View source for Cardiovascular disease

{{short description|Class of diseases that involve the heart or blood vessels}}
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{{redirect|Heart condition}}
{{Infobox medical condition (new)
| name          = Cardiovascular disease
| image         = Cardiac amyloidosis very high mag movat.jpg
| caption       = [[Micrograph]] of a [[heart]] with [[fibrosis]] (yellow) and [[AL amyloidosis|amyloidosis]] (brown). [[Movat's stain]].
| field         = [[Cardiology]]
| symptoms      = [[Chest pain]], [[shortness of breath]], [[fatigue]], [[Unconsciousness|loss of consciousness]]
| complications =Heart failure, heart attack, stroke, aneurysm, peripheral artery disease, sudden cardiac arrest.<ref>{{cite web|title=Heart disease |url=https://www.mayoclinic.org/diseases-conditions/heart-disease/symptoms-causes/syc-20353118|publisher=Mayo Clinic |date=2022-08-25}}</ref>
| onset         = Older adults<ref name=Go2013/>
| duration      =
| types         = [[Coronary artery disease]]s, [[stroke]], [[heart failure]], [[hypertensive heart disease]], [[rheumatic heart disease]], [[cardiomyopathy]],<ref name=WHO2011/><ref name=GDB2013/> [[Arrhythmia]]
| risks         =[[Diabetes]],<ref name=WHO2011/> [[hyperlipidemia|high blood lipids]], excess weight, [[Smoking]], excessive drug use, excessive [[Alcohol (drug)|alcohol]] intake, genetic predisposition
| diagnosis     =
| differential  =
| prevention    = [[Healthy eating]], exercise, avoiding tobacco smoke, limited alcohol intake,<ref name=WHO2011/> Overall lifestyle changes
| treatment     = Treating [[high blood pressure]], [[hyperlipidemia|high blood lipids]], [[diabetes]]<ref name=WHO2011/>
| medication    = [[Aspirin]], [[beta blocker]]s, [[Anticoagulant|blood thinners]]
| prognosis     =
| frequency     =
| deaths        = 17.9 million / 32% (2015)<ref name=GBD2015De/>
}}
<!-- Definition and symptoms -->

'''Cardiovascular disease''' ('''CVD''') is any disease involving the [[heart]] or [[blood vessel]]s.<ref name="WHO2011">{{cite book| vauthors = Shanthi M, Pekka P, Norrving B |title=Global Atlas on Cardiovascular Disease Prevention and Control|url=http://whqlibdoc.who.int/publications/2011/9789241564373_eng.pdf?ua=1|year=2011|publisher=World Health Organization in collaboration with the World Heart Federation and the World Stroke Organization|pages=3–18|isbn=978-92-4-156437-3|url-status=live|archive-url=https://web.archive.org/web/20140817123106/http://whqlibdoc.who.int/publications/2011/9789241564373_eng.pdf?ua=1|archive-date=2014-08-17}}</ref> CVDs constitute a class of diseases that includes: [[coronary artery disease]]s (e.g. [[angina pectoris|angina]], [[myocardial infarction|heart attack]]), [[heart failure]], [[hypertensive heart disease]], [[rheumatic heart disease]], [[cardiomyopathy]], [[arrhythmia]], [[congenital heart disease]], [[valvular heart disease]], [[carditis]], [[aortic aneurysm]]s, [[peripheral artery disease]], [[Thrombosis|thromboembolic disease]], and [[venous thrombosis]].<ref name=WHO2011/><ref name=GDB2013/>

<!-- Types -->
The underlying mechanisms vary depending on the disease.<ref name=WHO2011/> It is estimated that dietary risk factors are associated with 53% of CVD deaths.<ref>{{Cite journal|last1=Petersen|first1=Kristina S.|last2=Kris-Etherton|first2=Penny M.|journal=Nutrients|volume=13|issue=12|page=4305|date=2021-11-28|title=Diet quality assessment and the relationship between diet quality and cardiovascular disease risk|doi=10.3390/nu13124305|issn=2072-6643|pmid=34959857|pmc=8706326|doi-access=free}}</ref> Coronary artery disease, stroke, and peripheral artery disease involve [[atherosclerosis]].<ref name=WHO2011/> This may be caused by [[hypertension|high blood pressure]], [[tobacco smoking|smoking]], [[diabetes mellitus]], lack of [[physical exercise|exercise]], [[obesity]], [[hypercholesterolaemia|high blood cholesterol]], poor diet, excessive [[alcoholic beverage|alcohol]] consumption,<ref name=WHO2011/>  and poor [[sleep]],<ref name="Jackson"/><ref name="Wang"/> among other things. High blood pressure is estimated to account for approximately 13% of CVD deaths, while tobacco accounts for 9%, diabetes 6%, lack of exercise 6%, and obesity 5%.<ref name=WHO2011/> Rheumatic heart disease may follow untreated [[streptococcal pharyngitis|strep throat]].<ref name=WHO2011/>

<!-- Prevention and treatment -->
It is estimated that up to 90% of CVD may be preventable.<ref name=McGill2008>{{cite journal | vauthors = McGill HC, McMahan CA, Gidding SS | title = Preventing heart disease in the 21st century: implications of the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study | journal = Circulation | volume = 117 | issue = 9 | pages = 1216–27 | date = March 2008 | pmid = 18316498 | doi = 10.1161/CIRCULATIONAHA.107.717033 | doi-access = free }}</ref><ref>{{cite journal | vauthors = O'Donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, Rao-Melacini P, Zhang X, Pais P, Agapay S, Lopez-Jaramillo P, Damasceno A, Langhorne P, McQueen MJ, Rosengren A, Dehghan M, Hankey GJ, Dans AL, Elsayed A, Avezum A, Mondo C, Diener HC, Ryglewicz D, Czlonkowska A, Pogosova N, Weimar C, Iqbal R, Diaz R, Yusoff K, Yusufali A, Oguz A, Wang X, Penaherrera E, Lanas F, Ogah OS, Ogunniyi A, Iversen HK, Malaga G, Rumboldt Z, Oveisgharan S, Al Hussain F, Magazi D, Nilanont Y, Ferguson J, Pare G, Yusuf S | title = Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study | journal = Lancet | volume = 388 | issue = 10046 | pages = 761–75 | date = August 2016 | pmid = 27431356 | doi = 10.1016/S0140-6736(16)30506-2 | s2cid = 39752176 | url = https://repositorio.udes.edu.co/handle/001/3452 | url-access = subscription }}</ref> Prevention of CVD involves improving risk factors through: [[healthy eating]], exercise, avoidance of tobacco smoke and limiting alcohol intake.<ref name=WHO2011/> Treating risk factors, such as high blood pressure, blood lipids and diabetes is also beneficial.<ref name=WHO2011/> Treating people who have strep throat with [[antibiotic]]s can decrease the risk of rheumatic heart disease.<ref>{{Cite journal |last1=Spinks |first1=Anneliese |last2=Glasziou |first2=Paul P. |last3=Del Mar |first3=Chris B. |date=2021-12-09 |title=Antibiotics for treatment of sore throat in children and adults |journal=The Cochrane Database of Systematic Reviews |volume=2021 |issue=12 |article-number=CD000023 |doi=10.1002/14651858.CD000023.pub5 |issn=1469-493X |pmc=8655103 |pmid=34881426}}</ref> The use of [[aspirin]] in people who are otherwise healthy is of unclear benefit.<ref>{{cite journal | vauthors = Sutcliffe P, Connock M, Gurung T, Freeman K, Johnson S, Ngianga-Bakwin K, Grove A, Gurung B, Morrow S, Stranges S, Clarke A | title = Aspirin in primary prevention of cardiovascular disease and cancer: a systematic review of the balance of evidence from reviews of randomized trials | journal = PLOS ONE | volume = 8 | issue = 12 | article-number = e81970 | date = 2013 | pmid = 24339983 | pmc = 3855368 | doi = 10.1371/journal.pone.0081970 | bibcode = 2013PLoSO...881970S | doi-access = free }}</ref><ref>{{cite journal|vauthors=Sutcliffe P, Connock M, Gurung T, Freeman K, Johnson S, Kandala NB, Grove A, Gurung B, Morrow S, Clarke A|date=September 2013|title=Aspirin for prophylactic use in the primary prevention of cardiovascular disease and cancer: a systematic review and overview of reviews|journal=[[Health Technology Assessment (journal)|Health Technology Assessment]]|volume=17|issue=43|pages=1–253|doi=10.3310/hta17430|pmc=4781046|pmid=24074752}}</ref>

