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The Importance of Heart Diseases

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Published: Mar 20, 2024

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Heart Disease - Free Essay Examples and Topic Ideas

Heart disease refers to a range of conditions that affect the heart’s ability to function properly. These conditions may include issues with the heart’s blood vessels, valves, or rhythm. Heart disease is a leading cause of death worldwide, and common risk factors include a poor diet, lack of exercise, smoking, and high blood pressure or cholesterol. Symptoms of heart disease may include chest pain, shortness of breath, fatigue, and palpitations. Treatment options range from medications and lifestyle changes to surgery or other medical procedures, depending on the severity of the condition.

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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.

• 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 […]
• 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.
• 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.
• 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.
• 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.
• 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.
• 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 […]
• 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 Coronary Heart Disease In such a manner, the delivery of blood with oxygen and nutrients to the whole body is timely and undisrupted, which guarantees the healthy functioning of the whole physiological system.
• 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 […]
• 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.
• Pathophysiology of Congestive Heart Failure Cardiac output and stroke volume is lowered due to vasoconstriction. It causes pressure overload, which leads to congestion.
• 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.
• 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 […]
• 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.
• 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 […]
• 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.
• 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.
• 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.
• 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.
• 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.
• 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 […]
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Heart disease is rampant in parts of the rural South. Researchers are hitting the road to learn why

Public health experts from some of the nation’s leading research universities have deployed a massive medical trailer to rural parts of the South as part of an ambitious and unusual new health study

Darrell Dixon’s father was just 25 when he had a major heart attack in the rural Mississippi Delta. By his early 40s, a series of additional attacks had left his heart muscle too weak to pump enough blood to his body. He died in 2013 at the age of 49.

“It was a big jolt for our family,” Dixon, 36, recalled. “For myself, personally, it also got me thinking about heredity. I just wondered whether I was next.”

The death spurred Dixon to get involved in an unusual and ambitious new health study.

Public health experts from some of the nation’s leading research institutions have deployed a massive medical trailer to rural parts of the South to test and survey thousands of local residents. The goal: to understand why the rates of heart and lung disease are dramatically higher there than in other parts of the U.S.

“This rural health disadvantage, it doesn’t matter whether you’re white or Black, it hurts you,” said Dr. Vasan Ramachandran, a leader of the project who used to oversee the Framingham Heart Study — the nation's longest-running study of heart disease. “No race is spared, although people of color fare worse.”

The researchers aim to test the heart and lung function of roughly 4,600 residents of 10 counties and parishes in Alabama, Kentucky, Louisiana and Mississippi while collecting information about their environments, health history and lifestyles. They are also giving participants a fitness tracker and plan to survey them repeatedly for years to check for any major medical events.

Ramachandran, now dean of the University of Texas School of Public Health in San Antonio, said rural populations in the U.S. rarely receive such personal, long-term attention from epidemiologists. More than a dozen institutions are helping with the study, including Johns Hopkins University, the University of California, Berkeley, and Duke University.

The 52-foot-long (16-meter-long), 27-ton trailer is outfitted with instruments that examine calcium in the arteries, the structure of the heart, lung capacity and other, more common health indicators such as blood pressure and weight. The initial exam can take more than three hours.

“They’re reaching out and going out into the community in ways that I have not seen before,” said Lynn Spruill, the mayor of Starkville, Mississippi, in Oktibbeha County, where the trailer arrived in 2022 and medical staff tested more than 700 people.

Studies and data from U.S. health officials show rural populations in the U.S. are unhealthier and have lower life expectancy than Americans in urban areas. The health disparity is even greater in the South, where mortality rates from heart disease — the leading cause of death in the U.S. — for people 35 and older are more than twice the national average in some rural communities. Lung conditions such as chronic obstructive pulmonary disease, or COPD, which the study is also examining, are also more prevalent in the South.

Researchers have multiple theories for the disparity. Hospital closures and physician shortages have left many rural residents with limited access to care. Healthy food, fitness opportunities and public transit are often scarcer. Poverty rates are higher, and fewer people receive health coverage through their employers. In the rural South, poverty rates and the share of people without health insurance are even greater.

Smoking cigarettes is a major cause of heart disease, and at least 20% of adults smoked in Alabama, Kentucky, Louisiana and Mississippi , according to 2019 data from the U.S. Centers for Disease Control and Prevention. Obesity is another factor. In 2022, self-reported height and weight put between 38% and 40% of adults in the four states in the obese body mass index category.

By closely examining local residents and their environments, the rural study seeks clearer answers about what's driving the additional health burden in the South. Researchers also want to understand what makes some rural counties there much healthier than others.

“We’re interested in both the risk, but also the resilience piece of it," said Lindsay Pool, an epidemiologist with the National Heart Lung and Blood Institute, which has awarded more than $40 million for the study.

To accomplish that goal, researchers are also visiting rural areas with low risk for heart and lung disease in three of the states — Louisiana, Mississippi and Kentucky — despite similar demographics.

Oktibbeha County, home to Mississippi State University, in the eastern part of Mississippi near the Alabama border, is the low-risk location. The researchers are contrasting it with Panola County in northern Mississippi about 60 miles (97 kilometers) south of Memphis, Tennessee.

Both counties have poverty rates that exceed 20% and a similar and sizeable share of people under 65 without health insurance. But between 2019 and 2021, the death rate from heart disease for those 35 and over was 647 per 100,000 people in Panola County compared to 395 per 100,000 in Oktibbeha County, according to CDC data .

In more urban Rankin County, Mississippi, part of the Jackson metro area, the figure was 331. The U.S. average over the same period was 326.

Dixon, who works in Panola County for a regional development organization and serves as a consultant for the heart and lung study, helped recruit more than 600 Panola County residents for the project. Heart conditions are so prevalent there that it's common to hear people discussing their medications and side effects at local shops and churches, he said.

Dixon’s father, Darrell Dixon Sr., lived in Clarksdale, about 40 miles (64 kilometers) west of Panola County. He long suffered from high blood pressure and had a strong family history of heart disease.

He had an additional major heart attack after an inmate he had grown close to as chaplain of the Mississippi State Penitentiary was executed, Dixon said, and then spent the last years of his life in and out of the hospital with congestive heart failure.

“He really suffered,” Dixon said. He hopes the study will shed light on any unseen environmental factors that may have played a role in his dad's death and raise awareness among local residents about “how to live better.”

The trailer is now in Louisiana's northeastern Franklin Parish, where the death rate from heart disease between 2019 and 2021 was a whopping 859 per 100,000 people for those 35 and over, according to the CDC data. About 200 miles (322 kilometers) south in New Orleans, it was 340.

The National Heart, Lung and Blood Institute plans to extend the study to 2031, and researchers hope to examine all the participants in person again.

“The longer you can follow people, the more you can understand disease development and progression,” Pool, the epidemiologist, said.

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Reflection and perspective are invited, collected, and presented here about the causes, care, control, prevention, epidemiology, and public policy of heart attacks.

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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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Cardiovascular disease.

Edgardo Olvera Lopez ; Brian D. Ballard ; Arif Jan .

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Last Update: August 22, 2023 .

• Continuing Education Activity

The cardiovascular system consists of the heart and its blood vessels. A wide array of problems can arise within the cardiovascular system, a few of which include endocarditis, rheumatic heart disease, and conduction system abnormalities. Cardiovascular disease, also known as heart disease, refers to the following 4 entities: coronary artery disease (CAD) which is also referred to as coronary heart disease (CHD), cerebrovascular disease, peripheral artery disease (PAD), and aortic atherosclerosis. CAD results from decreased myocardial perfusion that causes angina due to ischemia and can result in myocardial infarction (MI), and/or heart failure. It accounts for one-third to one-half of all cases of cardiovascular disease. Cerebrovascular disease is the entity associated with strokes, also termed cerebrovascular accidents, and transient ischemic attacks (TIAs). Peripheral arterial disease (PAD) is arterial disease predominantly involving the limbs that may result in claudication. Aortic atherosclerosis is the entity associated with thoracic and abdominal aneurysms. This activity reviews the evaluation and treatment of cardiovascular disease and the role of the medical team in evaluating and treating these conditions.

