Cardiovascular disorder is a group of conditions that affect the heart and blood vessels, representing the leading cause of death worldwide. While these diseases can be serious, many cases are preventable through healthy lifestyle choices and early detection.

Epidemiology

Cardiovascular disease stands as the most common cause of death globally and in the United States. The numbers are staggering and reveal just how widespread these conditions have become in modern society. An estimated 19.8 million people died from cardiovascular diseases in 2022, which accounts for approximately 32 percent of all deaths worldwide. Of these deaths, 85 percent were caused by heart attack and stroke, two of the most severe consequences of cardiovascular problems.^[3]

The impact is particularly severe in low- and middle-income countries, where more than three-quarters of cardiovascular disease deaths occur. This disparity points to differences in healthcare access, lifestyle factors, and availability of preventive measures across different regions of the world.^[3]

In the United States alone, almost half of all adults have at least one form of heart disease. This means that millions of people are living with cardiovascular conditions, making it a public health challenge of enormous proportions. The disease affects people of all ages, sexes, ethnicities, and socioeconomic levels, though certain groups face higher risks than others.^[1]

One in every five deaths in the United States is due to heart disease, and the condition does not discriminate based on gender. However, women face particular risks, with one in three women dying from cardiovascular disease. Women may also experience more subtle symptoms than men, which can delay diagnosis and treatment.^[7][1]

Among premature deaths from noncommunicable diseases in people under the age of 70, at least 38 percent are caused by cardiovascular diseases. This statistic reveals that cardiovascular problems are not just an issue for the elderly but can affect people during their most productive years of life.^[3]

Causes

The causes of cardiovascular disease vary depending on the specific type of condition, but many share common underlying processes. The most frequent cause is atherosclerosis, which is the buildup of fatty deposits, cholesterol, and other substances inside the walls of blood vessels. Over time, this buildup, called plaque, narrows the arteries and restricts blood flow to the heart, brain, and other organs.^[4]

When arteries become narrow or blocked, the heart cannot receive enough oxygen-rich blood. This reduced blood flow can lead to chest pain known as angina, or in more severe cases, to a heart attack when the blood supply is suddenly cut off. The brain can also be affected when blood vessels supplying it become blocked or rupture, resulting in a stroke.^[8]

Coronary artery disease, one of the most common forms of cardiovascular disease, results from decreased blood flow to the heart muscle due to plaque buildup in the coronary arteries. Over time, this condition can weaken the heart muscle and lead to heart failure, where the heart cannot pump blood effectively throughout the body.^[5]

Some cardiovascular conditions have different origins. For example, heart valve problems can develop from infections, aging, or damage to the heart. Arrhythmias, which are irregular heart rhythms, can be caused by coronary artery disease, scarring of the heart muscle, genetic problems, or certain medications. Some people are born with heart defects, known as congenital heart disease, which affect the normal development and functioning of the heart from birth.^[1]

Rheumatic heart disease develops as a complication of strep throat caused by streptococcal bacteria. When left untreated, this infection can damage the heart muscle and heart valves, leading to long-term cardiovascular problems.^[3]

Risk Factors

Understanding what puts you at risk for cardiovascular disease is crucial because many risk factors can be modified or controlled. The most important behavioral risk factors include unhealthy diet, physical inactivity, tobacco use, and harmful use of alcohol. These lifestyle choices contribute to conditions that directly damage the heart and blood vessels.^[3]

High blood pressure, also called hypertension, is one of the most significant risk factors for cardiovascular disease. When blood pressure remains elevated, it damages blood vessels and makes the heart work harder than it should. High blood pressure usually has no symptoms, which is why it’s sometimes called a “silent killer.” It is estimated to account for approximately 13 percent of cardiovascular disease deaths.^[9]

High cholesterol levels in the blood contribute to plaque formation inside arteries. When too much cholesterol circulates in the bloodstream, it can stick to artery walls, narrowing the vessels and increasing the risk of blockages. High blood cholesterol is a major contributor to coronary artery disease and stroke.^[4]

Smoking and other tobacco use significantly increase cardiovascular disease risk. Tobacco accounts for about 9 percent of cardiovascular disease deaths worldwide. The harmful substances in tobacco damage and narrow blood vessels, reduce oxygen in the blood, and force the heart to work harder.^[9][18]

Diabetes is another major risk factor, accounting for approximately 6 percent of cardiovascular disease deaths. High blood sugar levels from diabetes can damage blood vessels over time, making them more likely to become narrowed or blocked. Many people with type 2 diabetes are also overweight or obese, which compounds their risk.^[9]

Physical inactivity contributes to about 6 percent of cardiovascular disease deaths. When people don’t exercise regularly, they are more likely to develop high blood pressure, high cholesterol, and excess weight. Obesity itself accounts for about 5 percent of cardiovascular disease deaths and puts extra stress on the heart and blood vessels.^[9]