<!-- Epidemiology -->
Cardiovascular diseases are the [[List of causes of death by rate|leading cause of death]] worldwide except Africa.<ref name=WHO2011/> Together CVD resulted in 17.9 million deaths (32.1%) in 2015, up from 12.3 million (25.8%) in 1990.<ref name=GBD2015De>{{cite journal | vauthors = Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, etal | collaboration = GBD 2015 Mortality and Causes of Death Collaborators | title = Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1459–1544 | date = October 2016 | pmid = 27733281 | pmc = 5388903 | doi = 10.1016/S0140-6736(16)31012-1 }}</ref><ref name=GDB2013>{{cite journal | vauthors = Naghavi M, Wang H, Lozano R, Davis A, Liang X, Zhou M, etal | collaboration = GBD 2013 Mortality and Causes of Death Collaborators | title = Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 | journal = Lancet | volume = 385 | issue = 9963 | pages = 117–71 | date = January 2015 | pmid = 25530442 | pmc = 4340604 | doi = 10.1016/S0140-6736(14)61682-2 }}</ref> [[Age standardized deaths|Deaths, at a given age]], from CVD are more common and have been increasing in much of the [[developing world]], while rates have declined in most of the [[developed world]] since the 1970s.<ref name=IOM2010>{{cite book|title=Promoting cardiovascular health in the developing world: a critical challenge to achieve global health|year=2010|publisher=National Academies Press|location=Washington, DC |isbn=978-0-309-14774-3 |chapter=Epidemiology of Cardiovascular Disease |chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK45688/ | veditors = Fuster V, Kelly BB |author=Institute of Medicine of the National Academies |url-status=live |archive-url=https://web.archive.org/web/20170908144309/https://www.ncbi.nlm.nih.gov/books/NBK45688/ |archive-date=2017-09-08}}</ref><ref>{{cite journal | vauthors = Moran AE, Forouzanfar MH, Roth GA, Mensah GA, Ezzati M, Murray CJ, Naghavi M | title = Temporal trends in ischemic heart disease mortality in 21 world regions, 1980 to 2010: the Global Burden of Disease 2010 study | journal = Circulation | volume = 129 | issue = 14 | pages = 1483–92 | date = April 2014 | pmid = 24573352 | pmc = 4181359 | doi = 10.1161/circulationaha.113.004042 }}</ref> Coronary artery disease and stroke account for 80% of CVD deaths in males and 75% of CVD deaths in females.<ref name=WHO2011/> 
Most cardiovascular disease affects older adults. In high income countries, the mean age at first cardiovascular disease diagnosis lies around 70 years (73 years in women, 68 years in men).<ref name="Conrad">{{cite journal |last1=Conrad |first1=Nathalie |last2=Molenberghs |first2=Geert |last3=Verbeke |first3=Geert |last4=Zaccardi |first4=Francesco |last5=Lawson |first5=Claire |last6=Friday |first6=Jocelyn M |last7=Su |first7=Huimin |last8=Jhund |first8=Pardeep S |last9=Sattar |first9=Naveed |last10=Rahimi |first10=Kazem |last11=Cleland |first11=John G |last12=Khunti |first12=Kamlesh |last13=Budts |first13=Werner |last14=McMurray |first14=John J V |title=Trends in cardiovascular disease incidence among 22 million people in the UK over 20 years: population based study |journal=BMJ |date=26 June 2024 |article-number=e078523 |doi=10.1136/bmj-2023-078523}}</ref> In the United States 11% of people between 20 and 40 have CVD, while 37% between 40 and 60, 71% of people between 60 and 80, and 85% of people over 80 have CVD.<ref name=Go2013>{{cite journal | vauthors = Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Magid D, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Nichol G, Paynter NP, Schreiner PJ, Sorlie PD, Stein J, Turan TN, Virani SS, Wong ND, Woo D, Turner MB | title = Heart disease and stroke statistics--2013 update: a report from the American Heart Association | journal = Circulation | volume = 127 | issue = 1 | pages = e6–e245 | date = January 2013 | pmid = 23239837 | pmc = 5408511 | doi = 10.1161/cir.0b013e31828124ad }}</ref> The average age of death from coronary artery disease in the developed world is around 80, while it is around 68 in the developing world.<ref name=IOM2010/> 
At same age, men are about 50% more likely to develop CVD and are typically diagnosed seven to ten years earlier in men than in women.<ref name="Conrad" /><ref name="WHO2011" />{{rp|48}}
{{TOC limit|3}}

==Types==
[[File:Inflammatory heart diseases world map - DALY - WHO2004.svg|thumb|upright=1.4|[[Disability-adjusted life year]] for inflammatory heart diseases per 100,000&nbsp;inhabitants in 2004<ref name="World Health Organization">{{cite web |url=https://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html |title=WHO Disease and injury country estimates |year=2009 |work=World Health Organization|archive-url=https://web.archive.org/web/20091111101009/http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html |archive-date=2009-11-11 }}</ref>{{Div col|small=yes|colwidth=10em}}
{{legend|#b3b3b3|No data}}
{{legend|#ffff65|Less than 70}}
{{legend|#fff200|70–140}}
{{legend|#ffdc00|140–210}}
{{legend|#ffc600|210–280}}
{{legend|#ffb000|280–350}}
{{legend|#ff9a00|350–420}}
{{legend|#ff8400|420–490}}
{{legend|#ff6e00|490–560}}
{{legend|#ff5800|560–630}}
{{legend|#ff4200|630–700}}
{{legend|#ff2c00|700–770}}
{{legend|#cb0000|More than 770}}
{{div col end}}]]
There are many cardiovascular diseases involving the blood vessels. They are known as [[vascular disease]]s.<ref name="medl">{{Cite web |title=Vascular Diseases: MedlinePlus |url=https://medlineplus.gov/vasculardiseases.html |access-date=2015-06-23 |website=www.nlm.nih.gov}}</ref>
* [[Coronary artery disease]] (coronary heart disease or ischemic heart disease)
* [[Peripheral arterial disease]] – a disease of blood vessels that supply blood to the arms and legs
* [[Cerebrovascular disease]] – a disease of blood vessels that supply blood to the brain (includes [[stroke]])
* [[Renal artery stenosis]]
* [[Aortic aneurysm]]

There are also many cardiovascular diseases that involve the heart.
* [[Cardiomyopathy]] – diseases of cardiac muscle
* [[Hypertensive heart disease]] – diseases of the heart secondary to high [[blood pressure]] or [[hypertension]]
* [[Heart failure]] – a clinical syndrome caused by the inability of the heart to supply sufficient blood to the tissues to meet their metabolic requirements
* [[Pulmonary heart disease]] – a failure at the right side of the heart with respiratory system involvement
* [[Cardiac dysrhythmias]] – abnormalities of heart rhythm
* Inflammatory heart diseases
** [[Endocarditis]] – [[inflammation]] of the inner layer of the heart, the [[endocardium]]. The structures most commonly involved are the [[heart valve]]s.
** Inflammatory [[cardiomegaly]]
** [[Myocarditis]] – inflammation of the [[myocardium]], the muscular part of the heart, caused most often by viral infection and less often by bacterial infections, certain medications, toxins, and autoimmune disorders. It is characterized in part by infiltration of the heart by [[lymphocyte]] and [[monocyte]] types of [[white blood cells]].
** [[Eosinophilic myocarditis]] – inflammation of the myocardium caused by pathologically activated [[eosinophils|eosinophilic]] white blood cells. This disorder differs from myocarditis in its causes and treatments.
* [[Valvular heart disease]]
* [[Congenital heart disease]] – heart structure malformations existing at birth
* [[Rheumatic heart disease]] – heart muscles and valves damage due to [[rheumatic fever]] caused by  ''[[Streptococcus pyogenes]]'' a [[group A streptococcal infection]].

==Risk factors==
There are many risk factors for heart diseases: age, sex, tobacco use, physical inactivity, [[non-alcoholic fatty liver disease]], excessive [[alcohol (drug)|alcohol]] consumption, unhealthy diet, obesity, genetic predisposition and family history of cardiovascular disease, raised blood pressure ([[hypertension]]), raised blood sugar ([[diabetes mellitus]]), raised blood cholesterol ([[hyperlipidemia]]), undiagnosed [[celiac disease]], psychosocial factors, poverty and low educational status, [[air pollution]], and poor [[sleep]].<ref name="WHO2011" /><ref name = Fuster>{{cite book | veditors = Fuster V, Kelly BB  |title=Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health |publisher=National Academies Press |location=Washington, DC |year=2010 |isbn=978-0-309-14774-3 }}</ref><ref>{{cite journal | vauthors = Finks SW, Airee A, Chow SL, Macaulay TE, Moranville MP, Rogers KC, Trujillo TC | title = Key articles of dietary interventions that influence cardiovascular mortality | journal = Pharmacotherapy | volume = 32 | issue = 4 | pages = e54-87 | date = April 2012 | pmid = 22392596 | doi = 10.1002/j.1875-9114.2011.01087.x | s2cid = 36437057 | doi-access = free }}</ref><ref name="MichaMichas2012"/><ref name="CiaccioLewis2017">{{cite journal | vauthors = Ciaccio EJ, Lewis SK, Biviano AB, Iyer V, Garan H, Green PH | title = Cardiovascular involvement in celiac disease | journal = World Journal of Cardiology | volume = 9 | issue = 8 | pages = 652–666 | date = August 2017 | pmid = 28932354 | pmc = 5583538 | doi = 10.4330/wjc.v9.i8.652 | type = Review | doi-access = free }}</ref><ref name="Duell2022">{{cite journal |last1=Duell |first1=PB |last2=Welty |first2=FK |last3=Miller |first3=M |last4=Chait |first4=A |last5=Hammond |first5=G |last6=Ahmad |first6=Z |last7=Cohen |first7=DE |last8=Horton |first8=JD |last9=Pressman |first9=GS |last10=Toth |first10=PP |last11=American Heart Association Council on Atherosclerosis, Thrombosis, and Vascular Biology |last12=Council on Hypertension |last13=Council on the Kidney in Cardiovascular Disease |last14=Council on Lifestyle and Cardiometabolic Health |last15=Council on Peripheral Vascular Disease |title=Nonalcoholic Fatty Liver Disease and Cardiovascular Risk: A Scientific Statement From the American Heart Association |journal=Arteriosclerosis, Thrombosis, and Vascular Biology |date=April 2022 |volume=42 |issue=6 |pages=e168–e185 |doi=10.1161/ATV.0000000000000153 |pmid=35418240 |s2cid=248155592 |doi-access=free }}</ref> While the individual contribution of each risk factor varies between different communities or ethnic groups the overall contribution of these risk factors is very consistent.<ref name = interheart>{{cite journal | vauthors = Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L | title = Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study | journal = Lancet | volume = 364 | issue = 9438 | pages = 937–52 | year = 2004 | pmid = 15364185 | doi = 10.1016/S0140-6736(04)17018-9 | s2cid = 30811593 | hdl = 10983/21615 | hdl-access = free }}</ref> Some of these risk factors, such as age, sex or family history/genetic predisposition, are immutable; however, many important cardiovascular risk factors are modifiable by lifestyle change, social change, drug treatment (for example prevention of hypertension, hyperlipidemia, and diabetes).<ref name = McPhee2012>{{cite book | vauthors = McPhee S | title = Current medical diagnosis & treatment | publisher = McGraw-Hill Medical | location = New York | year = 2012 | isbn = 978-0-07-176372-1 | pages = [https://archive.org/details/currentmedicaldi00step/page/430 430] | url-access = registration | url = https://archive.org/details/currentmedicaldi00step/page/430 }}</ref> People with obesity are at increased risk of [[atherosclerosis]] of the [[coronary arteries]].<ref>{{cite journal | vauthors = Eckel RH | title = Obesity and heart disease: a statement for healthcare professionals from the Nutrition Committee, American Heart Association | journal = Circulation | volume = 96 | issue = 9 | pages = 3248–50 | date = November 1997 | pmid = 9386201 | doi = 10.1161/01.CIR.96.9.3248 }}</ref>

