titled "The Way to a Man's Heart."

That attitude persisted throughout the 20th century, a time when questions about a woman's health were centered on the parts of her body under her bikini, said Dr. Gina Lundberg, clinical director of the Emory Woman's Heart Center and a professor at Emory University School of Medicine in Atlanta.

"It was, 'Get a pap smear and a mammogram and you're good,'" she said. "We left out all the things we were checking men for, like diabetes and cardiovascular disease. But between a woman's breasts and her reproductive organs is her heart."

Women were believed to have some natural protection from heart disease until their hormone levels dropped during menopause, Lundberg said. After menopause, it was believed that hormone replacement therapy could prolong that protection, a premise since amended to apply only to women who take it during the early stages of this transition.

It wasn't until the turn of the century neared that evidence began to slowly emerge that women, as well as men, faced a substantial risk from heart disease, beginning at a much earlier stage in life and with sometimes differing symptoms than men.

Left out of the research

It wasn't until the mid-1980s when anyone began looking at how heart disease might affect women.

That's when the Framingham Heart Study , the first in-depth, long-term cardiovascular investigation in the U.S., began reporting sex-specific patterns of heart disease, questioning whether the magnitude of this condition in women was being overlooked. The researchers noted that heart attacks were less likely to be recognized in women than in men.

They also pointed out that prior investigations had failed to adequately assess sex differences in heart disease because an insufficient number of women were included in the research. Since heart disease was thought to predominantly affect men, only men were being studied.

This started to change in the 1990s, after Atlanta cardiologist Dr. Nanette Wenger and others led a push for the equitable inclusion of women in National Institutes of Health-funded research. Doing so became NIH policy in 1989 and was written into law in 1993. But Wenger later said the legislation amounted to little more than a directive, falling short of achieving parity. "It had no teeth," she recently told The Fuller Project .

Meanwhile, the prevention and treatment of heart disease in women was based on evidence that came from studies of predominantly middle-aged men, said Dr. Jennifer Mieres, a professor of cardiology and associate dean for faculty affairs at the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York.

"We thought that you could treat men and women the same," said Mieres, who was the first woman to be a full-time faculty cardiologist at Northwell Health's North Shore University Hospital. "We had great advances in treatment strategies, but we were applying a one-size-fits-all approach and clearly that wasn't working."

A landmark 2001 report from the Institute of Medicine, a nonprofit policy research organization now known as the National Academy of Medicine, highlighted the underrepresentation of women in clinical trials and sex biases in medicine, calling for a better understanding of differences in how men and women were affected by disease.

Mieres said women often failed to meet the criteria for clinical trials because their signs and symptoms didn't match assumptions about what constituted cardiovascular risk. "Our research criteria were customized to men as the gold standard."

This realization led to a push for sex-specific clinical trials, allowing researchers to focus exclusively on how cardiovascular disease develops in women, she said. And that led to the discovery that heart disease caused by narrowed heart arteries is more complex and behaves differently in women than in men.

Beyond the bikini: A new picture of women's health

One of the biggest questions driving the push for more research was why, despite developing heart disease about 10 years later than men, more women were dying from it. And why were women under 65 twice as likely to die from a heart attack as their male peers?

As researchers began to dig, a new picture of women's health emerged.

One problem was health care professionals were doing less to protect women from heart disease, according to a 1999 report from the AHA and American College of Cardiology, the first women-specific clinical recommendations for the prevention of heart disease.

For example, women were less likely to be counseled by health care professionals to reduce their cardiovascular risk factors, such as by losing weight, eating a healthier diet or becoming more physically active. They also were less likely than men to be referred to cardiac rehabilitation following a heart attack or bypass surgery.

Mieres said it became clear that women needed better information so they could take control of their own health decisions. So, the AHA established Go Red for Women, a national campaign to raise awareness of heart disease and stroke as leading killers of women and to advance the science of sex differences in heart disease. It also joined forces with the National Heart, Lung, and Blood Institute, which was developing its own campaign, The Heart Truth. The two campaigns were launched back-to-back in 2003 and 2004.

The Heart Truth went first, unveiling the Red Dress as the national symbol for women and heart disease. That same year, the cover of Time magazine told women they were wrong to think breast cancer was their biggest worry and proclaimed, "ONE OUT OF THREE women will die of heart disease."

A year later, the AHA launched Go Red for Women, along with women-specific, evidence-based heart disease prevention guidelines. The report emphasized that despite significant gains in the treatment of heart disease, it remained the leading killer of women in the U.S.

Mieres, a member of AHA's national board of directors during Go Red's formative years, said the idea for a media campaign was heavily influenced by an AHA-sponsored survey showing women were more likely to turn to media sources than their doctors for health information.

"To me, that was an 'aha' moment," she said. "That's when we realized the way to get accurate science out to women and encourage women to become heart health literate was through these partnerships that could provide the tools and information needed to truly begin the journey of heart-healthy living. We used the power of storytelling. We produced public service announcements and documentaries. We wanted women to know that heart disease could be prevented by making lifestyle changes."

And for a while, it worked. The number of women recognizing heart disease as a major health risk nearly doubled, from 7% in 1997 to 13% in 2003. By 2009, 65% of women understood heart disease was their leading cause of death. Mortality from cardiovascular disease began to decline in women, though at a slower rate than it did in men.

