Heart Health Score

Heart disease remains the leading cause of death for Americans, claiming more lives each year than all forms of cancer combined. Yet it is also one of the most preventable diseases in medicine — with the right knowledge and lifestyle changes, the majority of heart disease cases can be delayed, minimized, or avoided entirely.

What Is Heart Disease?

The term "heart disease" encompasses a wide spectrum of conditions affecting the heart and blood vessels. The most common and deadly form is coronary artery disease (CAD), also called coronary heart disease. CAD develops when the coronary arteries — the blood vessels that supply the heart muscle itself with oxygen-rich blood — become narrowed or blocked by a buildup of plaque (a combination of cholesterol, fat, calcium, and other substances). This process, called atherosclerosis, begins silently in early adulthood and progresses over decades.

When a coronary artery becomes severely narrowed, it may cause angina (chest pain or pressure during exertion). When a plaque ruptures and a blood clot forms suddenly, it can completely block an artery, triggering a heart attack (myocardial infarction). Without immediate treatment, a heart attack causes permanent damage to the heart muscle.

Other forms of heart disease include heart failure (the heart cannot pump blood efficiently), arrhythmias (abnormal heart rhythms such as atrial fibrillation), valvular heart disease, and congenital heart defects. Many of these conditions share the same underlying risk factors as CAD. Stroke, while affecting the brain, is also a cardiovascular event driven by the same risk factors and is grouped with heart disease under the umbrella of cardiovascular disease (CVD).

Risk Factors for Heart Disease

The American Heart Association identifies several major risk factors for cardiovascular disease, grouped into those you cannot control and those you can:

Non-Modifiable Risk Factors

• Age: Risk increases with age. For men, significant cardiovascular risk begins around age 45; for women, risk rises sharply after menopause, typically around age 55. Estrogen has a protective cardiovascular effect in premenopausal women.
• Sex: Men generally develop heart disease earlier than women, but heart disease is the #1 killer of both sexes. Women are more likely to die from a first heart attack than men, partly due to different symptom presentations and lower rates of early recognition.
• Family history: Having a first-degree relative (parent or sibling) who developed heart disease before age 65 significantly increases personal risk, reflecting shared genetics and lifestyle.
• Race and ethnicity: African Americans have higher rates of hypertension and significantly elevated cardiovascular risk. Hispanic and South Asian populations also face elevated risk compared to white Americans.

Modifiable Risk Factors

• High blood pressure (hypertension): Chronically elevated blood pressure damages arterial walls, accelerating plaque buildup and increasing the risk of both heart attack and stroke. Hypertension is the "silent killer" — it typically has no symptoms until serious damage has occurred.
• High cholesterol: Elevated LDL ("bad") cholesterol deposits plaque in artery walls. Low HDL ("good") cholesterol and elevated triglycerides further compound cardiovascular risk.
• Smoking: Smoking damages the lining of arteries, promotes systemic inflammation, reduces HDL cholesterol, and increases blood clotting tendency. Even secondhand smoke exposure meaningfully raises cardiovascular risk. Smoking cessation cuts heart attack risk in half within one year.
• Diabetes: Chronically elevated blood sugar damages blood vessels throughout the body. People with diabetes are 2–4 times more likely to develop cardiovascular disease than those without it.
• Obesity: Excess weight, particularly abdominal (visceral) obesity, promotes inflammation, hypertension, dyslipidemia, and insulin resistance — all major cardiovascular risk drivers.
• Physical inactivity: Sedentary behavior is an independent risk factor for cardiovascular disease. Regular aerobic exercise strengthens the heart, lowers blood pressure, improves cholesterol profiles, and reduces systemic inflammation.
• Unhealthy diet: Diets high in saturated fat, trans fat, sodium, and added sugars promote atherosclerosis, hypertension, and obesity.
• Chronic stress: Psychological stress activates the sympathetic nervous system, raising blood pressure and promoting inflammation. It also drives unhealthy coping behaviors like smoking, overeating, and physical inactivity.

Warning Signs of a Heart Attack

Recognizing heart attack symptoms and calling 911 immediately can save a life. Common warning signs include:

• Chest pain, pressure, squeezing, or discomfort lasting more than a few minutes, or going away and returning
• Pain or discomfort radiating to one or both arms, the back, neck, jaw, or stomach
• Shortness of breath, with or without chest discomfort
• Cold sweats, nausea, or lightheadedness

Women are more likely than men to experience atypical heart attack symptoms — such as back or jaw pain, nausea, and extreme fatigue — without classic chest pain. This difference contributes to women being less likely to receive timely diagnosis and treatment. If in doubt, call 911. Time lost is heart muscle lost.

Prevention & Next Steps

The evidence base for cardiovascular disease prevention is robust. Even small, consistent lifestyle changes compound into dramatically lower risk over time:

• Know your numbers: Get your blood pressure, cholesterol, blood glucose, and BMI checked regularly. You cannot manage what you do not measure.
• Exercise regularly: Aim for at least 150 minutes of moderate-intensity aerobic activity per week (brisk walking, cycling, swimming) plus muscle-strengthening activities twice per week.
• Eat heart-healthy: Emphasize fruits, vegetables, whole grains, legumes, nuts, and fish. Reduce sodium (target <2,300 mg/day), saturated fats, trans fats, and added sugars. The Mediterranean and DASH diets have the strongest evidence for cardiovascular protection.
• Quit smoking: No matter how long you have smoked, quitting at any age reduces cardiovascular risk substantially and almost immediately.
• Manage blood pressure: Target <130/80 mmHg. Lifestyle changes (DASH diet, exercise, sodium reduction, weight loss, alcohol moderation) can lower blood pressure meaningfully before medication is needed.
• Control cholesterol and blood sugar: Work with your doctor on statin therapy and diabetes medications if lifestyle alone is insufficient to reach targets.
• Manage stress: Evidence-based stress reduction techniques including mindfulness meditation, yoga, and cognitive-behavioral therapy can reduce cardiovascular risk through multiple pathways.