===Genetics===
Cardiovascular disease in a person's parents increases their risk by ~3 fold,<ref>{{cite journal |vauthors=Kathiresan S, Srivastava D |date=March 2012 |title=Genetics of human cardiovascular disease |journal=Cell |volume=148 |issue=6 |pages=1242–57 |doi=10.1016/j.cell.2012.03.001 |pmc=3319439 |pmid=22424232 |doi-access=free}}</ref> and genetics is an important risk factor for cardiovascular diseases. Genetic cardiovascular disease can occur either as
a consequence of single variant (Mendelian) or polygenic influences.<ref name=":3">{{Cite journal |last1=Semsarian |first1=Christopher |last2=Ingles |first2=Jodie |last3=Ross |first3=Samantha Barratt |last4=Dunwoodie |first4=Sally L. |last5=Bagnall |first5=Richard D. |last6=Kovacic |first6=Jason C. |date=2021-05-25 |title=Precision Medicine in Cardiovascular Disease: Genetics and Impact on Phenotypes: JACC Focus Seminar 1/5 |journal=Journal of the American College of Cardiology |language=en |volume=77 |issue=20 |pages=2517–2530 |doi=10.1016/j.jacc.2020.12.071 |issn=0735-1097 |pmid=34016265 |doi-access=free |s2cid=235073575}}</ref> There are more than 40 inherited cardiovascular disease that can be traced to a single disease-causing DNA variant, although these conditions are rare.<ref name=":3" /> Most common cardiovascular diseases are non-Mendelian and are thought to be due to hundreds or thousands of genetic variants (known as single nucleotide polymorphisms), each associated with a small effect.<ref>{{cite journal |vauthors=Nikpay M, Goel A, Won HH, Hall LM, Willenborg C, Kanoni S, Saleheen D, Kyriakou T, Nelson CP, Hopewell JC, Webb TR, Zeng L, Dehghan A, Alver M, Armasu SM, Auro K, Bjonnes A, Chasman DI, Chen S, Ford I, Franceschini N, Gieger C, Grace C, Gustafsson S, Huang J, Hwang SJ, Kim YK, Kleber ME, Lau KW, Lu X, Lu Y, Lyytikäinen LP, Mihailov E, Morrison AC, Pervjakova N, Qu L, Rose LM, Salfati E, Saxena R, Scholz M, Smith AV, Tikkanen E, Uitterlinden A, Yang X, Zhang W, Zhao W, de Andrade M, de Vries PS, van Zuydam NR, Anand SS, Bertram L, Beutner F, Dedoussis G, Frossard P, Gauguier D, Goodall AH, Gottesman O, Haber M, Han BG, Huang J, Jalilzadeh S, Kessler T, König IR, Lannfelt L, Lieb W, Lind L, Lindgren CM, Lokki ML, Magnusson PK, Mallick NH, Mehra N, Meitinger T, Memon FU, Morris AP, Nieminen MS, Pedersen NL, Peters A, Rallidis LS, Rasheed A, Samuel M, Shah SH, Sinisalo J, Stirrups KE, Trompet S, Wang L, Zaman KS, Ardissino D, Boerwinkle E, Borecki IB, Bottinger EP, Buring JE, Chambers JC, Collins R, Cupples LA, Danesh J, Demuth I, Elosua R, Epstein SE, Esko T, Feitosa MF, Franco OH, Franzosi MG, Granger CB, Gu D, Gudnason V, Hall AS, Hamsten A, Harris TB, Hazen SL, Hengstenberg C, Hofman A, Ingelsson E, Iribarren C, Jukema JW, Karhunen PJ, Kim BJ, Kooner JS, Kullo IJ, Lehtimäki T, Loos RJ, Melander O, Metspalu A, März W, Palmer CN, Perola M, Quertermous T, Rader DJ, Ridker PM, Ripatti S, Roberts R, Salomaa V, Sanghera DK, Schwartz SM, Seedorf U, Stewart AF, Stott DJ, Thiery J, Zalloua PA, O'Donnell CJ, Reilly MP, Assimes TL, Thompson JR, Erdmann J, Clarke R, Watkins H, Kathiresan S, McPherson R, Deloukas P, Schunkert H, Samani NJ, Farrall M |date=October 2015 |title=A comprehensive 1,000 Genomes-based genome-wide association meta-analysis of coronary artery disease |url=https://discovery.dundee.ac.uk/ws/files/7268983/CAD1000G2015.pdf |journal=Nature Genetics |volume=47 |issue=10 |pages=1121–1130 |doi=10.1038/ng.3396 |pmc=4589895 |pmid=26343387 |via=University of Dundee}}</ref><ref name="MacRae 2634–2639">{{cite journal |vauthors=MacRae CA, Vasan RS |date=June 2016 |title=The Future of Genetics and Genomics: Closing the Phenotype Gap in Precision Medicine |journal=Circulation |volume=133 |issue=25 |pages=2634–9 |doi=10.1161/CIRCULATIONAHA.116.022547 |pmc=6188655 |pmid=27324359 |doi-access=free}}</ref>

===Age===
[[File:Calcified Heart.jpg|thumb|Calcified heart of an older woman with cardiomegaly]]

Age is the most important risk factor in developing cardiovascular or heart diseases, with approximately a tripling of risk with each decade of life.<ref name=Finegold>{{cite journal |vauthors=Finegold JA, Asaria P, Francis DP |title=Mortality from ischaemic heart disease by country, region, and age: statistics from the World Health Organization and the United Nations |journal=International Journal of Cardiology |volume=168 |issue=2 |pages=934–45 |date=September 2013 |pmid=23218570 |pmc=3819990 |doi=10.1016/j.ijcard.2012.10.046 }}</ref>  Coronary fatty streaks can begin to form in adolescence.<ref>{{cite journal |vauthors=D'Adamo E, Guardamagna O, Chiarelli F, Bartuli A, Liccardo D, Ferrari F, Nobili V |title=Atherogenic dyslipidemia and cardiovascular risk factors in obese children |journal=International Journal of Endocrinology |volume=2015 |article-number=912047 |date=2015 |pmid=25663838 |pmc=4309297 |doi=10.1155/2015/912047 |doi-access=free }}</ref> It is estimated that 82 percent of people who die of coronary heart disease are 65 and older.<ref>"Understand Your Risk of Heart Attack". American Heart Association.http://www.heart.org/HEARTORG/Conditions/HeartAttack/UnderstandYourRiskofHeartAttack/Understand-Your-Risk-of-Heart-Attack_UCM_002040_Article.jsp</ref> Simultaneously, the risk of stroke doubles every decade after age 55.<ref>{{Cite book|last1=Mackay |first1=Judith |last2=Mensah |first2=George |last3=Mendis |first3=Shanthi |last4=Greenland |first4=Kurt |title=The Atlas of Heart Disease and Stroke |publisher=World Health Organization and U. S. Centers for Disease Control and Prevention |date=January 2004 |hdl=10665/43007 |isbn=978-92-4-156276-8 |url=https://apps.who.int/iris/handle/10665/43007}}</ref>

Multiple explanations are proposed to explain why age increases the risk of cardiovascular/heart diseases. One of them relates to serum cholesterol level.<ref name=Jou99>{{cite journal |vauthors=Jousilahti P, Vartiainen E, Tuomilehto J, Puska P |title=Sex, age, cardiovascular risk factors, and coronary heart disease: a prospective follow-up study of 14 786 middle-aged men and women in Finland |journal=Circulation |volume=99 |issue=9 |pages=1165–72 |date=March 1999 |pmid=10069784 |doi=10.1161/01.cir.99.9.1165 |doi-access=free }}</ref> In most populations, the serum total cholesterol level increases as age increases. In men, this increase levels off around age 45 to 50 years. In women, the increase continues sharply until age 60 to 65 years.<ref name=Jou99/>

Aging is also associated with changes in the mechanical and structural properties of the vascular wall, which leads to the loss of arterial elasticity and reduced arterial compliance and may subsequently lead to coronary artery disease.<ref name="autogenerated357">{{cite journal |vauthors=Jani B, Rajkumar C |title=Ageing and vascular ageing |journal=Postgraduate Medical Journal |volume=82 |issue=968 |pages=357–62 |date=June 2006 |pmid=16754702 |pmc=2563742 |doi=10.1136/pgmj.2005.036053 }}</ref>