But those gains did not last. By 2019, only 44% of women recognized heart disease as their No. 1 killer, and a majority failed to recognize the signs and symptoms of a heart attack. Young women and Hispanic and Black women experienced the greatest drop in awareness.

Among health care professionals, Lundberg said awareness of how big a risk heart disease is for women remains poor, even a decade after a survey found weight issues and breast health ranked higher than heart health when primary care physicians were asked about their level of concern for various health issues in their patients.

And a staggering 70% of physician trainees report they aren't getting enough, if any, education in gender-based medical concepts during postgraduate medical training. In a nationwide survey, only 22% of primary care doctors and 42% of cardiologists said they feel extremely well prepared to assess cardiovascular risks in women.

"We are lagging in implementing risk prevention guidelines for women," Lundberg said. "A lot of women are being told to just watch their cholesterol levels and see their doctor in a year. That's a year of delayed care."

It may be costing women their lives.

Heart attack hospitalization rates among women under 55 have increased, as rates among men of the same age have dropped, one study found. And recent studies show women are more likely to die after having heart attack.

Research shows women continue to be undertreated for cardiovascular problems compared to men. They are less likely to be treated for high cholesterol with statins, which have been shown to lower the risk for heart attacks and strokes. They also are less likely than men to be prescribed blood-thinning drugs to prevent or treat blood clots as treatment for atrial fibrillation, or AFib.

"Statins have helped us make huge improvements in cardiovascular health, but women still aren't getting all the benefit," Lundberg said.

Although they are more likely to have heart failure, women also are substantially less likely than men to receive lifesaving treatments for it, including heart transplants. They are less likely to receive guideline-directed treatment after a heart attack or unstable angina, or to receive treatment in a timely fashion. They are less likely to undergo procedures to restore blood flow to the heart, such as bypass surgery or inserting stents to open blocked arteries.

Unique risks to women's heart health

While gains in awareness may have backslid, progress toward understanding the unique cardiovascular risks women face has surged in recent decades.

Over the past 20 years, there have been significant strides in showing how menopause contributes to heart health. For example, menopause symptoms such as hot flashes and night sweats have been linked to an increased risk for high blood pressure, a major risk factor for cardiovascular disease.

One of the biggest discoveries of the past decade has been the link between pregnancy complications and heart disease and stroke risk, Lundberg said.

"Now we know that if a woman has gestational diabetes, hypertension, preeclampsia or eclampsia, they are at increased risk for cardiovascular disease later in life," she said.

Research has also shown that having high blood pressure before becoming pregnant might double a woman's risk of developing cardiovascular disease within a decade of giving birth.

Other sex-specific risk factors that have come to light include starting menopause before age 40 and having endometriosis or polycystic ovary syndrome, a hormonal disorder that affects the ovaries. Women also are more likely to have autoimmune disorders, such as rheumatoid arthritis or lupus, that cause plaque to build up faster in their arteries and lead to worse outcomes following a heart attack or stroke.

As for better understanding differences in the ways heart disease develops in men and women, it's now known that atherosclerosis—the buildup of plaque in the arteries that leads to heart attacks and strokes—differs in the size of the plaque, where it is found and how vulnerable it may be to rupture. Women are more likely than men to have a heart attack caused by plaque erosion, spontaneous coronary artery dissection and problems other than an obstruction, while men are more likely to have heart attacks caused by rupturing plaque in their arteries.

What we still don't know

Many knowledge gaps remain, Lundberg said, especially in the ways heart disease disproportionately affects women from different racial and ethnic groups. Compared to other women in the U.S., Black women have the highest rates of high blood pressure, stroke, heart failure and coronary artery disease. They also have been less likely to be included in clinical studies.

A growing body of evidence suggests structural racism and other social determinants of health play a role, such as having less access to health care services and healthy foods or challenges created by language barriers and acculturation. Many of these conditions likely add to their stress, Lundberg said, which in turn can contribute to higher cardiovascular risks.

"We know that stressful things in these women's lives cause heart disease, but we don't know exactly how or how to prevent it," she said.

Too few women in cardiology

One of the biggest problems for women with heart disease can be finding a doctor who will understand what they're going through, said Lundberg, who also chairs the Women in Cardiology section of the American College of Cardiology.

"There are not enough women and especially not enough women of color who are entering the field of cardiology," she said. "If you're a male taking care of a female, you may have a bias that women are more dramatic about pain or don't have as big a heart problem. But if you are a woman taking care of a woman, you may listen differently."

The entire medical community, including the AHA and ACC, have been pushing to expand the medical workforce to include more women, especially those from diverse racial and ethnic backgrounds, Mieres said.

"The medical workforce should reflect the diverse population being served," she said. "If a medical team member looks like the person they are treating, there's more trust. The patient will share more and is more likely to stick to a treatment plan."

Change takes time, so start early

Mieres said she's convinced the only way to make lasting changes to women's heart health is to promote good habits—including regular physical activity and the importance of eating a healthy diet—much earlier in life.

"People need to be better educated about health in general," she said. "I'm a big believer that it should start in kindergarten."

If nothing else has been learned over the past century, it's that change may take time, but it's possible, Mieres said.

"It has been a slow evolution," she said. "And we need to do more."

Provided by American Heart Association

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A Report on Heart Diseases

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Published: Oct 2, 2020

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• Instructions Followed To The Letter
• Deadlines Met At Every Stage
• Unique And Plagiarism Free