• Review the cause of coronary artery disease.
• Describe the pathophysiology of atherosclerosis.
• Summarize the treatment options for heart disease.
• Outline the evaluation and treatment of cardiovascular disease and the role of the medical team in evaluating and treating this condition.
• Introduction

The cardiovascular system consists of the heart and blood vessels. [1]  There is a wide array of problems that may arise within the cardiovascular system, for example, endocarditis, rheumatic heart disease, abnormalities in the conduction system, among others, cardiovascular disease (CVD) or heart disease refer to the following 4 entities that are the focus of this article [2] :

• Coronary artery disease (CAD): Sometimes referred to as Coronary Heart Disease (CHD), results from decreased myocardial perfusion that causes angina, myocardial infarction (MI), and/or heart failure. It accounts for one-third to one-half of the cases of CVD.
• Cerebrovascular disease (CVD): Including stroke and transient ischemic attack (TIA)
• Peripheral artery disease (PAD): Particularly arterial disease involving the limbs that may result in claudication
• Aortic atherosclerosis:  Including thoracic and abdominal aneurysms

Although CVD may directly arise from different etiologies such as emboli in a patient with atrial fibrillation resulting in ischemic stroke, rheumatic fever causing valvular heart disease, among others, addressing risks factors associated to the development of atherosclerosis is most important because it is a common denominator in the pathophysiology of CVD.

The industrialization of the economy with a resultant shift from physically demanding to sedentary jobs, along with the current consumerism and technology-driven culture that is related to longer work hours, longer commutes, and less leisure time for recreational activities, may explain the significant and steady increase in the rates of CVD during the last few decades. Specifically, physical inactivity, intake of a high-calorie diet, saturated fats, and sugars are associated with the development of atherosclerosis and other metabolic disturbances like metabolic syndrome, diabetes mellitus, and hypertension that are highly prevalent in people with CVD. [3] [2] [4] [5]

According to the INTERHEART study that included subjects from 52 countries, including high, middle, and low-income countries, 9 modifiable risks factors accounted for 90% of the risk of having a first MI: smoking, dyslipidemia, hypertension, diabetes, abdominal obesity, psychosocial factors, consumption of fruits and vegetables, regular alcohol consumption, and physical inactivity. It is important to mention that in this study 36% of the population-attributable risk of MI was accounted to smoking. [6]

Other large cohort studies like the Framingham Heart Study [7] and the Third National Health and Nutrition Examination Survey (NHANES III) [5] have also found a strong association and predictive value of dyslipidemia, high blood pressure, smoking, and glucose intolerance. Sixty percent to 90% of CHD events occurred in subjects with at least one risk factor.

These findings have been translated into health promotion programs by the American Heart Association with emphasis on seven recommendations to decrease the risk of CVD: avoiding smoking, being physically active, eating healthy, and keeping normal blood pressure, body weight, glucose, and cholesterol levels. [8] [9]

On the other hand, non-modifiable factors as family history, age, and gender have different implications. [4] [7] Family history, particularly premature atherosclerotic disease defined as CVD or death from CVD in a first-degree relative before 55 years (in males) or 65 years (in females) is considered an independent risk factor. [10] There is also suggestive evidence that the presence of CVD risk factors may differently influence gender. [4] [7]  For instance, diabetes and smoking more than 20 cigarettes per day had increased CVD risk in women compared to men. [11] Prevalence of CVD increases significantly with each decade of life. [12]  

The presence of HIV (human immunodeficiency virus), [13]  history of mediastinal or chest wall radiation, [14]  microalbuminuria, [15] , increased inflammatory markers [16] [17]  have also been associated with an increased rate and incidence of CVD. 

Pointing out specific diet factors like meat consumption, fiber, and coffee and their relation to CVD remains controversial due to significant bias and residual confounding encountered in epidemiological studies. [18] [19]

• Epidemiology

Cardiovascular diseases (CVD) remain among the 2 leading causes of death in the United States since 1975 with 633,842 deaths or 1 in every 4 deaths, heart disease occupied the leading cause of death in 2015 followed by 595,930 deaths related to cancer. [2]  CVD is also the number 1 cause of death globally with an estimated 17.7 million deaths in 2015, according to the World Health Organization (WHO). The burden of CVD further extends as it is considered the most costly disease even ahead of Alzheimer disease and diabetes with calculated indirect costs of $237 billion dollars per year and a projected increased to $368 billion by 2035. [20]

Although the age-adjusted rate and acute mortality from MI have been declining over time, reflecting the progress in diagnosis and treatment during the last couple of decades, the risk of heart disease remains high with a calculated 50% risk by age 45 in the general population. [7] [21]  The incidence significantly increases with age with some variations between genders as the incidence is higher in men at younger ages. [2]  The difference in incidence narrows progressively in the post-menopausal state. [2]

• Pathophysiology

Atherosclerosis is the pathogenic process in the arteries and the aorta that can potentially cause disease as a consequence of decreased or absent blood flow from stenosis of the blood vessels. [22]

It involves multiple factors dyslipidemia, immunologic phenomena, inflammation, and endothelial dysfunction. These factors are believed to trigger the formation of fatty streak, which is the hallmark in the development of the atherosclerotic plaque [23] ; a progressive process that may occur as early as in the childhood. [24]  This process comprises intimal thickening with subsequent accumulation of lipid-laden macrophages (foam cells) and extracellular matrix, followed by aggregation and proliferation of smooth muscle cells constituting the formation of the atheroma plaque. [25]  As this lesions continue to expand, apoptosis of the deep layers can occur, precipitating further macrophage recruitment that can become calcified and transition to atherosclerotic plaques. [26]

Other mechanisms like arterial remodeling and intra-plaque hemorrhage play an important role in the delay and accelerated the progression of atherosclerotic CVD but are beyond the purpose of this article. [27]

• History and Physical

The clinical presentation of cardiovascular diseases can range from asymptomatic (e.g., silent ischemia, angiographic evidence of coronary artery disease without symptoms, among others) to classic presentations as when patients present with typical anginal chest pain consistent of myocardial infarction and/or those suffering from acute CVA presenting with focal neurological deficits of sudden onset. [28] [29] [28]

Historically, coronary artery disease typically presents with angina that is a pain of substernal location, described as a crushing or pressure in nature, that may radiate to the medial aspect of the left upper extremity, to the neck or the jaw and that can be associated with nausea, vomiting, palpitations, diaphoresis, syncope or even sudden death. [30]  Physicians and other health care providers should be aware of possible variations in symptom presentation for these patients and maintain a high index of suspicion despite an atypical presentation, for example, dizziness and nausea as the only presenting symptoms in patients having an acute MI [31] ), particularly in people with a known history of CAD/MI and for those with the presence of CVD risk factors. [32] [33] [34] [33] [32]  Additional chest pain features suggestive of ischemic etiology are the exacerbation with exercise and or activity and resolution with rest or nitroglycerin. [35]

Neurologic deficits are the hallmark of cerebrovascular disease including TIA and stroke where the key differentiating factor is the resolution of symptoms within 24 hours for patients with TIA. [36]  Although the specific symptoms depend on the affected area of the brain, the sudden onset of extremity weakness, dysarthria, and facial droop are among the most commonly reported symptoms that raise concern for a diagnosis of a stroke. [37] [38]  Ataxia, nystagmus and other subtle symptoms as dizziness, headache, syncope, nausea or vomiting are among the most reported symptoms with people with posterior circulation strokes challenging to correlate and that require highly suspicion in patients with risks factors. [39]

Patients with PAD may present with claudication of the limbs, described as a cramp-like muscle pain precipitated by increased blood flow demand during exercise that typically subsides with rest. [40] Severe PAD might present with color changes of the skin and changes in temperature. [41]  

Most patients with thoracic aortic aneurysm will be asymptomatic, but symptoms can develop as it progresses from subtle symptoms from compression to surrounding tissues causing cough, shortness of breath or dysphonia, to the acute presentation of sudden crushing chest or back pain due to acute rupture. [42]  The same is true for abdominal aortic aneurysms (AAA) that cause no symptoms in early stages to the acute presentation of sudden onset of abdominal pain or syncope from acute rupture. [43]

A thorough physical examination is paramount for the diagnosis of CVD. Starting with a general inspection to look for signs of distress as in patients with angina or with decompensated heart failure, or chronic skin changes from PAD. Carotid examination with the patient on supine position and the back at 30 degrees for the palpation and auscultation of carotid pulses, bruits and to evaluate for jugular venous pulsations on the neck is essential. Precordial examination starting with inspection, followed by palpation looking for chest wall tenderness, thrills, and identification of the point of maximal impulse should then be performed before auscultating the precordium. Heart sounds auscultation starts in the aortic area with the identification of the S1 and S2 sounds followed by characterization of murmurs if present. Paying attention to changes with inspirations and maneuvers to correctly characterize heart murmurs is encouraged. Palpating peripheral pulses with bilateral examination and comparison when applicable is an integral part of the CVD examination. [44]

Thorough clinical history and physical exam directed but not limited to the cardiovascular system are the hallmarks for the diagnosis of CVD. Specifically, a history compatible with obesity, angina, decreased exercise tolerance, orthopnea, paroxysmal nocturnal dyspnea, syncope or presyncope, and claudication should prompt the clinician to obtain a more detailed history and physical exam and, if pertinent, obtain ancillary diagnostic test according to the clinical scenario (e.g., electrocardiogram and cardiac enzymes for patients presenting with chest pain). 