===Sex===
{{see also|Cardiovascular disease in women}}
At same age, men are about 50% more likely to develop CVD and are typically diagnosed seven to ten years earlier in men than in women.<ref name="Conrad" /> A notable exception are [[Thromboembolic disease|thromboembolic diseases]] which are similarly common in men and women.<ref name="Conrad" /> It has been argued that the excess risk of CVD observed in men compared to women only applied to the pre-menopausal period,<ref name=Finegold/><ref name=WHF>{{cite web |url=http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors |title=Cardiovascular disease risk factors|date=2012|publisher=World Heart Federation|archive-url=https://web.archive.org/web/20120510135600/http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors/ |archive-date=2012-05-10 }}</ref> but more recent data from the WHO and UN disputes this.<ref name=Finegold/> If a female has diabetes, she is more likely to develop heart disease than a male with diabetes.<ref>{{cite web|url=https://www.npr.org/blogs/health/2014/05/22/314869923/diabetes-raises-womens-risk-of-heart-disease-more-than-for-men|title=Diabetes raises women's risk of heart disease more than for men|work=NPR.org|date=May 22, 2014|access-date=May 23, 2014|url-status=live|archive-url=https://web.archive.org/web/20140523093525/http://www.npr.org/blogs/health/2014/05/22/314869923/diabetes-raises-womens-risk-of-heart-disease-more-than-for-men|archive-date=May 23, 2014}}</ref> Women who have high blood pressure and had complications in their pregnancy have three times the risk of developing cardiovascular disease compared to women with normal blood pressure who had no complications in pregnancy.<ref>{{Cite journal |date=2023-11-21 |title=Pregnancy complications increase the risk of heart attacks and stroke in women with high blood pressure |url=https://evidence.nihr.ac.uk/alert/pregnancy-complications-increase-the-risk-of-heart-attacks-and-stroke-in-women-with-high-blood-pressure/ |journal=NIHR Evidence |type=Plain English summary |publisher=National Institute for Health and Care Research |doi=10.3310/nihrevidence_60660|s2cid=265356623 |url-access=subscription }}</ref><ref>{{cite journal |vauthors=Al Khalaf S, Chappell LC, Khashan AS, McCarthy FP, O'Reilly ÉJ |date=July 2023 |title=Association Between Chronic Hypertension and the Risk of 12 Cardiovascular Diseases Among Parous Women: The Role of Adverse Pregnancy Outcomes |journal=Hypertension |volume=80 |issue=7 |pages=1427–1438 |doi=10.1161/HYPERTENSIONAHA.122.20628 |pmid=37170819|doi-access=free }}</ref>

Coronary heart diseases are 2 to 5 times more common among middle-aged men than women.<ref name=Jou99/>  In a study done by the [[World Health Organization]], sex contributes to approximately 40% of the variation in sex ratios of coronary heart disease mortality.<ref>Jackson R, Chambles L, Higgins M, Kuulasmaa K, Wijnberg L, Williams D (WHO MONICA Project, and ARIC Study.) Sex difference in ischaemic heart disease mortality and risk factors in 46 communities:  an ecologic analysis. Cardiovasc Risk Factors. 1999; 7:43–54.</ref> Another study reports similar results finding that sex differences explains nearly half the risk associated with cardiovascular diseases<ref name=Jou99/> One of the proposed explanations for sex differences in cardiovascular diseases is hormonal difference.<ref name=Jou99/>  Among women, estrogen is the predominant sex hormone. [[Estrogen]] may have protective effects on glucose metabolism and hemostatic system, and may have direct effect in improving [[endothelial]] cell function.<ref name=Jou99/>  The production of estrogen decreases after menopause, and this may change the female lipid metabolism toward a more atherogenic form by decreasing the [[High-density lipoprotein|HDL]] cholesterol level while increasing LDL and total cholesterol levels.<ref name=Jou99/>

Among men and women, there are differences in body weight, height, body fat distribution, heart rate, stroke volume, and arterial compliance.<ref name="autogenerated357"/> In the very elderly, age-related large artery pulsatility and stiffness are more pronounced among women than men.<ref name="autogenerated357"/> This may be caused by the women's smaller body size and arterial dimensions which are independent of menopause.<ref name="autogenerated357"/>

===Tobacco===
Cigarettes are the major form of smoked tobacco.<ref name="WHO2011" /> Risks to health from tobacco use result not only from direct consumption of tobacco, but also from exposure to second-hand smoke.<ref name="WHO2011" /> Approximately 10% of cardiovascular disease is attributed to smoking;<ref name="WHO2011" /> however, people who quit smoking by age 30 have almost as low a risk of death as never smokers.<ref>{{cite journal | vauthors = Doll R, Peto R, Boreham J, Sutherland I | title = Mortality in relation to smoking: 50 years' observations on male British doctors | journal = BMJ | volume = 328 | issue = 7455 | page = 1519 | date = June 2004 | pmid = 15213107 | pmc = 437139 | doi = 10.1136/bmj.38142.554479.AE }}</ref>

===Physical inactivity===
{{see|Sedentary lifestyle}}
Insufficient physical activity (defined as less than 5 x 30 minutes of moderate activity per week, or less than 3 x 20 minutes of vigorous activity per week) is currently the fourth leading risk factor for mortality worldwide.<ref name="WHO2011" />  In 2008, 31.3% of adults aged 15 or older (28.2% men and 34.4% women) were insufficiently physically active.<ref name="WHO2011" />
The risk of ischemic heart disease and diabetes mellitus is reduced by almost a third in adults who participate in 150 minutes of moderate physical activity each week (or equivalent).<ref name="OrganizationUNAIDS2007">{{cite book|author1=World Health Organization|author2=UNAIDS|title=Prevention of Cardiovascular Disease|url=https://books.google.com/books?id=AS2RmtQVuLwC&pg=PT3|year=2007|publisher=World Health Organization|isbn=978-92-4-154726-0|pages=3–|url-status=live|archive-url=https://web.archive.org/web/20160427013804/https://books.google.com/books?id=AS2RmtQVuLwC&pg=PT3|archive-date=27 April 2016}}</ref> In addition, physical activity assists weight loss and improves blood glucose control, blood pressure, lipid profile and insulin sensitivity. These effects may, at least in part, explain its cardiovascular benefits.<ref name="WHO2011" />

===Diet===
{{Further|Saturated fat#Cardiovascular disease|Salt and cardiovascular disease|Lipid hypothesis}}
High dietary intakes of saturated fat, trans-fats and salt, and low intake of fruits, vegetables and fish are linked to cardiovascular risk, although whether all these associations indicate causes is disputed. The World Health Organization attributes approximately 1.7 million deaths worldwide to low fruit and vegetable consumption.<ref name="WHO2011" />  Frequent consumption of high-energy foods, such as processed foods that are high in fats and sugars, promotes obesity and may increase cardiovascular risk.<ref name="WHO2011" />  The amount of dietary salt consumed may also be an important determinant of blood pressure levels and overall cardiovascular risk.<ref name="WHO2011" />  There is moderate quality evidence that reducing saturated fat intake for at least two years reduces the risk of cardiovascular disease.<ref>{{cite journal | vauthors = Hooper L, Martin N, Jimoh OF, Kirk C, Foster E, Abdelhamid AS | title = Reduction in saturated fat intake for cardiovascular disease | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | article-number = CD011737 | date = August 2020 | issue = 8 | pmid = 32827219 | pmc = 8092457 | doi = 10.1002/14651858.CD011737.pub3}}</ref> High [[trans-fat]] intake has adverse effects on blood lipids and circulating inflammatory markers,<ref name="BookerMann2008">{{cite journal | vauthors = Booker CS, Mann JI | title = Trans fatty acids and cardiovascular health: translation of the evidence base | journal = Nutrition, Metabolism, and Cardiovascular Diseases | volume = 18 | issue = 6 | pages = 448–56 | date = July 2008 | pmid = 18468872 | doi = 10.1016/j.numecd.2008.02.005 }}</ref> and elimination of trans-fat from diets has been widely advocated.<ref name="RemigFranklin2010">{{cite journal | vauthors = Remig V, Franklin B, Margolis S, Kostas G, Nece T, Street JC | title = Trans fats in America: a review of their use, consumption, health implications, and regulation | journal = Journal of the American Dietetic Association | volume = 110 | issue = 4 | pages = 585–92 | date = April 2010 | pmid = 20338284 | doi = 10.1016/j.jada.2009.12.024 | hdl-access = free | hdl = 2097/6377 }}</ref><ref name="WHO2018">{{cite press release|title=WHO plan to eliminate industrially-produced trans-fatty acids from global food supply|url=https://www.who.int/news-room/detail/14-05-2018-who-plan-to-eliminate-industrially-produced-trans-fatty-acids-from-global-food-supply|publisher=World Health Organization|date=14 May 2018}}</ref> In 2018 the World Health Organization estimated that trans fats were the cause of more than half a million deaths per year.<ref name="WHO2018" /> There is evidence that higher consumption of sugar is associated with higher blood pressure and unfavorable blood lipids,<ref name="Te MorengaHowatson2014">{{cite journal | vauthors = Te Morenga LA, Howatson AJ, Jones RM, Mann J | title = Dietary sugars and cardiometabolic risk: systematic review and meta-analyses of randomized controlled trials of the effects on blood pressure and lipids | journal = The American Journal of Clinical Nutrition | volume = 100 | issue = 1 | pages = 65–79 | date = July 2014 | pmid = 24808490 | doi = 10.3945/ajcn.113.081521 | doi-access = free }}</ref> and sugar intake also increases the risk of diabetes mellitus.<ref name="Wylie-Rosett2002">{{cite journal |last=Howard|first=BV|author2=Wylie-Rosett, J |title=Sugar and cardiovascular disease: A statement for healthcare professionals from the Committee on Nutrition of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association.|journal=Circulation|date=Jul 23, 2002 |volume=106 |issue=4 |pages=523–7|pmid=12135957|doi=10.1161/01.cir.0000019552.77778.04|s2cid=1589727 |doi-access=free}}</ref> High consumption of processed meats [[Meat#Heart disease|is associated with an increased risk]] of cardiovascular disease, possibly in part due to increased dietary salt intake.<ref name="MichaMichas2012">{{cite journal | vauthors = Micha R, Michas G, Mozaffarian D | title = Unprocessed red and processed meats and risk of coronary artery disease and type 2 diabetes--an updated review of the evidence | journal = Current Atherosclerosis Reports | volume = 14 | issue = 6 | pages = 515–24 | date = December 2012 | pmid = 23001745 | pmc = 3483430 | doi = 10.1007/s11883-012-0282-8 }}</ref>

