Cardiovascular Disease Overview
Also indexed as: Circulatory Disease, Heart Disease
A heart-to-heart on cardiovascular disease: Make simple changes
to help you beat the odds against heart disease, a leading cause of death. According to
research or other evidence, the following self-care steps may be helpful:
- Get smoke-free
- Quit smoking and stay clear of cigarette smoke to lower your risk
of several types of cardiovascular disease
- Watch what you eat
- Eat lots of fruits, vegetables, legumes, whole grains, fish, and
avoid fats from meat, dairy, and processed foods high in hydrogenated oils
- Stay active
- Couch potatoes have increased cardiovascular disease risk, so make
sure you get regular exercise
- Get tested
- See your healthcare provider to find out if you have problems with
high blood pressure or high blood levels of cholesterol, triglycerides, or glucose
These recommendations are not comprehensive and are not intended to replace
the advice of your doctor or pharmacist. Continue reading the full cardiovascular disease
article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and
dietary and lifestyle changes that may be helpful.
About cardiovascular disease
Cardiovascular disease is a wide-encompassing category that includes all conditions that
affect the heart and the blood vessels.
Cardiovascular disease is the number one cause of death in the United States. This
introductory article briefly discusses several diseases that have a role in the development of
cardiovascular disease. Many risk factors are associated with cardiovascular disease; most can
be managed, but some cannot. The aging process and hereditary predisposition are risk factors
that cannot be altered. Until age 50, men are at greater risk than women of developing heart
disease, though once a woman enters menopause,
her risk triples.1
Many people with cardiovascular disease have elevated or high cholesterol levels.2 Low HDL
cholesterol (known as the “good” cholesterol) and high LDL cholesterol (known as
the “bad” cholesterol) are more specifically linked to cardiovascular disease than
is total cholesterol.3 A blood test, administered by most healthcare professionals,
is used to determine cholesterol levels.
Atherosclerosis (hardening of the arteries)
of the vessels that supply the heart with blood is the most common cause of heart attacks. Atherosclerosis and high cholesterol
usually occur together, though cholesterol levels can change quickly and atherosclerosis
generally takes decades to develop.
The link between high triglyceride levels
and heart disease is not as well established as the link between high cholesterol and heart
disease. According to some studies, a high triglyceride level is an independent risk factor
for heart disease in some people.4
High homocysteine levels have been
identified as an independent risk factor for heart disease.5 Homocysteine can be
measured by a blood test that must be ordered by a healthcare professional.
Hypertension (high blood pressure) is a
major risk factor for cardiovascular disease, and the risk increases as blood pressure
rises.6 Glucose intolerance and
diabetes constitute separate risk factors for heart disease. Smoking increases the risk of
heart disease caused by hypertension.
Abdominal fat, or a “beer belly,” versus fat that accumulates on the hips, is
associated with increased risk of cardiovascular disease and heart attack.7 Overweight individuals are more likely to have
additional risk factors related to heart disease, specifically hypertension, high blood sugar
levels, high cholesterol, high triglycerides, and diabetes.
What are the symptoms?
People with cardiovascular disease may not have any symptoms, or they may experience
difficulty in breathing during exertion or when lying down, fatigue, lightheadedness,
dizziness, fainting, depression, memory
problems, confusion, frequent waking during sleep, chest pain, an awareness of the heartbeat,
sensations of fluttering or pounding in the chest, swelling around the ankles, or a large
Over the counter aspirin (Bayer
Children’s Aspirin®, Ecotrin Adult Low Strength®, Halfprin 81®) might be
beneficial for reducing recurrent strokes and for reducing the risk of future heart
Use of prescription medications is directed toward any underlying causes. Drugs used may
include ACE inhibitors, such as captopril (Capoten®), enalapril (Vasotec®), and lisinopril (Zestril®, Prinivil®); beta-blockers, such as atenolol (Tenormin®), metoprolol (Lopressor®, Toprol XL®), and propranolol (Inderal®); and the combination
of hydralazine (Apresoline®) and isosorbide dinitrate (Isordil®). Other
medications often prescribed include the blood thinner warfarin (Coumadin®); digoxin (Lanoxin®); nitroglycerin (Nitrostat®, Nitro-Dur®); and
diuretics, such as hydrochlorothiazide
(HydroDIURIL®) and furosemide (Lasix®).
Surgical treatments, such as angioplasty, bypass surgery, valve replacement, pacemaker
installation, and heart transplantation, may be recommended for severe cases. Individuals with
cardiovascular disease are strongly encouraged to stop smoking.
Dietary changes that may be helpful
Preliminary evidence has linked high salt consumption with increased cardiovascular disease
incidence and death among overweight, but not normal weight, people. Among overweight people,
an increase in salt consumption of 2.3 grams per day was associated with a 32% increase in stroke incidence, an 89% increase in stroke
mortality, a 44% increase in heart disease mortality, a 61% increase in cardiovascular disease
mortality, and a 39% increase in death from all causes.8 Intervention trials are
required to confirm these preliminary observations.