Besides a diagnosis prompted by clinical suspicion, most of the efforts should be oriented for primary prevention by targeting people with the presence of risk factors and treat modifiable risk factors by all available means. All patient starting at age 20 should be engaged in the discussion of CVD risk factors and lipid measurement. [9]  Several calculators that use LDL-cholesterol and HDL-cholesterol levels and the presence of other risk factors calculate a 10-year or 30-year CVD score to determine if additional therapies like the use of statins and aspirin are indicated for primary prevention, generally indicated if such risk is more than ten percent. [10]  Like other risk assessment tools, the use of this calculators have some limitations, and it is recommended to exert precaution when assessing patients with diabetes and familial hypercholesterolemia as their risk can be underestimated. Another limitation to their use is that people older than 79 were usually excluded from the cohorts where these calculators were formulated, and individualized approach for these populations is recommended by discussing risk and benefits of adjunctive therapies and particular consideration of life expectancy. Some experts recommend a reassessment of CVD risk every 4 to 6 years. [9]

Preventative measures like following healthy food habits, avoiding overweight and following an active lifestyle are pertinent in all patients, particularly for people with non-modifiable risk factors such as family history of premature CHD or post-menopause. [9] [8]

The use of inflammatory markers and other risk assessment methods as coronary artery calcification score (CAC) are under research and have limited applications that their use should not replace the identification of people with known risk factors, nonetheless these resources remain as promising tools in the future of primary prevention by detecting people with subclinical atherosclerosis at risk for CVD. [45]

• Treatment / Management

Management of CVD is very extensive depending on the clinical situation (catheter-directed thrombolysis for acute ischemic stroke, angioplasty for peripheral vascular disease, coronary stenting for CHD); however, patients with known CVD should be strongly educated on the need for secondary prevention by risk factor and lifestyle modification. [9] [46]

• Differential Diagnosis
• Acute pericarditis
• Angina pectoris
• Artherosclerosis
• Coronary artery vasospasm
• Dilated cardiomyopathy
• Giant cell arteritis
• Hypertension
• Hypertensive heart disease
• Kawasaki disease
• Myocarditis

The prognosis and burden of CVD have been discussed in other sections.

• Complications

The most feared complication from CVD is death and, as explained above, despite multiple discoveries in the last decades CVD remains in the top leading causes of death all over the world owing to the alarming prevalence of CVD in the population. [2]  Other complications as the need for longer hospitalizations, physical disability and increased costs of care are significant and are the focus for health-care policymakers as it is believed they will continue to increase in the coming decades. [20]

For people with heart failure with reduced ejection fraction (HFreEF) of less than 35%, as the risk of life-threatening arrhythmias is exceedingly high in these patients, current guidelines recommend the implantation of an implantable-cardioverter defibrillator (ICD) for those with symptoms equivalent to a New York Heart Association (NYHA) Class II-IV despite maximal tolerated medical therapy. [47]

Strokes can leave people with severe disabling sequelae like dysarthria or aphasia, dysphagia, focal or generalized muscle weakness or paresis that can be temporal or cause permanent physical disability that may lead to a complete bedbound state due to hemiplegia with added complications secondary to immobility as is the higher risk of developing urinary tract infections and/or risk for thromboembolic events. [48] [49]

There is an increased risk of all-cause death for people with PAD compared to those without evidence of peripheral disease. [50]  Chronic wounds, physical limitation, and limb ischemia are among other complications from PAD. [51]

• Consultations

An interprofessional approach that involves primary care doctors, nurses, dietitians, cardiologists, neurologists, and other specialists is likely to improve outcomes. This has been shown to be beneficial in patients with heart failure, [52]  coronary disease, [53]  and current investigations to assess the impact on other forms of CVD are under planning and promise encouraging results.

• Deterrence and Patient Education

Efforts should be directed toward primary prevention by leading a healthy lifestyle, and an appropriate diet starting as early as possible with the goal of delay or avoid the initiation of atherosclerosis as it relates to the future risk of CVD. The AHA developed the concept of "ideal cardiovascular health" defined by the presence of [8] :

• Ideal health behaviors: Nonsmoking, body mass index less than 25 kg/m2, physical activity at goal levels, and the pursuit of a diet consistent with current guideline recommendations
• Ideal health factors: Untreated total cholesterol less than 200 mg/dL, untreated blood pressure less than 120/80 mm Hg, and fasting blood glucose less than 100 mg/dL) with the goal to improve the health of all Americans with an expected decrease in deaths from CVD by 20%

Specific attention should be made to people at higher risk for CVD as are people with diabetes, hypertension, hyperlipidemia, smokers, and obese patients. Risk factors modification by controlling their medical conditions, avoiding smoking, taking appropriate measures to lose weight and maintaining an active lifestyle is of extreme importance. [8] [9] [10] The recommendations on the use of statins and low-dose aspirin for primary and secondary prevention has been discussed in other sections.

• Pearls and Other Issues

Cardiovascular disease generally refers to 4 general entities: CAD, CVD, PVD, and aortic atherosclerosis. 

CVD is the main cause of death globally.

Measures aimed to prevent the progression of atherosclerosis are the hallmark for primary prevention of CVD.

Risk factor and lifestyle modification are paramount in the prevention of CVD.

• Enhancing Healthcare Team Outcomes

An interprofessional and patient-oriented approach can help to improve outcomes for people with cardiovascular disease as shown in patients with heart failure (HF) who had better outcomes when the interprofessional involvement of nurses, dietitians, pharmacists, and other health professionals was used (Class 1A). [52]

Similarly, positive results were obtained in people in an intervention group who were followed by an interprofessional team comprised of pharmacists, nurses and a team of different physicians. This group had a reduction in all-cause mortality associated with CAD by 76% compared to the control group. [53]  Healthcare workers should educate the public on lifestyle changes and reduce the modifiable risk factors for heart disease to a minimum.

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• Access free multiple choice questions on this topic.
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Atherosclerosis as a result of coronary heart disease. Contributed by National Heart, Lung and Blood Institute (NIH)

Coronary Artery Disease Pathophysiology. Coronary artery disease is usually caused by an atherosclerotic plaque that blocks the lumen of a coronary artery, typically the left anterior descending artery. Contributed by S Bhimji, MD

Disclosure: Edgardo Olvera Lopez declares no relevant financial relationships with ineligible companies.

Disclosure: Brian Ballard declares no relevant financial relationships with ineligible companies.

Disclosure: Arif Jan declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Olvera Lopez E, Ballard BD, Jan A. Cardiovascular Disease. [Updated 2023 Aug 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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• Review De-risking primary prevention: role of imaging. [Ther Adv Cardiovasc Dis. 2021] Review De-risking primary prevention: role of imaging. Shafter AM, Shaikh K, Johanis A, Budoff MJ. Ther Adv Cardiovasc Dis. 2021 Jan-Dec; 15:17539447211051248.
• Shared and non-shared familial susceptibility of coronary heart disease, ischemic stroke, peripheral artery disease and aortic disease. [Int J Cardiol. 2013] Shared and non-shared familial susceptibility of coronary heart disease, ischemic stroke, peripheral artery disease and aortic disease. Calling S, Ji J, Sundquist J, Sundquist K, Zöller B. Int J Cardiol. 2013 Oct 3; 168(3):2844-50. Epub 2013 Apr 30.
• Stenting for peripheral artery disease of the lower extremities: an evidence-based analysis. [Ont Health Technol Assess Ser....] Stenting for peripheral artery disease of the lower extremities: an evidence-based analysis. Medical Advisory Secretariat. Ont Health Technol Assess Ser. 2010; 10(18):1-88. Epub 2010 Sep 1.
• Polyvascular disease and long-term cardiovascular outcomes in older patients with non-ST-segment-elevation myocardial infarction. [Circ Cardiovasc Qual Outcomes....] Polyvascular disease and long-term cardiovascular outcomes in older patients with non-ST-segment-elevation myocardial infarction. Subherwal S, Bhatt DL, Li S, Wang TY, Thomas L, Alexander KP, Patel MR, Ohman EM, Gibler WB, Peterson ED, et al. Circ Cardiovasc Qual Outcomes. 2012 Jul 1; 5(4):541-9. Epub 2012 Jun 19.
• Review Prevention of ventricular fibrillation, acute myocardial infarction (myocardial necrosis), heart failure, and mortality by bretylium: is ischemic heart disease primarily adrenergic cardiovascular disease? [Am J Ther. 2004] Review Prevention of ventricular fibrillation, acute myocardial infarction (myocardial necrosis), heart failure, and mortality by bretylium: is ischemic heart disease primarily adrenergic cardiovascular disease? Bacaner M, Brietenbucher J, LaBree J. Am J Ther. 2004 Sep-Oct; 11(5):366-411.