=== Alcohol ===
{{further|Alcohol and cardiovascular disease}}
The relationship between alcohol consumption and cardiovascular disease is complex, and may depend on the amount of alcohol consumed.<ref>{{cite journal | vauthors = Bell S, Daskalopoulou M, Rapsomaniki E, George J, Britton A, Bobak M, Casas JP, Dale CE, Denaxas S, Shah AD, Hemingway H | title = Association between clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases: population based cohort study using linked health records | journal = BMJ | volume = 356 | pages = j909 | date = March 2017 | pmid = 28331015 | pmc = 5594422 | doi = 10.1136/bmj.j909 }}</ref> There is a direct relationship between high levels of drinking alcohol and cardiovascular disease.<ref name="WHO2011" />  Drinking at low levels without episodes of heavy drinking may be associated with a reduced risk of cardiovascular disease,<ref name="MukamalChen2010">{{cite journal | vauthors = Mukamal KJ, Chen CM, Rao SR, Breslow RA | title = Alcohol consumption and cardiovascular mortality among U.S. adults, 1987 to 2002 | journal = Journal of the American College of Cardiology | volume = 55 | issue = 13 | pages = 1328–35 | date = March 2010 | pmid = 20338493 | pmc = 3865979 | doi = 10.1016/j.jacc.2009.10.056 }}</ref> but there is evidence that associations between moderate alcohol consumption and protection from stroke are non-causal.<ref>{{cite journal | vauthors = Millwood IY, Walters RG, Mei XW, Guo Y, Yang L, Bian Z, Bennett DA, Chen Y, Dong C, Hu R, Zhou G, Yu B, Jia W, Parish S, Clarke R, Davey Smith G, Collins R, Holmes MV, Li L, Peto R, Chen Z | title = Conventional and genetic evidence on alcohol and vascular disease aetiology: a prospective study of 500 000 men and women in China | journal = Lancet | volume = 393 | issue = 10183 | pages = 1831–1842 | date = May 2019 | pmid = 30955975 | pmc = 6497989 | doi = 10.1016/S0140-6736(18)31772-0 }}</ref> Moderate drinking is defined as one drink per day for women or two drinks a day for men. At the population level, the health risks of drinking alcohol exceed any potential benefits.<ref name="WHO2011" /><ref name="Organization2011">{{cite book|author=World Health Organization|title=Global Status Report on Alcohol and Health|url=https://books.google.com/books?id=ktyfuAAACAAJ|year=2011|publisher=World Health Organization|isbn=978-92-4-156415-1|url-status=live|archive-url=https://web.archive.org/web/20160507000025/https://books.google.com/books?id=ktyfuAAACAAJ|archive-date=2016-05-07}}</ref> Exercising regularly can provide the same benefits as potentially consuming small amounts of alcohol and is a much safer alternative. Consuming too much alcohol can cause a high blood pressure, heart failure, and cardiomyopathy. Drinking alcohol can also cause obesity, which can contribute to cardiovascular issues as well.<ref>{{Cite news |title=Alcohol and Heart Health: Separating Fact from Fiction |url=http://www.hopkinsmedicine.org/health/wellness-and-prevention/alcohol-and-heart-health-separating-fact-from-fiction#:~:text=Heavy%20drinking,%20on%20the%20other,that%20affects%20the%20heart%20muscle. |archive-url=http://web.archive.org/web/20250222182811/https://www.hopkinsmedicine.org/health/wellness-and-prevention/alcohol-and-heart-health-separating-fact-from-fiction |archive-date=2025-02-22 |access-date=2025-04-23 |language=en}}</ref>

===Celiac disease===
Untreated [[celiac disease]] can cause the development of many types of cardiovascular diseases, most of which improve or resolve with a [[gluten-free diet]] and intestinal healing. However, delays in recognition and diagnosis of celiac disease can cause irreversible heart damage.<ref name="CiaccioLewis2017" />

===Sleep===

A lack of good sleep, in amount or quality, is documented as increasing cardiovascular risk in both adults and teens. Recommendations suggest that infants typically need 12 or more hours of sleep per day, adolescents at least eight or nine hours, and adults seven or eight. About one-third of adult Americans get less than the recommended seven hours of sleep per night, and in a study of teenagers, just 2.2 percent of those studied got enough sleep, many of whom did not get good quality sleep.  Studies have shown that short sleepers getting less than seven hours sleep per night have a 10 percent to 30 percent higher risk of cardiovascular disease.<ref name="Jackson">{{cite journal | vauthors = Jackson CL, Redline S, Emmons KM | title = Sleep as a potential fundamental contributor to disparities in cardiovascular health | journal = Annual Review of Public Health | volume = 36 | issue = 1 | pages = 417–40 | date = March 2015 | pmid = 25785893 | pmc = 4736723 | doi = 10.1146/annurev-publhealth-031914-122838 }}</ref><ref name="Cespedes">{{cite journal | vauthors = Cespedes Feliciano EM, Quante M, Rifas-Shiman SL, Redline S, Oken E, Taveras EM | title = Objective Sleep Characteristics and Cardiometabolic Health in Young Adolescents | journal = Pediatrics | volume = 142 | issue = 1 | pages = e20174085 | date = July 2018 | pmid = 29907703 | pmc = 6260972 | doi = 10.1542/peds.2017-4085 }}</ref>

Sleep disorders such as [[Sleep and breathing#Sleep-disordered breathing (abnormal sleep and breathing or sleep-related breathing disorders)|sleep-disordered breathing]] and [[insomnia]], are also associated with a higher cardiometabolic risk.<ref name="pmid27647451">{{cite journal | vauthors = St-Onge MP, Grandner MA, Brown D, Conroy MB, Jean-Louis G, Coons M, Bhatt DL | title = Sleep Duration and Quality: Impact on Lifestyle Behaviors and Cardiometabolic Health: A Scientific Statement From the American Heart Association | journal = Circulation | volume = 134 | issue = 18 | pages = e367–e386 | date = November 2016 | pmid = 27647451 | pmc = 5567876 | doi = 10.1161/CIR.0000000000000444 | type = Review }}</ref>
An estimated 50 to 70 million Americans have insomnia, [[sleep apnea]] or other  chronic [[sleep disorders]].{{cn|date=February 2023}}

In addition, sleep research displays differences in race and class. Short sleep and poor sleep tend to be more frequently reported in ethnic minorities than in whites. African-Americans report experiencing short durations of sleep five times more often than whites, possibly as a result of social and environmental factors.  Black children and children living in disadvantaged neighborhoods have much higher rates of sleep apnea.<ref name="Wang">{{cite journal | vauthors = Wang R, Dong Y, Weng J, Kontos EZ, Chervin RD, Rosen CL, Marcus CL, Redline S | title = Associations among Neighborhood, Race, and Sleep Apnea Severity in Children. A Six-City Analysis | journal = Annals of the American Thoracic Society | volume = 14 | issue = 1 | pages = 76–84 | date = January 2017 | pmid = 27768852 | pmc = 5291481 | doi = 10.1513/AnnalsATS.201609-662OC }}</ref>

One study found that of adults who are 45 and older, subjects that fell asleep at different times each night and slept inconsistent numbers of hours each night were more likely to develop atherosclerosis. Poor sleep habits, such as too little sleep, too much sleep, or fragmented sleep, were associated with cardiovascular disease, obesity, and high blood pressure. Another study noted that participants whose sleep duration varied by more than two hours within the course of a week were 1.4 times more likely to have elevated levels of coronary artery calcium, a predictor of cardiovascular events.<ref>{{Cite web |title=Older adults with irregular sleep patterns may face higher risk of hardened arteries |url=https://www.heart.org/en/news/2023/02/15/older-adults-with-irregular-sleep-patterns-may-face-higher-risk-of-hardened-arteries |access-date=2025-04-23 |website=www.heart.org |language=en}}</ref>