Moderate alcohol consumption appears protective against heart disease.9 However,
regular, light alcohol consumption in men with established coronary heart disease is not
associated with either benefit or deleterious effect.10
A high intake of carotenoids from dietary
sources has been shown to be protective against heart disease in several population-based
studies.11 12 A diet high in fruits and vegetables,13 fiber,14 and possibly fish15 appears protective against heart
disease, while a high intake of saturated fat
(found in meat and dairy fat) and trans fatty acids (in margarine and processed foods containing hydrogenated
vegetable oils)16 may contribute to
heart disease. In a preliminary study, the total number of deaths from cardiovascular disease
was significantly lower among men with high fruit consumption17 than among those
with low fruit consumption. A large study of male healthcare professionals found that those
men eating mostly a “prudent” diet (high in fruits, vegetables, legumes,
whole grains, fish, and poultry) had a 30%
lower risk of heart attacks compared
with men who ate the fewest foods in the “prudent” category.18 By
contrast, men who ate the highest percentage of their foods from the “typical American
diet” category (high in red meat, processed meat, refined grains, sweets, and desserts)
had a 64% increased risk of heart attack, compared with men who ate the fewest foods
in that category. The various risks in this study were derived after controlling for all other
beneficial or harmful influencing factors.
A parallel study of female healthcare professionals showed a 15% reduction in
cardiovascular risk for those women eating a diet high in fruits and vegetables—compared
with those eating a diet low in fruits and vegetables.19
Lifestyle changes that may be helpful
Both smoking20 and exposure to secondhand smoke21 increase
cardiovascular disease risk.
Moderate exercise protects both lean and
obese individuals from cardiovascular disease.22
1. Kannel WB. Hazards, risks, and threats of heart disease from the early
stages to symptomatic coronary heart disease and cardiac failure. Cardiovasc Drugs
Ther 1997;11 Suppl:199–212 [review].
2. Kinosian B, Glick H, Garland G. Cholesterol and coronary heart
disease: predicting risks by levels and ratios. Ann Intern Med
3. Kwiterovich PO Jr. The antiatherogenic role of high-density
lipoprotein cholesterol. Am J Cardiol 1998;82:Q13–21 [review].
4. Gotto AM Jr. Triglyceride as a risk factor for coronary artery
disease. Am J Cardiol 1998;1998;82:Q22–5 [review].
5. Seman LJ, McNamara JR, Schaefer EJ. Lipoprotein(a), homocysteine, and
remnantlike particles: emerging risk factors. Curr Opin Cardiol
6. Kannel WB. Office assessment of coronary candidates and risk factor
insights from the Framingham study. J Hypertens Suppl 1991;9:S13–9.
7. Megnien JL, Denarie N, Cocaul M, et al. Predictive value of
waist-to-hip ratio on cardiovascular risk events. Int J Obes Relat Metab Disord
8. He J, Ogden LG, Vupputuri S, et al. Dietary sodium intake and
subsequent risk of cardiovascular disease in overweight adults. JAMA
9. Schaefer FJ, Lamon-Fava S, Ordovas JM, et al. Factors associated with
low and elevated plasma high density lipoprotein cholesterol and apolipoprotein A-1 levels in
the Framingham Offspring Study. J Lipid Res 1994;35:871–82.
10. Shaper AG, Wannamethee SG. Alcohol intake and mortality in middle
aged men with diagnosed coronary heart disease. Heart 2000;83:394–9.
11. Kritchevsky SB. Beta-carotene, carotenoids and the prevention of
coronary heart disease. J Nutr 1999;129:5–8 [review].
12. Palace VP, Khaper N, Qin Q, Singal PK. Antioxidant potentials of
vitamin A and carotenoids and their relevance to heart disease. Free Radic Biol Med
13. Law MR, Morris JK. By how much does fruit and vegetable consumption
reduce the risk of ischaemic heart disease? Eur J Clin Nutr 1998;52:549–56.
14. Pietinen P, Rimm EB, Korhonen P, et al. Intake of dietary fiber and
risk of coronary heart disease in a cohort of Finnish men. The Alpha-Tocopherol, Beta-Carotene
Cancer Prevention Study. Circulation 1996;94:2720–7.
15. Albert CM, Hennekens CH, O’Donnell CJ, et al. Fish consumption
and risk of sudden cardiac death. JAMA 1998;279:23–8.
16. Hu FB, Stampfer MJ, Rimm E, et al. Dietary fat and coronary heart
disease: a comparison of approaches for adjusting for total energy intake and modeling
repeated dietary measurements. Am J Epidemiol 1999;149:531–40.
17. Strandhagen E, Hansson PO, Bosaeus I, et al. High fruit intake may
reduce mortality among middle-aged and elderly men. The Study of Men Born in 1913. Eur J
Clin Nutr 2000;54:337–41.
18. Kinosian B, Glick H, Garland G. Cholesterol and coronary heart
disease: predicting risks by levels and ratios. Ann Intern Med
19. Kannel WB. Hazards, risks, and threats of heart disease from the
early stages to symptomatic coronary heart disease and cardiac failure. Cardiovasc Drugs
Ther 1997;11 Suppl:199–212 [review].
20. Freund KM, Belanger AJ, D’Agostino RB, Kannel WB. The health
risks of smoking. The Framingham Study: 34 years of follow-up. Ann Epidemiol
21. Law MR, Morris JK, Wald NJ. Environmental tobacco smoke exposure and
ischaemic heart disease: an evaluation of the evidence. BMJ
22. Lee CD, Blair SN, Jackson AS. Cardiorespiratory fitness, body
composition, and all-cause and cardiovascular disease mortality in men. Am J Clin