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• Coronary artery disease

Coronary artery disease (CAD) is a common type of heart disease. It affects the main blood vessels that supply blood to the heart, called the coronary arteries. In CAD, there is reduced blood flow to the heart muscle. A buildup of fats, cholesterol and other substances in and on the artery walls, a condition called atherosclerosis, usually causes coronary artery disease. The buildup, called plaque, makes the arteries narrow.

Coronary artery disease often develops over many years. Symptoms are from the lack of blood flow to the heart. They may include chest pain and shortness of breath. A complete blockage of blood flow can cause a heart attack.

Treatment for coronary artery disease may include medicines and surgery. Eating a nutritious diet, getting regular exercise and not smoking can help prevent coronary artery disease and the conditions that can cause it.

Coronary artery disease also may be called coronary heart disease.

• What is coronary artery disease? A Mayo Clinic cardiologist explains.

Stephen Kopecky, M.D., talks about the risk factors, symptoms and treatment of coronary artery disease (CAD). Learn how lifestyle changes can lower your risk.

{Music playing}

Stephen Kopecky, M.D., Cardiovascular Disease, Mayo Clinic: I'm Dr. Stephen Kopecky, a cardiologist at Mayo Clinic. In this video, we'll cover the basics of coronary artery disease. What is it? Who gets it? The symptoms, diagnosis and treatment. Whether you're looking for answers for yourself or someone you love, we're here to give you the best information available.

Coronary artery disease, also called CAD, is a condition that affects your heart. It is the most common heart disease in the United States. CAD happens when coronary arteries struggle to supply the heart with enough blood, oxygen and nutrients. Cholesterol deposits, or plaques, are almost always to blame. These buildups narrow your arteries, decreasing blood flow to your heart. This can cause chest pain, shortness of breath or even a heart attack. CAD typically takes a long time to develop. So often, patients don't know that they have it until there's a problem. But there are ways to prevent coronary artery disease, and ways to know if you're at risk and ways to treat it.

Who gets it?

Anyone can develop CAD . It begins when fats, cholesterols and other substances gather along the walls of your arteries. This process is called atherosclerosis. It's typically no cause for concern. However, too much buildup can lead to a blockage, obstructing blood flow. There are a number of risk factors, common red flags, that can contribute to this and ultimately lead to coronary artery disease. First, getting older can mean more damaged and narrowed arteries. Second, men are generally at a greater risk. But the risk for women increases after menopause. Existing health conditions matter, too. High blood pressure can thicken your arteries, narrowing your blood flow. High cholesterol levels can increase the rate of plaque buildup. Diabetes is also associated with higher risk, as is being overweight. Your lifestyle plays a large role as well. Physical inactivity, long periods of unrelieved stress in your life, an unhealthy diet and smoking can all increase your risk. And finally, family history. If a close relative was diagnosed at an early age with heart disease, you're at a greater risk. All these factors together can paint a picture of your risk for developing CAD .

What are the symptoms?

When coronary arteries become narrow, the heart doesn't get enough oxygen-rich blood. Remember, unlike most pumps, the heart has to pump its own energy supply. It's working harder with less. And you may begin to notice these signs and symptoms of pressure or tightness in your chest. This pain is called angina. It may feel like somebody is standing on your chest. When your heart can't pump enough blood to meet your body's needs, you might develop shortness of breath or extreme fatigue during activities. And if an artery becomes totally blocked, it leads to a heart attack. Classic signs and symptoms of a heart attack include crushing, substernal chest pain, pain in your shoulders or arms, shortness of breath, and sweating. However, many heart attacks have minimal or no symptoms and are found later during routine testing.

How is it diagnosed?

Diagnosing CAD starts by talking to your doctor. They'll be able to look at your medical history, do a physical exam and order routine blood work. Depending on that, they may suggest one or more of the following tests: an electrocardiogram or ECG, an echocardiogram or soundwave test of the heart, stress test, cardiac catheterization and angiogram, or a cardiac CT scan.

How is it treated?

Treating coronary artery disease usually means making changes to your lifestyle. This might be eating healthier foods, exercising regularly, losing excess weight, reducing stress or quitting smoking. The good news is these changes can do a lot to improve your outlook. Living a healthier life translates to having healthier arteries. When necessary, treatment could involve drugs like aspirin, cholesterol-modifying medications, beta-blockers, or certain medical procedures like angioplasty or coronary artery bypass surgery.

Discovering you have coronary artery disease can be overwhelming. But be encouraged. There are things you can do to manage and live with this condition. Reducing cholesterol, lowering blood pressure, quitting tobacco, eating healthier, exercising and managing your stress can make a world of difference. Better heart health starts by educating yourself. So don't be afraid to seek out information and ask your doctors about coronary artery disease. If you'd like to learn even more about this condition, watch our other related videos or visit Mayoclinic.org. We wish you well.

Symptoms of coronary artery disease happen when the heart doesn't get enough oxygen-rich blood. Coronary artery disease symptoms may include:

• Chest pain, called angina. You may feel squeezing, pressure, heaviness, tightness or pain in the chest. It may feel like somebody is standing on your chest. The chest pain usually affects the middle or left side of the chest. Activity or strong emotions can trigger angina. There are different types of angina. The type depends on the cause and whether rest or medicine makes symptoms better. In some people, especially women, the pain may be brief or sharp and felt in the neck, arm or back.
• Shortness of breath. You may feel like you can't catch your breath.
• Fatigue . If the heart can't pump enough blood to meet your body's needs, you may feel unusually tired.

Symptoms of coronary artery disease may not be noticed at first. Sometimes symptoms only happen when the heart is beating hard, such as during exercise. As the coronary arteries continue to narrow, symptoms can get more severe or frequent.

A completely blocked coronary artery will cause a heart attack. Common heart attack symptoms include:

• Chest pain that may feel like pressure, tightness, squeezing or aching.
• Pain or discomfort that spreads to the shoulder, arm, back, neck, jaw, teeth or sometimes the upper belly.
• Cold sweats.
• Shortness of breath.
• Lightheadedness or sudden dizziness.

Chest pain is usually the most common symptom of heart attack. But for some people, such as women, the elderly and those with diabetes, symptoms may seem unrelated to a heart attack. For example, they may have nausea or a very brief pain in the neck or back. Some people having a heart attack don't notice symptoms.

When to see a doctor

If you think you're having a heart attack, immediately call 911 or your local emergency number. If you don't have access to emergency medical services, have someone drive you to the nearest hospital. Drive yourself only as a last option.

Smoking or having high blood pressure, high cholesterol, diabetes, obesity or a strong family history of heart disease makes you more likely to get coronary artery disease. If you're at high risk of coronary artery disease, talk to your healthcare professional. You may need tests to check for narrowed arteries and coronary artery disease.

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Development of atherosclerosis

If there's too much cholesterol in the blood, the cholesterol and other substances may form deposits called plaque. Plaque can cause an artery to become narrowed or blocked. If a plaque ruptures, a blood clot can form. Plaque and blood clots can reduce blood flow through an artery.

Coronary artery disease is caused by the buildup of fats, cholesterol and other substances in and on the walls of the heart arteries. This condition is called atherosclerosis. The buildup is called plaque. Plaque can cause the arteries to narrow, blocking blood flow. The plaque also can burst, causing a blood clot.

Some causes of atherosclerosis and coronary artery disease are:

• Diabetes or insulin resistance.
• High blood pressure.
• Lack of exercise.
• Smoking or tobacco use.

Risk factors

Coronary artery disease is common.

Coronary artery disease risk factors you can't control include:

• Age. Getting older increases the risk of damaged and narrowed arteries.
• Birth sex. Men are generally at greater risk of coronary artery disease. However, the risk for women increases after menopause.
• Family history. A family history of heart disease makes you more likely to get coronary artery disease. This is especially true if a parent, brother, sister or child got heart disease at an early age. The risk is highest if your father or a brother had heart disease before age 55 or if your mother or a sister developed it before age 65.