===Socioeconomic disadvantage===
Cardiovascular disease has a greater impact on low- and middle-income countries compared to those with higher income.<ref name = "Di Cesare 2013">{{cite journal | vauthors = Di Cesare M, Khang YH, Asaria P, Blakely T, Cowan MJ, Farzadfar F, Guerrero R, Ikeda N, Kyobutungi C, Msyamboza KP, Oum S, Lynch JW, Marmot MG, Ezzati M | title = Inequalities in non-communicable diseases and effective responses | journal = Lancet | volume = 381 | issue = 9866 | pages = 585–97 | date = February 2013 | pmid = 23410608 | doi = 10.1016/S0140-6736(12)61851-0 | hdl = 10906/80012 | s2cid = 41892834 | hdl-access = free }}</ref> Although data on the social patterns of cardiovascular disease in low- and middle-income countries is limited,<ref name = "Di Cesare 2013"/> reports from high-income countries consistently demonstrate that low education, income, and socioeconomic status are associated with a greater risk of cardiovascular disease.<ref name="Conrad" /><ref>{{cite journal |vauthors=Mackenbach JP, Cavelaars AE, Kunst AE, Groenhof F |date=July 2000 |title=Socioeconomic inequalities in cardiovascular disease mortality; an international study |journal=European Heart Journal |volume=21 |issue=14 |pages=1141–51 |doi=10.1053/euhj.1999.1990 |pmid=10924297 |s2cid=8747779 |doi-access=free}}</ref> Policies that have resulted in increased socio-economic inequalities have been associated with greater subsequent socio-economic differences in cardiovascular disease<ref name = "Di Cesare 2013"/> implying a cause and effect relationship. Psychosocial factors, environmental exposures, health behaviours, and health-care access and quality contribute to socio-economic differentials in cardiovascular disease.<ref name="Alexander 2009">{{cite journal | vauthors = Clark AM, DesMeules M, Luo W, Duncan AS, Wielgosz A | title = Socioeconomic status and cardiovascular disease: risks and implications for care | journal = Nature Reviews. Cardiology | volume = 6 | issue = 11 | pages = 712–22 | date = November 2009 | pmid = 19770848 | doi = 10.1038/nrcardio.2009.163 | s2cid = 21835944 }}</ref> The Commission on Social Determinants of Health recommended that more equal distributions of power, wealth, education, housing, environmental factors, nutrition, and health care were needed to address inequalities in cardiovascular disease and non-communicable diseases.<ref name="CSDoH2008">{{cite book|author=World Health Organization|title=Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health: Commission on Social Determinants of Health Final Report|url=https://books.google.com/books?id=zc_VfH7wfV8C&pg=PA26|year=2008|publisher=World Health Organization|isbn=978-92-4-156370-3|pages=26–|url-status=live|archive-url=https://web.archive.org/web/20160501062510/https://books.google.com/books?id=zc_VfH7wfV8C&pg=PA26|archive-date=2016-05-01}}</ref>

===Air pollution===
[[Particulate matter]] has been studied for its short- and long-term exposure [[Particulate matter#Health effects|effects on cardiovascular disease]]. Currently, airborne particles under 2.5 micrometers in diameter (PM<sub>2.5</sub>) are the major focus, in which gradients are used to determine CVD risk. Overall, long-term PM exposure increased rate of atherosclerosis and inflammation. In regards to short-term exposure (2 hours), every 25 μg/m<sup>3</sup> of PM<sub>2.5</sub> resulted in a 48% increase of CVD mortality risk.<ref name="DOIthromres" /> In addition, after only 5 days of exposure, a rise in systolic (2.8 mmHg) and diastolic (2.7 mmHg) blood pressure occurred for every 10.5 μg/m<sup>3</sup> of PM<sub>2.5</sub>.<ref name="DOIthromres">{{cite journal | vauthors = Franchini M, Mannucci PM | title = Air pollution and cardiovascular disease | journal = Thrombosis Research | volume = 129 | issue = 3 | pages = 230–4 | date = March 2012 | pmid = 22113148 | doi = 10.1016/j.thromres.2011.10.030 }}</ref>  Other research has implicated PM<sub>2.5</sub> in irregular heart rhythm, reduced heart rate variability (decreased vagal tone), and most notably heart failure.<ref name="DOIthromres" /><ref name="Doicirculationaha">{{cite journal | vauthors = Sun Q, Hong X, Wold LE | title = Cardiovascular effects of ambient particulate air pollution exposure | journal = Circulation | volume = 121 | issue = 25 | pages = 2755–65 | date = June 2010 | pmid = 20585020 | pmc = 2924678 | doi = 10.1161/CIRCULATIONAHA.109.893461 }}</ref>  PM<sub>2.5</sub> is also linked to [[carotid artery]] thickening and increased risk of acute myocardial infarction.<ref name="DOIthromres" /><ref name="Doicirculationaha" />

===Cardiovascular risk assessment===
Existing cardiovascular disease or a previous cardiovascular event, such as a heart attack or stroke, is the strongest predictor of a future cardiovascular event.<ref name="Tunstall-Pedoe2011">{{cite journal | vauthors = Tunstall-Pedoe H | s2cid = 6420111 | title = Cardiovascular Risk and Risk Scores: ASSIGN, Framingham, QRISK and others: how to choose | journal = Heart | volume = 97 | issue = 6 | pages = 442–4 | date = March 2011 | pmid = 21339319 | doi = 10.1136/hrt.2010.214858 }}</ref> Age, sex, smoking, blood pressure, blood lipids and diabetes are important predictors of future cardiovascular disease in people who are not known to have cardiovascular disease.<ref name="Organization2007">{{cite book|author=World Health Organization|title=Prevention of Cardiovascular Disease: Guidelines for Assessment and Management of Cardiovascular Risk|url=https://books.google.com/books?id=oOfHQgAACAAJ|year=2007|publisher=World Health Organization|isbn=978-92-4-154717-8|url-status=live|archive-url=https://web.archive.org/web/20160506185216/https://books.google.com/books?id=oOfHQgAACAAJ|archive-date=2016-05-06}}</ref> These measures, and sometimes others, may be combined into composite risk scores to estimate an individual's future risk of cardiovascular disease.<ref name="Tunstall-Pedoe2011"/> Numerous risk scores exist although their respective merits are debated.<ref name="Hernandezvan Staa2014">{{cite journal | vauthors = van Staa TP, Gulliford M, Ng ES, Goldacre B, Smeeth L | title = Prediction of cardiovascular risk using Framingham, ASSIGN and QRISK2: how well do they predict individual rather than population risk? | journal = PLOS ONE | volume = 9 | issue = 10 | article-number = e106455 | year = 2014 | pmid = 25271417 | pmc = 4182667 | doi = 10.1371/journal.pone.0106455 | bibcode = 2014PLoSO...9j6455V | doi-access = free }} {{open access}}</ref> Other diagnostic tests and biomarkers remain under evaluation but currently these lack clear-cut evidence to support their routine use. They include family history, coronary artery [[calcification]] score, [[high sensitivity C-reactive protein]] (hs-CRP), [[ankle–brachial pressure index]],  lipoprotein subclasses and particle concentration, lipoprotein(a), apolipoproteins A-I and B, [[fibrinogen]], white blood cell count, [[homocysteine]], N-terminal pro B-type natriuretic peptide  (NT-proBNP), and markers of kidney function.<ref name="HlatkyGreenland2009">{{cite journal | vauthors = Hlatky MA, Greenland P, Arnett DK, Ballantyne CM, Criqui MH, Elkind MS, Go AS, Harrell FE, Hong Y, Howard BV, Howard VJ, Hsue PY, Kramer CM, McConnell JP, Normand SL, O'Donnell CJ, Smith SC, Wilson PW | title = Criteria for evaluation of novel markers of cardiovascular risk: a scientific statement from the American Heart Association | journal = Circulation | volume = 119 | issue = 17 | pages = 2408–16 | date = May 2009 | pmid = 19364974 | pmc = 2956982 | doi = 10.1161/CIRCULATIONAHA.109.192278 }}</ref><ref name="EckelCornier2014">{{cite journal | vauthors = Eckel RH, Cornier MA | title = Update on the NCEP ATP-III emerging cardiometabolic risk factors | journal = BMC Medicine | volume = 12 | issue = 1 | page = 115 | date = August 2014 | pmid = 25154373 | pmc = 4283079 | doi = 10.1186/1741-7015-12-115 | doi-access = free }} {{open access}}</ref> [[High blood phosphorus]] is also linked to an increased risk.<ref>{{cite journal | vauthors = Bai W, Li J, Liu J | title = Serum phosphorus, cardiovascular and all-cause mortality in the general population: A meta-analysis | journal = Clinica Chimica Acta; International Journal of Clinical Chemistry | volume = 461 | pages = 76–82 | date = October 2016 | pmid = 27475981 | doi = 10.1016/j.cca.2016.07.020 }}</ref>

===Psychological stress===
There is evidence that mental health problems, in particular depression and traumatic stress, is linked to cardiovascular diseases. Whereas mental health problems are known to be associated with risk factors for cardiovascular diseases such as smoking, poor diet, and a sedentary lifestyle, these factors alone do not explain the increased risk of cardiovascular diseases seen in depression, stress, and anxiety.<ref>{{cite journal | vauthors = Cohen BE, Edmondson D, Kronish IM | title = State of the Art Review: Depression, Stress, Anxiety, and Cardiovascular Disease | journal = American Journal of Hypertension | volume = 28 | issue = 11 | pages = 1295–302 | date = November 2015 | pmid = 25911639 | pmc = 4612342 | doi = 10.1093/ajh/hpv047 }}</ref> Moreover, [[posttraumatic stress disorder]] is independently associated with increased risk for incident coronary heart disease, even after adjusting for depression and other covariates.<ref>{{cite journal | vauthors = Edmondson D, Kronish IM, Shaffer JA, Falzon L, Burg MM | title = Posttraumatic stress disorder and risk for coronary heart disease: a meta-analytic review | journal = American Heart Journal | volume = 166 | issue = 5 | pages = 806–14 | date = November 2013 | pmid = 24176435 | pmc = 3815706 | doi = 10.1016/j.ahj.2013.07.031 }}</ref>