Other medical conditions can increase risk as well. People with chronic kidney disease have an elevated risk of developing cardiovascular problems. Poor sleep quality and sleep disorders can also contribute to heart disease risk, as can high stress levels and mental health conditions.^[4]

Some risk factors cannot be changed but still affect your likelihood of developing heart disease. Your age matters, with men over 45 and women over 55 facing higher risk. Family history also plays a role. If your father or brother had heart disease before age 55, or your mother or sister had it before age 65, your own risk increases.^[23]

Environmental factors also contribute to cardiovascular disease risk. Air pollution is an important risk factor that affects cardiovascular health, though individuals have less control over this exposure compared to lifestyle factors.^[3]

Symptoms

Cardiovascular disease symptoms can vary greatly depending on the specific condition and which part of the cardiovascular system is affected. Some people may not experience any symptoms at all, a situation known as being asymptomatic, while others may have noticeable signs that something is wrong. Older adults and women often have more subtle symptoms, but they can still have serious cardiovascular disease.^[1]

When the heart itself is affected, symptoms often include chest pain, which doctors call angina. This pain may feel like pressure, heaviness, or discomfort in the center or left side of the chest. Some people describe it as feeling like a belt tightening around the chest or a weight pressing down. The pain can also spread to the upper body, including the arms, back, shoulders, neck, jaw, or upper stomach.^[1]

Shortness of breath, called dyspnea, is another common symptom of heart problems. This can occur during physical activity or even while resting. People may feel like they cannot catch their breath or that breathing requires more effort than it should. Dizziness, fainting, and unusual fatigue or exhaustion can also signal cardiovascular problems.^[1]

When blood vessels throughout the body are affected, symptoms appear in different areas. Blockages in blood vessels supplying the legs can cause pain or cramps when walking, leg sores that won’t heal, cool or red skin on the legs, and swelling. These symptoms point to peripheral artery disease, which affects blood flow to the limbs.^[1]

Problems with blood vessels supplying the brain can cause numbness in the face or limbs, often on just one side of the body. Difficulty with talking, seeing, or walking can signal that the brain is not receiving adequate blood flow. These symptoms may indicate a stroke or transient ischemic attack, sometimes called a mini-stroke.^[1]

Heart failure produces its own set of symptoms as the heart struggles to pump blood effectively. Fluid builds up in the body, causing shortness of breath, fatigue, and swelling in the feet, ankles, legs, abdomen, or neck veins. People with heart failure may feel exhausted even with minimal activity.^[7]

Arrhythmias, or irregular heart rhythms, can cause a fluttering feeling in the chest, which doctors call palpitations. Some people feel like their heart is racing, skipping beats, or beating too slowly. These sensations can be accompanied by dizziness or fatigue.^[7]

Sometimes cardiovascular disease remains silent, with no obvious symptoms until a serious event occurs like a heart attack or stroke. This is why regular checkups and screening are so important, even when you feel perfectly healthy.^[7]

Prevention

The encouraging news about cardiovascular disease is that it is largely preventable. It is estimated that up to 90 percent of cardiovascular disease may be preventable through healthy lifestyle choices and management of risk factors. This means that most people have significant control over their heart health through the decisions they make every day.^[9]

One of the most important prevention strategies is following a heart-healthy eating pattern. This means choosing meals and snacks that include plenty of fresh fruits, vegetables, and whole grains while limiting processed foods. Foods high in saturated fat and trans fat can contribute to heart disease, so it’s important to reduce these in your diet. Eating foods high in fiber and low in saturated fats, trans fat, and cholesterol helps prevent high cholesterol levels.^[17]

Limiting salt, also called sodium, in your diet can lower blood pressure. Similarly, reducing sugar intake helps control blood sugar levels and prevent or manage diabetes. Both high blood pressure and diabetes are major risk factors for cardiovascular disease, so controlling them through diet is crucial.^[17]

Regular physical activity is another cornerstone of cardiovascular disease prevention. For adults, health experts recommend at least 150 minutes of moderate-intensity exercise each week, which works out to about 30 minutes five days a week. Activities like brisk walking, bicycling, or dancing can help maintain a healthy weight and lower blood pressure, cholesterol, and blood sugar levels. Children and adolescents should get at least one hour of physical activity every day.^[17]

Maintaining a healthy weight reduces the risk of heart disease. People who are overweight or obese face higher risk because the extra weight puts stress on the heart and blood vessels. Even modest weight loss can provide health benefits and reduce cardiovascular disease risk.^[17]

Quitting smoking is one of the most powerful steps anyone can take to prevent heart disease. The risk of heart disease drops significantly after quitting, even for people who have smoked for many years. After just one year without cigarettes, the risk of heart disease drops to about half that of a smoker. It’s also important to avoid secondhand smoke, which can also damage the heart and blood vessels.^[18]