Coronary artery disease risk factors you can control are:

• Smoking. If you smoke, quit. Smoking is bad for heart health. People who smoke have a much greater risk of heart disease. Breathing in secondhand smoke also increases the risk.
• High blood pressure. Uncontrolled high blood pressure can make arteries hard and stiff. This can lead to atherosclerosis, which causes coronary artery disease.
• Cholesterol. Too much "bad" cholesterol in the blood can increase the risk of atherosclerosis. "Bad" cholesterol is called low-density lipoprotein (LDL) cholesterol. Not enough "good" cholesterol, called high-density lipoprotein (HDL) cholesterol, also leads to atherosclerosis.
• Diabetes. Diabetes increases the risk of coronary artery disease. Type 2 diabetes and coronary artery disease share some risk factors, such as obesity and high blood pressure.
• Obesity. Too much body fat is bad for overall health. Obesity can lead to type 2 diabetes and high blood pressure. Ask your healthcare team what a healthy weight is for you.
• Chronic kidney disease. Having long-term kidney disease increases the risk of coronary artery disease.
• Not getting enough exercise. Physical activity is important for good health. A lack of exercise is linked to coronary artery disease and some of its risk factors.
• A lot of stress . Emotional stress may damage the arteries and worsen other risk factors for coronary artery disease.
• Unhealthy diet. Eating foods with a lot of saturated fat, trans fat, salt and sugar can increase the risk of coronary artery disease.
• Alcohol use. Heavy alcohol use can lead to heart muscle damage. It also can worsen other risk factors of coronary artery disease.
• Amount of sleep. Too little sleep and too much sleep both have been linked to an increased risk of heart disease.

Risk factors often happen together. One risk factor may trigger another. When grouped together, some risk factors make you even more likely to develop coronary artery disease. For example, metabolic syndrome is a group of conditions that includes high blood pressure, high blood sugar, too much body fat around the waist and high triglyceride levels. Metabolic syndrome increases the risk of coronary artery disease.

Other possible risk factors for coronary artery disease may include:

• Breathing pauses during sleep, called obstructive sleep apnea. This condition causes breathing to stop and start during sleep. It can cause sudden drops in blood oxygen levels. The heart must work harder to pump blood. Blood pressure goes up.
• Increased high-sensitivity C-reactive protein (hs-CRP). This protein appears in higher than usual amounts when there's inflammation somewhere in the body. High hs-CRP levels may be a risk factor for heart disease. It's thought that as coronary arteries narrow, the level of hs-CRP in the blood goes up.
• High triglycerides. This is a type of fat in the blood. High levels may raise the risk of coronary artery disease, especially for women.
• High levels of homocysteine. Homocysteine is a substance that the body uses to make protein and to build and maintain tissue. But high levels of homocysteine may raise the risk of coronary artery disease.
• Preeclampsia. This pregnancy complication causes high blood pressure and increased protein in the urine. It can lead to a higher risk of heart disease later in life.
• Other pregnancy complications. Diabetes or high blood pressure during pregnancy are known risk factors for coronary artery disease.
• Certain autoimmune diseases. People who have conditions such as rheumatoid arthritis and lupus have an increased risk of atherosclerosis.

Complications

Complications of coronary artery disease may include:

• Chest pain, also called angina. This is a symptom of coronary artery disease. But it also can be a complication of worsening CAD. The chest pain happens when arteries narrow and the heart doesn't get enough blood.
• Heart attack. A heart attack can happen if atherosclerosis causes a blood clot. A clot can block blood flow. The lack of blood can damage the heart muscle. The amount of damage depends in part on how quickly you are treated.
• Heart failure. Narrowed arteries in the heart or high blood pressure can slowly make the heart weak or stiff. This can make it harder for the heart to pump blood.
• Irregular heart rhythms, called arrhythmias. If the heart doesn't get enough blood, changes in heart signaling can happen. This can cause irregular heartbeats.

Coronary artery disease care at Mayo Clinic

• Ferri FF. Coronary artery disease. In: Ferri's Clinical Advisor 2022. Elsevier; 2022. https://www.clinicalkey.com. Accessed March 8, 2022.
• Coronary heart disease. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/coronary-heart-disease. March 8, 2022.
• Usatine RP, et al., eds. Coronary artery disease. In: Color Atlas and Synopsis of Heart Failure. McGraw Hill; 2019.
• Wilson PWF. Overview of the possible risk factors for cardiovascular disease. https://www.uptodate.com/contents/search. Accessed March 8, 2022.
• Masjedi MS, et al. Effects of flaxseed on blood lipids in healthy and dyslipidemic subjects: A systematic review and meta-analysis of randomized controlled trials. Current Problems in Cardiology. 2021; doi:10.1016/j.cpcardiol.2021.100931.
• Riaz H, et al. Association between obesity and cardiovascular outcomes: A systematic review and meta-analysis of mendelian randomization studies. JAMA Network Open. 2018; doi:10.1001/jamanetworkopen.2018.3788.
• 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 March 8, 2022.
• Your guide to lowering your cholesterol with therapeutic lifestyle changes (TLC). National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/all-publications-and-resources/your-guide-lowering-cholesterol-therapeutic-lifestyle. Accessed March 24, 2022.
• Rethinking drinking. National Institute on Alcohol Abuse and Alcoholism. https://www.rethinkingdrinking.niaaa.nih.gov/. Accessed March 24, 2022.
• 2015-2020 Dietary Guidelines for Americans. U.S. Department of Health and Human Services and U.S. Department of Agriculture. https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines. Accessed March 24, 2022.
• Omega-3 supplements: In depth. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/omega3-supplements-in-depth. Accessed March 8, 2022.
• Lopez-Jimenez F (expert opinion). Mayo Clinic. May 9, 2024.
• Siscovick DS, et al. Omega-3 polyunsaturated fatty acid (fish oil) supplementation and the prevention of clinical cardiovascular disease: A science advisory from the American Heart Association. Circulation. 2017; doi:10.1161/CIR.0000000000000482.
• Barley. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed March 24, 2022.
• Black psyllium. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed March 24, 2022.
• Nimmagadda R. Allscripts EPSi. Mayo Clinic. April 10, 2024.
• Liao KP. Coronary artery disease in rheumatoid arthritis: Pathogenesis, risk factors, clinical manifestations, and diagnostic implications. https://www.uptodate.com/contents/search. Accessed March 8, 2022.
• What is coronary heart disease? National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/coronary-heart-disease Accessed March 8, 2022.
• Kannam JP, et al. Chronic coronary syndrome: Overview of care. https://www.uptodate.com/contents/search. Accessed March 8, 2022.
• Arnett DK, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019; doi:10.1161/CIR.0000000000000678.
• Aspirin use to prevent cardiovascular disease: Preventive medication. U.S. Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/aspirin-use-to-prevent-cardiovascular-disease-preventive-medication. Accessed March 23, 2021.
• Zheng SL, et al. Association of aspirin use for primary prevention with cardiovascular events and bleeding events: A systematic review and meta-analysis. JAMA. 2019; doi:10.1001/jama.2018.20578.
• Cutlip D, et al. Revascularization in patients with stable coronary artery disease: Coronary artery bypass graft surgery versus percutaneous coronary intervention. https://www.uptodate.com/contents/search. Accessed March 24, 2022.
• Hypertension in Adults: Screening. U.S. Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/hypertension-in-adults-screening. Accessed March 24, 2022.
• How and when to have your cholesterol checked. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/cholesterol/checked.htm. Accessed March 24, 2022.
• Blond psyllium. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed March 24, 2022.
• Oats. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed March 24, 2022.
• Garlic. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed March 24, 2022.
• Plant sterols. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed March 24, 2022.
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• Ono M, et al. 10-year follow-up after revascularization in elderly patients with complex coronary artery disease. Journal of the American College of Cardiology. 2021; doi:10.1016/j.jacc.2021.04.016.
• Coyle M, et al. A critical review of chronic kidney disease as a risk factor for coronary artery disease. International Journal of Cardiology: Heart & Vasculature. 2021; doi:10.1016/j.ijcha.2021.100822.
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• Scientific Report of the 2020 Dietary Guidelines Advisory Committee. Alcoholic beverages. U.S. Department of Health and Human Services and U.S. Department of Agriculture. https://www.dietaryguidelines.gov/2020-advisory-committee-report. Accessed Feb. 1, 2024.
• Heart disease in women. American Heart Association. https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack/heart-attack-symptoms-in-women. May 8, 2024.
• Angina treatment: Stents, drugs, lifestyle changes — What's best?
• Coronary artery disease FAQs
• Coronary artery disease: Angioplasty or bypass surgery?
• Coronary artery stent
• Drug-eluting stents
• Four Steps to Heart Health

Associated Procedures

• Cardiac catheterization
• Coronary angiogram
• Coronary angioplasty and stents
• Coronary artery bypass surgery
• Coronary calcium scan
• Echocardiogram
• Electrocardiogram (ECG or EKG)
• Stress test

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• Mayo Clinic Minute: Signs of coronary artery disease, how to reduce your risk Jan. 24, 2023, 04:15 p.m. CDT
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Related Topics:

• About Stroke
• About High Blood Pressure
• About Cholesterol
• The term "heart disease" refers to several types of heart conditions.
• Know your risk for heart disease so you can prevent it.
• High blood pressure, high blood cholesterol, and smoking are key risk factors.
• About 1 in 5 people in the United States died from heart disease in 2022.