Many studies recognize depression and anxiety as two important disorders that can cause an increase in the risk of developing cardiovascular disease. Only half of the instances of cardiovascular disease are explained by factors such as age and gender that cannot be changed. The other half of instances are due to other sources, including psychological stress. Studies have shown that the prevalence of depression in patients with heart failure is higher than 20%.<ref>{{Cite journal |last1=Khayyam-Nekouei |first1=Zohreh |last2=Neshatdoost |first2=Hamidtaher |last3=Yousefy |first3=Alireza |last4=Sadeghi |first4=Masoumeh |last5=Manshaee |first5=Gholamreza |date=January 2013 |title=Psychological factors and coronary heart disease |journal=ARYA Atherosclerosis |volume=9 |issue=1 |pages=102–111 |issn=1735-3955 |pmc=3653260 |pmid=23690809}}</ref>

Another study assessed the link between men and women who had been divorced and instance of cardiovascular disease. The study found that women who had gone through at least two divorces were just as likely to experience cardiovascular disease as a smoker or diabetic. Men, on the other hand, also had a higher risk of cardiovascular disease, however, their health improved upon remarriage while women did not.<ref>{{Cite news |title=Risk Factors for Heart Disease: Don't Underestimate Stress |url=http://www.hopkinsmedicine.org/health/wellness-and-prevention/risk-factors-for-heart-disease-dont-underestimate-stress |archive-url=http://web.archive.org/web/20250226160027/https://www.hopkinsmedicine.org/health/wellness-and-prevention/risk-factors-for-heart-disease-dont-underestimate-stress |archive-date=2025-02-26 |access-date=2025-04-23 |language=en}}</ref>

This study also found that during a World Cup soccer event in Germany, heart attacks more than doubled during the days when the nation's team was playing. Researchers assume this link is due to the fact that stress can increase inflammation in the body, which can cause high blood pressure and low HDL cholesterol. Chronic stress can also affect sleep, exercise, and food choices.

=== Anxiety ===
Patients who suffer from generalized anxiety disorder are more likely to develop some form of cardiovascular disease. It is hypothesized that anxiety makes one more likely to develop cardiovascular disease due to the fact that it can change the body's stress response through hormonal and physiological reactions. People with anxiety often experience high blood pressure, arrhythmias, and heart attacks. The stress response caused by anxiety can increase inflammation in the body. It was also discovered that patients with anxiety had lower levels of omega-3-fatty acids which is linked to an increased risk of developing cardiovascular disease.<ref>{{Cite web |date=2015-06-11 |title=Calm your anxious heart |url=https://www.health.harvard.edu/heart-health/calm-your-anxious-heart |access-date=2025-04-23 |website=Harvard Health |language=en}}</ref>

=== Occupational exposure ===
{{Main|Occupational cardiovascular disease}}
Little is known about the relationship between work and cardiovascular disease, but links have been established between certain toxins, extreme heat and cold, exposure to tobacco smoke, and mental health concerns such as stress and depression.<ref>{{Cite web|url=https://www.cdc.gov/niosh/programs/crcd/|title=NIOSH Program Portfolio : Cancer, Reproductive, and Cardiovascular Diseases: Program Description|website=CDC|access-date=2016-06-07|url-status=live|archive-url=https://web.archive.org/web/20160515221455/http://www.cdc.gov/niosh/programs/crcd/|archive-date=2016-05-15}}</ref>

====Non-chemical risk factors====
A 2015 SBU-report looking at non-chemical factors found an association for those:<ref name=":2" />
* with mentally stressful work with a lack of control over their working situation — with an effort-reward imbalance<ref name=":2" />
* who experience low social support at work; who experience injustice or experience insufficient opportunities for personal development; or those who experience job insecurity<ref name=":2" />
* those who work night schedules; or have long working weeks<ref name=":2" />
* those who are exposed to noise<ref name=":2" />

Specifically the risk of [[stroke]] was also increased by exposure to ionizing radiation.<ref name=":2" /> Hypertension develops more often in those who experience job strain and who have shift-work.<ref name=":2" /> Differences between women and men in risk are small, however men risk having and dying of [[heart attack]]s or stroke twice as often as women during working life.<ref name=":2">{{Cite web|url=http://www.sbu.se/en/publications/sbu-assesses/occupational-exposures-and-cardiovascular-disease/|title=Occupational Exposures and Cardiovascular Disease|author=[[Swedish Agency for Health Technology Assessment and Assessment of Social Services]] (SBU)|website=www.sbu.se|language=en|access-date=2017-06-01|url-status=live|archive-url=https://web.archive.org/web/20170614063247/http://www.sbu.se/en/publications/sbu-assesses/occupational-exposures-and-cardiovascular-disease/|archive-date=2017-06-14|date=2015-08-26}}</ref>

====Chemical risk factors====
A 2017 SBU report found evidence that workplace exposure to [[silica dust]], [[engine exhaust]] or [[welding fumes]] is associated with heart disease.<ref name=SBU2017>{{Cite web|url=http://www.sbu.se/en/publications/sbu-assesses/occupational-health-and-safety--chemical-exposure/|title=Occupational health and safety – chemical exposure|author=[[Swedish Agency for Health Technology Assessment and Assessment of Social Services]] (SBU)|website=www.sbu.se|language=en|access-date=2017-06-01|archive-url=https://web.archive.org/web/20170606093333/http://www.sbu.se/en/publications/sbu-assesses/occupational-health-and-safety--chemical-exposure/|archive-date=2017-06-06}}</ref> Associations also exist for exposure to [[arsenic]], [[Benzo(a)pyrene|benzopyrenes]], [[lead]], [[dynamite]], [[Carbon disulfide|carbon disulphide]], [[carbon monoxide]], [[Cutting fluid|metalworking fluids]] and occupational exposure to [[tobacco smoke]].<ref name="SBU2017" /> Working  with  the  [[electrolytic]] production of  aluminium  or  the  production  of  paper  when  the  sulphate pulping  process  is  used  is  associated with heart disease.<ref name="SBU2017" /> An association was also found  between  heart  disease  and  exposure  to  compounds  which  are  no  longer  permitted  in certain  work  environments,  such  as  [[phenoxy acid]]s containing [[2,3,7,8-Tetrachlorodibenzodioxin|TCDD]](dioxin) or [[asbestos]].<ref name="SBU2017" />

Workplace exposure to silica dust or asbestos is also associated with [[pulmonary heart disease]]. There is evidence that workplace  exposure to lead, carbon disulphide, phenoxyacids containing  TCDD, as well as working in an environment where aluminum is being electrolytically produced, is associated with [[stroke]].<ref name="SBU2017" />

=== Somatic mutations ===
As of 2017, evidence suggests that certain [[leukemia]]-associated [[mutation]]s in [[blood cell]]s may also lead to increased risk of cardiovascular disease. Several large-scale research projects looking at human genetic data have found a robust link between the presence of these mutations, a condition known as [[clonal hematopoiesis]], and cardiovascular disease-related incidents and mortality.<ref>{{cite journal | vauthors = Jan M, Ebert BL, Jaiswal S | title = Clonal hematopoiesis | journal = Seminars in Hematology | volume = 54 | issue = 1 | pages = 43–50 | date = January 2017 | pmid = 28088988 | doi = 10.1053/j.seminhematol.2016.10.002 | pmc = 8045769 | doi-access = free }}</ref>

===Radiation therapy===
[[Radiation therapy|Radiation treatments (RT) for cancer]] can increase the risk of heart disease and death, as observed in breast cancer therapy.<ref>{{cite journal | vauthors = Taylor CW, Nisbet A, McGale P, Darby SC | title = Cardiac exposures in breast cancer radiotherapy: 1950s-1990s | journal = International Journal of Radiation Oncology, Biology, Physics | volume = 69 | issue = 5 | pages = 1484–95 | date = December 2007 | pmid = 18035211 | doi = 10.1016/j.ijrobp.2007.05.034 }}</ref>  Therapeutic radiation increases the risk of a subsequent heart attack or stroke by 1.5 to 4 times;<ref name="pmid:20298931">{{cite journal | vauthors = Weintraub NL, Jones WK, Manka D | title = Understanding radiation-induced vascular disease | journal = Journal of the American College of Cardiology | volume = 55 | issue = 12 | pages = 1237–1239 | date = March 2010 | pmid = 20298931 | pmc = 3807611 | doi = 10.1016/j.jacc.2009.11.053 }}</ref> the increase depends on the dose strength, volume, and location. Use of concomitant chemotherapy, e.g. anthracyclines, is an aggravating risk factor.<ref name="Benveniste" /> The occurrence rate of RT induced cardiovascular disease is estimated between 10% and 30%.<ref name="Benveniste">{{cite journal |last1=Benveniste |first1=Marcelo F. |last2=Gomez |first2=Daniel |last3=Carter |first3=Brett W. |last4=Betancourt Cuellar |first4=Sonia L. |last5=Shroff |first5=Girish S. |last6=Benveniste |first6=Ana Paula |last7=Odisio |first7=Erika G. |last8=Marom |first8=Edith M. |title=Recognizing Radiation Therapy–related Complications in the Chest |journal=RadioGraphics |date=March 7, 2019 |volume=39 |issue=2 |page=353 |doi=10.1148/rg.2019180061 |pmid=30844346 |s2cid=73477338 |url=https://pubs.rsna.org/doi/epdf/10.1148/rg.2019180061 |access-date=24 August 2023|url-access=subscription }}</ref>