Limiting alcohol consumption is important for heart health. Drinking too much alcohol can raise blood pressure and contribute to heart problems. Health guidelines recommend no more than one drink per day for women and no more than two drinks per day for men.^[17]

Managing stress and getting enough quality sleep are also important for cardiovascular health. Chronic stress can contribute to high blood pressure and other risk factors. Finding healthy ways to cope with stress, whether through relaxation techniques, social connections, or professional support, can benefit heart health. Poor sleep and sleep disorders have been linked to increased cardiovascular disease risk.^[18]

Regular health screenings allow for early detection and management of risk factors. Getting your blood pressure checked at least once every two years, or more often if you have risk factors, helps catch high blood pressure before it causes damage. Cholesterol levels should be tested every four to six years for most adults, or more frequently if you have high cholesterol or a family history of it. If you have diabetes, checking your blood sugar regularly is essential.^[17]

For people who already have risk factors like high blood pressure, high cholesterol, or diabetes, taking prescribed medications as directed is crucial. These medications can help control these conditions and reduce the risk of developing cardiovascular disease or experiencing complications.^[17]

Pathophysiology

Understanding what happens inside the body when cardiovascular disease develops helps explain why the condition is so serious and why prevention and treatment are so important. The changes that occur affect the normal functioning of the heart and blood vessels in ways that can have far-reaching consequences throughout the body.^[3]

The process of atherosclerosis is central to many cardiovascular diseases. This condition begins when the inner walls of arteries become damaged, often from factors like high blood pressure, smoking, high cholesterol, or diabetes. Once the artery wall is injured, cholesterol, fats, and other substances in the blood begin to stick to the damaged area. Over time, these substances accumulate and form plaque.^[8]

As plaque builds up inside the arteries, the space for blood to flow through becomes narrower. This narrowing is called stenosis. When arteries become narrow, less oxygen-rich blood can reach the tissues and organs that depend on that blood supply. The heart itself is particularly vulnerable because it requires a constant supply of oxygen to keep pumping.^[8]

Sometimes plaque becomes unstable and can rupture or break open. When this happens, the body responds by forming a blood clot over the rupture. If the clot becomes large enough, it can completely block blood flow through the artery. When this blockage occurs in a coronary artery supplying the heart muscle, it causes a heart attack. When it happens in an artery supplying the brain, it causes a stroke.^[3]

The heart muscle itself can undergo changes when it doesn’t receive enough blood and oxygen. Areas of heart muscle that are starved of oxygen can die, a process called myocardial infarction or heart attack. The dead tissue is eventually replaced by scar tissue, but this scar tissue cannot contract like normal heart muscle. As a result, the heart’s pumping ability is reduced.^[5]

When the heart’s pumping function becomes impaired, the condition progresses to heart failure. In heart failure, the heart muscle becomes too stiff or too weak to pump blood effectively throughout the body. Blood backs up in the veins, causing fluid to leak into tissues and creating swelling. Fluid can also accumulate in the lungs, making breathing difficult. The kidneys and other organs may not receive adequate blood flow, which can lead to further complications.^[8]

High blood pressure creates its own set of mechanical problems. When blood pressure remains elevated, it forces the heart to work harder to pump blood against the increased resistance in the arteries. Over time, this extra workload causes the heart muscle to thicken, particularly in the left ventricle, the main pumping chamber. While the thickened muscle may seem stronger, it actually becomes stiffer and less efficient at pumping blood. This condition, called hypertrophic cardiomyopathy, can lead to heart failure.^[4]

The electrical system of the heart can also be affected by cardiovascular disease. The heart relies on electrical signals to coordinate its beating. When the heart muscle is damaged or scarred from a heart attack or other condition, these electrical signals may not travel normally through the heart. This can result in arrhythmias, where the heart beats too fast, too slow, or irregularly. Some arrhythmias can be life-threatening because they prevent the heart from pumping blood effectively.^[1]

Heart valves, which control blood flow between the heart’s chambers and into the major blood vessels, can become damaged in cardiovascular disease. Valves may become narrowed, a condition called stenosis, which restricts blood flow. Or they may fail to close properly, allowing blood to leak backward, a condition called regurgitation. Either problem forces the heart to work harder to move blood through the body.^[1]

The effects of cardiovascular disease extend beyond the heart itself. When blood flow to the brain is reduced or blocked, brain cells begin to die within minutes. This causes the symptoms of a stroke, which may include paralysis, difficulty speaking, and loss of consciousness. Unlike some other tissues in the body, brain tissue cannot regenerate, so damage from stroke is often permanent.^[3]

In peripheral artery disease, reduced blood flow to the limbs can cause muscles to be starved of oxygen, particularly during exercise. This creates cramping pain and can lead to tissue damage. In severe cases, tissues may die, requiring amputation. Poor blood flow also impairs healing, so injuries to affected areas may not heal properly.^[1]