More Information

What is heart disease?

The term "heart disease" refers to several types of heart conditions. The most common type of heart disease in the United States is coronary artery disease (CAD). CAD affects the blood flow to the heart. Decreased blood flow can cause a heart attack.

Sometimes heart disease may be "silent" and not diagnosed until a person experiences signs or symptoms of a heart attack, heart failure, or an arrhythmia. When these events happen, symptoms may include: 1

• Heart attack : Chest pain or discomfort, upper back or neck pain, heartburn, nausea or vomiting, extreme fatigue, dizziness, and shortness of breath.
• Arrhythmia : Fluttering feelings in the chest (palpitations).
• Heart failure : Shortness of breath, fatigue, or swelling of the feet, ankles, legs, abdomen, or neck veins.

Risk factors

High blood pressure , high blood cholesterol , and smoking are key risk factors for heart disease. About half of people in the United States (47%) have at least one of these three risk factors. 2 Several other medical conditions and lifestyle choices can also put people at a higher risk for heart disease, including

• Overweight and obesity
• Unhealthy diet
• Physical inactivity
• Excessive alcohol use

Learn how heart disease and mental health disorders are related .

Learn the Facts About Heart Disease‎

Treatment and recovery, what is cardiac rehabilitation.

Cardiac rehabilitation is an important program for anyone recovering from a heart attack. This can also include heart failure, or some types of heart surgery. Cardiac rehabilitation is a supervised program that includes

• Physical activity.
• Education about healthy eating.
• Taking medicine as prescribed.
• Ways to help you quit smoking.
• Counseling to find ways to relieve stress and improve mental health.

A team of people may help you through cardiac rehabilitation. This may include

• Your health care team.
• Exercise and nutrition specialists.
• Physical therapists.
• Counselors or mental health professionals.

What CDC is doing

• Million Hearts ®
• National Heart, Lung, and Blood Institute
• National Center for Health Statistics. Multiple Cause of Death 2018–2022 on CDC WONDER Database . Accessed May 3, 2024.
• Tsao CW, Aday AW, Almarzooq ZI, et al. Heart Disease and Stroke Statistics—2023 Update: a report from the American Heart Association . Circulation. 2023;147:e93–e621.

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

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Home News Your Heart Changes in Size and Shape With Exercise – This Can Lead to Heart Problems for Some Athletes and Gym Rats back to News

Your Heart Changes in Size and Shape With Exercise – This Can Lead to Heart Problems for Some Athletes and Gym Rats

An enlarged heart can lead to abnormal heart rhythms.

minute read

Exercise has long been recognized by clinicians, scientists and public health officials as an   important way to maintain health   throughout a person’s lifespan. It improves overall fitness, helps build strong muscles and bones, reduces the risk of chronic disease, improves mood and slows physical decline.

Exercise can also significantly reduce the risk of developing conditions that negatively affect heart heath, such as high blood pressure, high cholesterol and obesity. But large amounts of exercise throughout life may also harm the heart, leading to the development of a condition called   athletic heart .

As the   sports cardiology director   at the University of Colorado Anschutz Medical Campus, I’m often asked how much and what kind of exercise is necessary to get the benefits of exercise. Many people also wonder about the risks of exercise, and what happens if you exercise too much.

The   American Heart Association generally recommends   150 minutes of moderate-intensity exercise, such as brisk walking, or 75 minutes of vigorous-intensity exercise, such as running, each week. It also recommends muscle strengthening exercises at least twice per week.

When people exceed these guidelines, the heart may remodel itself in response – that is, it begins to change its size and shape. As a result, heart function may also change. These changes in heart structure and function among people who engage in high levels of exercise are referred to as the athletic heart, or athlete’s heart. Athletic heart doesn’t necessarily cause problems, but in some people it can increase the risk of certain heart issues.

What is athletic heart?

To understand how exercise affects the heart, it’s important to consider what kind of exercise you’re participating in.

Exercise is generally divided into   two broad categories : dynamic and static.

Dynamic exercises, like running, cross-country skiing and soccer, require the heart to pump an increased amount of blood, compared to the amount delivered to the body at rest, in order to sustain the activity. For example, when running, the amount of blood the heart pumps to the body may increase by threefold to fivefold compared to at rest.

Static exercises, like weightlifting, gymnastics or rock climbing, require the body to use skeletal muscle in order to push or pull heavy amounts of weight. While the heart does pump more blood to skeletal muscles that are working during these activities, these kinds of exercises depend on a muscle’s ability to move the weight. For example, in order to do curls with dumbbells, the biceps must be strong enough to lift the desired weight.

Some exercises, like rowing or cycling, are both highly dynamic and highly static because they require the heart to pump large amounts of blood while simultaneously requiring a large amount of muscle strength to sustain effort.

It is important to distinguish between dynamic and static exercise because the heart adapts differently according to the type of exercise you engage in over time. Dynamic exercise increases the volume of blood pumping through the heart and can cause the heart to become enlarged, or dilated, over time. Static exercise increases the amount of pressure on the heart and can also cause it to become enlarged over time but with thickened walls.

Who develops athletic heart?

Exercise that exceeds guidelines, such as exercising more than an hour most days of the week, may lead to development of athletic heart. Athletic heart commonly occurs   among endurance athletes , who regularly compete in activities like marathons or other long-duration events. Many exercise several hours per day and more than 12 to 15 hours per week.

Among runners, for example, the heart remodels itself in response to having to pump a high volume of blood. As a result, the chambers of the heart enlarge to hold and pump more blood. Among weightlifters, the heart remodels itself by thickening in response to the increase in pressure applied on the heart.

Exercise is good for the body, and athletic heart results from a lifelong commitment to an activity that promotes good health. But there may be some issues that arise from an athletic heart.

First, athletes with markedly enlarged hearts may be at risk of developing   atrial fibrillation , which is abnormal heart rhythms that typically occur among older adults or people with high blood pressure or heart failure. Abnormal heart rhythms are worrisome because they may lead to a stroke.

There are many potential reasons atrial fibrillation occurs in athletes. A dilated atrium – the top chamber in the heart – may become inflamed and develop scar tissue, increasing the risk of atrial fibrillation.   Stress and environmental factors   may also work together to increase the risk of arrhythmia.

Coronary artery calcification, or CAC , is another concern among elite athletes. Coronary artery calcification, which commonly occurs in older adults or those with risk factors for coronary artery disease, increases the risk of having a heart attack or stroke. In recent years, doctors have been using imaging tests to monitor calcium buildup in the arteries of their patients to try to determine their risk of heart attack or stroke over time.

It is not entirely clear why elite athletes develop coronary artery calcification. Fortunately, it does not appear that athletes have an increased risk of heart attack, even among those with very high levels of CAC. For example, a large study of almost 22,000 participants found that even athletes who engaged in high amounts of exercise and had elevated levels of CAC   did not have an increased risk   of death from cardiovascular disease over a decade of follow-up.

Some athletes are appropriately concerned about having calcium buildup in their heart arteries and may wonder whether or not they should be taking medications like aspirin or statins. But risks   vary from person to person , so anyone concerned about CAC should talk to their doctor

Putting exercise in its place

Though elite athletes may have an increased risk of developing athletic heart, exercise undoubtedly remains one of, if not the best, methods to maintain a healthy lifestyle.

For example, if someone does not exercise routinely, their heart   will become stiff   and not pump blood as well as it once did. Routine exercise – especially dynamic exercise like running – maintains a compliant heart and prevents stiffening. A compliant heart will expand a lot more as it fills with blood and, in turn, pump out more blood with each heartbeat. A stiff heart has difficulty filling up with blood and has difficulty pumping blood through the body.

Generally, routine exercise throughout adulthood encourages the heart to   remain strong and flexible   even in old age. Even if someone were only to begin regularly exercising in their 40s to 50s, it is possible to   reverse some of the effects   of sedentary aging.

For example, a 2018 study of 53 sedentary people mostly in their early 50s found that those who participated in a two-year exercise training program using a combination of running, cycling and elliptical exercise had hearts that   became more compliant   compared to the hearts of those who did not exercise.

It is never too late to start exercising. Routinely following exercise guidelines can help promote physical and mental health and help your heart stay young throughout your life.

This article originally appeared in  The Conversation .

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Heart disease is rampant in parts of the rural South. Researchers are hitting the road to learn why

Darrell Dixon holds a photo of him and his dad, Darrell Dixon Sr., at his home in Hernando, Miss., on August 11, 2024. (Millicent Dixon via AP)

A medical trailer, being used to test rural residents’ heart and lung function as part of a study to determine why the rates of heart and lung disease are so much higher in the rural South, is seen, May 8, 2024, in Napoleonville, La. (Sean Coady/National Heart, Lung, and Blood Institute via AP)

A billboard for a new study about why heart and lung disease is so much higher in the rural South is seen in Napoleonville, La., on May 8, 2024. (Sean Coady/National Heart, Lung, and Blood Institute via AP)

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Darrell Dixon’s father was just 25 when he had a major heart attack in the rural Mississippi Delta. By his early 40s, a series of additional attacks had left his heart muscle too weak to pump enough blood to his body. He died in 2013 at the age of 49.

“It was a big jolt for our family,” Dixon, 36, recalled. “For myself, personally, it also got me thinking about heredity. I just wondered whether I was next.”

The death spurred Dixon to get involved in an unusual and ambitious new health study.

Public health experts from some of the nation’s leading research institutions have deployed a massive medical trailer to rural parts of the South to test and survey thousands of local residents. The goal: to understand why the rates of heart and lung disease are dramatically higher there than in other parts of the U.S.

“This rural health disadvantage, it doesn’t matter whether you’re white or Black, it hurts you,” said Dr. Vasan Ramachandran, a leader of the project who used to oversee the Framingham Heart Study — the nation’s longest-running study of heart disease. “No race is spared, although people of color fare worse.”

The researchers aim to test the heart and lung function of roughly 4,600 residents of 10 counties and parishes in Alabama, Kentucky, Louisiana and Mississippi while collecting information about their environments, health history and lifestyles. They are also giving participants a fitness tracker and plan to survey them repeatedly for years to check for any major medical events.

Ramachandran, now dean of the University of Texas School of Public Health in San Antonio, said rural populations in the U.S. rarely receive such personal, long-term attention from epidemiologists. More than a dozen institutions are helping with the study, including Johns Hopkins University, the University of California, Berkeley, and Duke University.

The 52-foot-long (16-meter-long), 27-ton trailer is outfitted with instruments that examine calcium in the arteries, the structure of the heart, lung capacity and other, more common health indicators such as blood pressure and weight. The initial exam can take more than three hours.

“They’re reaching out and going out into the community in ways that I have not seen before,” said Lynn Spruill, the mayor of Starkville, Mississippi, in Oktibbeha County, where the trailer arrived in 2022 and medical staff tested more than 700 people.

Studies and data from U.S. health officials show rural populations in the U.S. are unhealthier and have lower life expectancy than Americans in urban areas. The health disparity is even greater in the South, where mortality rates from heart disease — the leading cause of death in the U.S. — for people 35 and older are more than twice the national average in some rural communities. Lung conditions such as chronic obstructive pulmonary disease, or COPD, which the study is also examining, are also more prevalent in the South.

Researchers have multiple theories for the disparity. Hospital closures and physician shortages have left many rural residents with limited access to care. Healthy food, fitness opportunities and public transit are often scarcer. Poverty rates are higher, and fewer people receive health coverage through their employers. In the rural South, poverty rates and the share of people without health insurance are even greater.

Smoking cigarettes is a major cause of heart disease, and at least 20% of adults smoked in Alabama, Kentucky, Louisiana and Mississippi , according to 2019 data from the U.S. Centers for Disease Control and Prevention. Obesity is another factor. In 2022, self-reported height and weight put between 38% and 40% of adults in the four states in the obese body mass index category.

By closely examining local residents and their environments, the rural study seeks clearer answers about what’s driving the additional health burden in the South. Researchers also want to understand what makes some rural counties there much healthier than others.

“We’re interested in both the risk, but also the resilience piece of it,” said Lindsay Pool, an epidemiologist with the National Heart Lung and Blood Institute, which has awarded more than $40 million for the study.

To accomplish that goal, researchers are also visiting rural areas with low risk for heart and lung disease in three of the states — Louisiana, Mississippi and Kentucky — despite similar demographics.

Oktibbeha County, home to Mississippi State University, in the eastern part of Mississippi near the Alabama border, is the low-risk location. The researchers are contrasting it with Panola County in northern Mississippi about 60 miles (97 kilometers) south of Memphis, Tennessee.

Both counties have poverty rates that exceed 20% and a similar and sizeable share of people under 65 without health insurance. But between 2019 and 2021, the death rate from heart disease for those 35 and over was 647 per 100,000 people in Panola County compared to 395 per 100,000 in Oktibbeha County, according to CDC data .

In more urban Rankin County, Mississippi, part of the Jackson metro area, the figure was 331. The U.S. average over the same period was 326.

Dixon, who works in Panola County for a regional development organization and serves as a consultant for the heart and lung study, helped recruit more than 600 Panola County residents for the project. Heart conditions are so prevalent there that it’s common to hear people discussing their medications and side effects at local shops and churches, he said.

Dixon’s father, Darrell Dixon Sr., lived in Clarksdale, about 40 miles (64 kilometers) west of Panola County. He long suffered from high blood pressure and had a strong family history of heart disease.

He had an additional major heart attack after an inmate he had grown close to as chaplain of the Mississippi State Penitentiary was executed, Dixon said, and then spent the last years of his life in and out of the hospital with congestive heart failure.

“He really suffered,” Dixon said. He hopes the study will shed light on any unseen environmental factors that may have played a role in his dad’s death and raise awareness among local residents about “how to live better.”

The trailer is now in Louisiana’s northeastern Franklin Parish, where the death rate from heart disease between 2019 and 2021 was a whopping 859 per 100,000 people for those 35 and over, according to the CDC data. About 200 miles (322 kilometers) south in New Orleans, it was 340.

The National Heart, Lung and Blood Institute plans to extend the study to 2031, and researchers hope to examine all the participants in person again.

“The longer you can follow people, the more you can understand disease development and progression,” Pool, the epidemiologist, said.

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Depression and Heart Disease: What Is the Relationship?

• Treatment Options

Your mental and physical health are closely connected, and research has established a bidirectional relationship between depression and heart disease, where one condition can affect the other (and vice versa).

A heart disease diagnosis often increases stress, putting additional strain on your heart. Conversely, depression can lead to unhealthy eating habits and reduced physical activity, further burdening the heart and other body systems.

This article explores the relationship between depression and heart disease, including strategies for treating and managing these conditions together. 

JulPo / Getty Images

Connection Between Depression and Heart Disease

Depression can interfere with self-care, leading to behaviors that increase the risk of heart-related issues. These behaviors include:

• Drinking alcohol
• Lack of exercise
• Incorrect medication use

Additionally, the stress associated with depression can result in high blood pressure, irregular heart rhythms, reduced blood flow to the heart, and elevated cortisol levels. These factors can contribute to arterial calcium buildup, metabolic disorders , and heart disease.

Women Face a Higher Risk

Women with depression are more likely to have high blood pressure, diabetes, and obesity, all risk factors for heart disease. Additionally, estrogen, a cardioprotective hormone, decreases during menopause, which may contribute to the heart disease risk.

Depression and heart disease have a complex link because each condition can worsen or lead to the development of the other. Understanding this connection is essential for receiving appropriate care.

Depression Before Heart Disease

People with no history of heart disease who are diagnosed with depression have a higher risk of developing heart disease due to the impact of stress and inflammation on cardiovascular health.

Depression also influences your health habits and may make it less likely that you will eat a healthy diet, exercise regularly, and take any necessary medications. People who smoke may do so more or delay quitting when they experience stress.

These factors strain the heart and could compromise your body’s ability to repair and sustain cardiovascular function.

Depression After Heart Episode

Experiencing a cardiac event—such as a heart attack, stroke, or heart surgery—can lead to depression, even in people with no history of mental illness.

Recovery often involves significant lifestyle changes. Fear of the event recurring and impaired physical capabilities can significantly impact your mental health. These factors can lead to behaviors that stress your heart more, decreasing the chance of a full recovery.

Heart disease and depression are entwined. Early awareness, access to support services, and open communication with your healthcare provider are key factors in healing the heart and the mind.

Treatment to Manage Depression With Heart Disease

Options for managing depression are the same with or without heart disease. A healthcare provider will decide if psychotherapy, medications, or a combination of both are best for you.

• Psychotherapy : This treatment—also called "talk therapy"— involves specific techniques to help change thought patterns, behaviors, or emotions that can increase depression or disrupt your life.
• Medications : Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), work by increasing certain chemicals in the brain to help improve mood and stress responses.

Other things you can do to relieve depression include exercise, getting enough sleep, eating a healthy diet, and avoiding alcohol. Always check with a healthcare provider before taking up exercise if you are recovering from heart problems.

How Anxiety Impacts Heart Disease

Anxiety can have a profound impact on your body’s physiology. Anyone who has experienced anxiety or a panic attack is familiar with the following symptoms: shortness of breath, rapid heart rate, and even chest pains. These physical reactions put a strain on the heart and can be even more dangerous for someone with diagnosed heart disease.

How to Prevent Heart Disease

Some risk factors for heart disease include age, sex, and family history. While you can’t control these factors, you can minimize or eliminate many other risks through lifestyle changes to safeguard your heart and boost overall health and well-being. They include:

• Eating a healthy diet
• Exercising regularly
• Following treatment plans for chronic conditions, such as diabetes
• Keeping a healthy weight
• Managing stress
• Practicing good sleep hygiene
• Quitting smoking

Maintaining mental health is vital to heart disease prevention. Find activities that you enjoy and surround yourself with supportive friends and family. Taking small steps can lead to significant improvements in your mental and physical health.

Heart disease and depression are closely linked. Managing depression through therapy and antidepressant medication can positively impact heart health and overall well-being. If you are diagnosed with heart disease, be aware of your feelings and contact your healthcare provider if your depression symptoms don’t improve or worsen.

Take steps to prevent heart disease by managing stress, getting enough sleep, eating well, and exercising regularly. In addition, take all medications prescribed for chronic conditions and quit smoking. 

American Heart Association. How does depression affect the heart .

MedlinePlus. Heart disease and depression .

Centers for Disease Control and Prevention. About heart disease and mental health .

Senoo K, Kaneko H, Ueno K, et al. Sex differences in the association between depression and incident cardiovascular disease . JACC: Asia. 2024;4(4):279-288. doi: 10.1016/j.jacasi.2023.11.015

Sher LD, Geddie H, Olivier L, et al. Chronic stress and endothelial dysfunction: mechanisms, experimental challenges, and the way ahead .  Am J Physiol Heart Circ Physiol . 2020;319(2):H488-H506. doi:10.1152/ajpheart.00244.2020

Johns Hopkins Medicine. Depression and heart disease.

MedlinePlus. Antidepressants .

Johns Hopkins Medicine. Anxiety and heart disease .

MedlinePlus. How to prevent heart disease .

By Carisa Brewster Brewster is a freelance journalist with over 20 years of writing experience specializing in science and healthcare content.

Heart disease is rampant in parts of the rural South. Researchers are hitting the road to learn why.

Darrell Dixon’s father was just 25 when he had a major heart attack in the rural Mississippi Delta. By his early 40s, a series of additional attacks had left his heart muscle too weak to pump enough blood to his body. He died in 2013 at the age of 49.

“It was a big jolt for our family,” Dixon, 36, recalled. “For myself, personally, it also got me thinking about heredity. I just wondered whether I was next.”

The death spurred Dixon to get involved in an unusual and ambitious new health study.

Public health experts from some of the nation’s leading research institutions have deployed a massive medical trailer to rural parts of the South to test and survey thousands of local residents. The goal: to understand why the rates of heart and lung disease are dramatically higher there than in other parts of the U.S.

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“This rural health disadvantage, it doesn’t matter whether you’re white or Black, it hurts you,” said Dr. Vasan Ramachandran, a leader of the project who used to oversee the Framingham Heart Study — the nation’s longest-running study of heart disease. “No race is spared, although people of color fare worse.”

The researchers aim to test the heart and lung function of roughly 4,600 residents of 10 counties and parishes in Alabama, Kentucky, Louisiana and Mississippi while collecting information about their environments, health history and lifestyles. They are also giving participants a fitness tracker and plan to survey them repeatedly for years to check for any major medical events.

Ramachandran, now dean of the University of Texas School of Public Health in San Antonio, said rural populations in the U.S. rarely receive such personal, long-term attention from epidemiologists. More than a dozen institutions are helping with the study, including Johns Hopkins University, the University of California, Berkeley, and Duke University.

The 52-foot-long (16-meter-long), 27-ton trailer is outfitted with instruments that examine calcium in the arteries, the structure of the heart, lung capacity and other, more common health indicators such as blood pressure and weight. The initial exam can take more than three hours.

“They’re reaching out and going out into the community in ways that I have not seen before,” said Lynn Spruill, the mayor of Starkville, Mississippi, in Oktibbeha County, where the trailer arrived in 2022 and medical staff tested more than 700 people.

Studies and data from U.S. health officials show rural populations in the U.S. are unhealthier and have lower life expectancy than Americans in urban areas. The health disparity is even greater in the South, where mortality rates from heart disease — the leading cause of death in the U.S. — for people 35 and older are more than twice the national average in some rural communities. Lung conditions such as chronic obstructive pulmonary disease, or COPD, which the study is also examining, are also more prevalent in the South.

Researchers have multiple theories for the disparity. Hospital closures and physician shortages have left many rural residents with limited access to care. Healthy food, fitness opportunities and public transit are often scarcer. Poverty rates are higher, and fewer people receive health coverage through their employers. In the rural South, poverty rates and the share of people without health insurance are even greater.

Smoking cigarettes is a major cause of heart disease, and at least 20% of adults smoked in Alabama, Kentucky, Louisiana and Mississippi, according to 2019 data from the U.S. Centers for Disease Control and Prevention. Obesity is another factor. In 2022, self-reported height and weight put between 38% and 40% of adults in the four states in the obese body mass index category.

By closely examining local residents and their environments, the rural study seeks clearer answers about what's driving the additional health burden in the South. Researchers also want to understand what makes some rural counties there much healthier than others.

“We’re interested in both the risk, but also the resilience piece of it," said Lindsay Pool, an epidemiologist with the National Heart Lung and Blood Institute, which has awarded more than $40 million for the study.

To accomplish that goal, researchers are also visiting rural areas with low risk for heart and lung disease in three of the states — Louisiana, Mississippi and Kentucky — despite similar demographics.

Oktibbeha County, home to Mississippi State University, in the eastern part of Mississippi near the Alabama border, is the low-risk location. The researchers are contrasting it with Panola County in northern Mississippi about 60 miles (97 kilometers) south of Memphis, Tennessee.

Both counties have poverty rates that exceed 20% and a similar and sizeable share of people under 65 without health insurance. But between 2019 and 2021, the death rate from heart disease for those 35 and over was 647 per 100,000 people in Panola County compared to 395 per 100,000 in Oktibbeha County, according to CDC data.

In more urban Rankin County, Mississippi, part of the Jackson metro area, the figure was 331. The U.S. average over the same period was 326.

Dixon, who works in Panola County for a regional development organization and serves as a consultant for the heart and lung study, helped recruit more than 600 Panola County residents for the project. Heart conditions are so prevalent there that it's common to hear people discussing their medications and side effects at local shops and churches, he said.

Dixon’s father, Darrell Dixon Sr., lived in Clarksdale, about 40 miles (64 kilometers) west of Panola County. He long suffered from high blood pressure and had a strong family history of heart disease.

He had an additional major heart attack after an inmate he had grown close to as chaplain of the Mississippi State Penitentiary was executed, Dixon said, and then spent the last years of his life in and out of the hospital with congestive heart failure.

“He really suffered,” Dixon said. He hopes the study will shed light on any unseen environmental factors that may have played a role in his dad's death and raise awareness among local residents about “how to live better.”

The trailer is now in Louisiana's northeastern Franklin Parish, where the death rate from heart disease between 2019 and 2021 was a whopping 859 per 100,000 people for those 35 and over, according to the CDC data. About 200 miles (322 kilometers) south in New Orleans, it was 340.

The National Heart, Lung and Blood Institute plans to extend the study to 2031, and researchers hope to examine all the participants in person again.

“The longer you can follow people, the more you can understand disease development and progression,” Pool, the epidemiologist, said.