Side-effects from radiation therapy for cardiovascular diseases have been termed ''radiation-induced heart disease'' or ''radiation-induced cardiovascular disease''.<ref name="pmid:28911261">{{cite journal | vauthors = Klee NS, McCarthy CG, Martinez-Quinones P, Webb RC | title = Out of the frying pan and into the fire: damage-associated molecular patterns and cardiovascular toxicity following cancer therapy | journal = Therapeutic Advances in Cardiovascular Disease | volume = 11 | issue = 11 | pages = 297–317 | date = November 2017 | pmid = 28911261 | pmc = 5933669 | doi = 10.1177/1753944717729141 }}</ref><ref name="Belzile-Dugas">{{cite journal |vauthors=Belzile-Dugas E, Eisenberg MJ |title=Radiation-Induced Cardiovascular Disease: Review of an Underrecognized Pathology |journal=J Am Heart Assoc |volume=10 |issue=18 |article-number=e021686 |date=September 2021 |pmid=34482706 |pmc=8649542 |doi=10.1161/JAHA.121.021686 |url=}}</ref> Symptoms are dose-dependent and include [[cardiomyopathy]], [[myocardial fibrosis]], [[valvular heart disease]], [[coronary artery disease]], [[heart arrhythmia]] and [[peripheral artery disease]]. Radiation-induced fibrosis, vascular [[Endothelial dysfunction|cell damage]] and [[oxidative stress]] can lead to these and other late side-effect symptoms.<ref name="pmid:28911261" />

==Pathophysiology==
[[File:Cardiovascular calcification - Sergio Bertazzo.tif|thumbnail|right|Density-Dependent Colour Scanning Electron Micrograph SEM (DDC-SEM) of cardiovascular calcification, showing in orange calcium phosphate spherical particles (denser material) and, in green, the extracellular matrix (less dense material)<ref name="Bertazzo">{{cite journal | vauthors = Bertazzo S, Gentleman E, Cloyd KL, Chester AH, Yacoub MH, Stevens MM | title = Nano-analytical electron microscopy reveals fundamental insights into human cardiovascular tissue calcification | journal = Nature Materials | volume = 12 | issue = 6 | pages = 576–83 | date = June 2013 | pmid = 23603848 | pmc = 5833942 | doi = 10.1038/nmat3627 | bibcode = 2013NatMa..12..576B }}</ref>]]
Population-based studies show that atherosclerosis, the major precursor of cardiovascular disease, begins in childhood. The Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study demonstrated that intimal lesions appear in all the aortas and more than half of the right coronary arteries of youths aged 7–9 years.<ref>{{cite journal | vauthors = Vanhecke TE, Miller WM, Franklin BA, Weber JE, McCullough PA | title = Awareness, knowledge, and perception of heart disease among adolescents | journal = European Journal of Cardiovascular Prevention and Rehabilitation | volume = 13 | issue = 5 | pages = 718–23 | date = October 2006 | pmid = 17001210 | doi = 10.1097/01.hjr.0000214611.91490.5e | s2cid = 36312234 }}</ref>

Obesity and [[diabetes mellitus]] are linked to cardiovascular disease,<ref>{{cite journal | vauthors = Highlander P, Shaw GP | title = Current pharmacotherapeutic concepts for the treatment of cardiovascular disease in diabetics | journal = Therapeutic Advances in Cardiovascular Disease | volume = 4 | issue = 1 | pages = 43–54 | date = February 2010 | pmid = 19965897 | doi = 10.1177/1753944709354305 | s2cid = 23913203 }}</ref> as are a history of chronic [[kidney disease]] and [[hypercholesterolaemia]].<ref name="nps01">{{cite web |title=NPS Prescribing Practice Review 53: Managing lipids |url=http://www.nps.org.au/health_professionals/publications/prescribing_practice_review/current/prescribing_practice_review_53 |author=NPS Medicinewise |access-date=1 August 2011 |date=1 March 2011 |archive-url=https://web.archive.org/web/20110319103522/http://www.nps.org.au/health_professionals/publications/prescribing_practice_review/current/prescribing_practice_review_53 |archive-date=19 March 2011 }}</ref>  In fact, cardiovascular disease is the most life-threatening of the diabetic complications and diabetics are two- to four-fold more likely to die of cardiovascular-related causes than nondiabetics.<ref>{{cite journal | vauthors = Kvan E, Pettersen KI, Sandvik L, Reikvam A | title = High mortality in diabetic patients with acute myocardial infarction: cardiovascular co-morbidities contribute most to the high risk | journal = International Journal of Cardiology | volume = 121 | issue = 2 | pages = 184–8 | date = October 2007 | pmid = 17184858 | doi = 10.1016/j.ijcard.2006.11.003 }}</ref><ref>{{cite journal | vauthors = Norhammar A, Malmberg K, Diderholm E, Lagerqvist B, Lindahl B, Rydén L, Wallentin L | title = Diabetes mellitus: the major risk factor in unstable coronary artery disease even after consideration of the extent of coronary artery disease and benefits of revascularization | journal = Journal of the American College of Cardiology | volume = 43 | issue = 4 | pages = 585–91 | date = February 2004 | pmid = 14975468 | doi = 10.1016/j.jacc.2003.08.050 | doi-access = free }}</ref><ref>{{cite journal | author = DECODE, European Diabetes Epidemiology Group | title = Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. The DECODE study group. European Diabetes Epidemiology Group. Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe | journal = Lancet | volume = 354 | issue = 9179 | pages = 617–21 | date = August 1999 | pmid = 10466661 | doi = 10.1016/S0140-6736(98)12131-1 | s2cid = 54227479 }}</ref>

==Screening==
Screening [[ECG]]s (either at rest or with exercise) are not recommended in those without symptoms who are at low risk.<ref>{{cite journal | vauthors = Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW, Kemper AR, Kubik M, Landefeld CS, Mangione CM, Silverstein M, Simon MA, Tseng CW, Wong JB | title = Screening for Cardiovascular Disease Risk With Electrocardiography: US Preventive Services Task Force Recommendation Statement | journal = JAMA | volume = 319 | issue = 22 | pages = 2308–2314 | date = June 2018 | pmid = 29896632 | doi = 10.1001/jama.2018.6848 | doi-access = free }}</ref> This includes those who are young without risk factors.<ref>{{cite journal | vauthors = Maron BJ, Friedman RA, Kligfield P, Levine BD, Viskin S, Chaitman BR, Okin PM, Saul JP, Salberg L, Van Hare GF, Soliman EZ, Chen J, Matherne GP, Bolling SF, Mitten MJ, Caplan A, Balady GJ, Thompson PD | title = Assessment of the 12-lead ECG as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 Years of Age): a scientific statement from the American Heart Association and the American College of Cardiology | journal = Circulation | volume = 130 | issue = 15 | pages = 1303–34 | date = October 2014 | pmid = 25223981 | doi = 10.1161/CIR.0000000000000025 | doi-access = free }}</ref> In those at higher risk the evidence for screening with ECGs is inconclusive.<ref name=Annals2012>{{cite journal |author1-link=Virginia Moyer | vauthors = Moyer VA | title = Screening for coronary heart disease with electrocardiography: U.S. Preventive Services Task Force recommendation statement | journal = Annals of Internal Medicine | volume = 157 | issue = 7 | pages = 512–8 | date = October 2012 | pmid = 22847227 | doi = 10.7326/0003-4819-157-7-201210020-00514 | doi-access = free }}</ref> Additionally [[echocardiography]], [[myocardial perfusion imaging]], and [[cardiac stress test]]ing is not recommended in those at low risk who do not have symptoms.<ref>{{cite journal | vauthors = Chou R | title = Cardiac screening with electrocardiography, stress echocardiography, or myocardial perfusion imaging: advice for high-value care from the American College of Physicians | journal = Annals of Internal Medicine | volume = 162 | issue = 6 | pages = 438–47 | date = March 2015 | pmid = 25775317 | doi = 10.7326/M14-1225 | s2cid = 207538193 }}</ref> Some [[Biomarker (medicine)|biomarkers]] may add to conventional cardiovascular risk factors in predicting the risk of future cardiovascular disease; however, the value of some biomarkers is questionable.<ref>{{cite journal | vauthors = Wang TJ, Gona P, Larson MG, Tofler GH, Levy D, Newton-Cheh C, Jacques PF, Rifai N, Selhub J, Robins SJ, Benjamin EJ, D'Agostino RB, Vasan RS | s2cid = 196411135 | title = Multiple biomarkers for the prediction of first major cardiovascular events and death | journal = The New England Journal of Medicine | volume = 355 | issue = 25 | pages = 2631–9 | date = December 2006 | pmid = 17182988 | doi = 10.1056/NEJMoa055373 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Spence JD | title = Technology Insight: ultrasound measurement of carotid plaque--patient management, genetic research, and therapy evaluation | journal = Nature Clinical Practice. Neurology | volume = 2 | issue = 11 | pages = 611–9 | date = November 2006 | pmid = 17057748 | doi = 10.1038/ncpneuro0324 | s2cid = 26077254 }}</ref> [[Ankle-brachial index]] (ABI), [[high-sensitivity C-reactive protein]] (hsCRP), and [[coronary artery calcium]], are also of unclear benefit in those without symptoms as of 2018.<ref>{{cite journal | vauthors = Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW, Kemper AR, Kubik M, Landefeld CS, Mangione CM, Silverstein M, Simon MA, Tseng CW, Wong JB | title = Risk Assessment for Cardiovascular Disease With Nontraditional Risk Factors: US Preventive Services Task Force Recommendation Statement | journal = JAMA | volume = 320 | issue = 3 | pages = 272–280 | date = July 2018 | pmid = 29998297 | doi = 10.1001/jama.2018.8359 | doi-access = free }}</ref>

The NIH recommends lipid testing in children beginning at the age of 2 if there is a family history of heart disease or lipid problems.<ref>{{cite journal | author =  Expert Panel on Integrated Guidelines for Cardiovascular Health Risk Reduction in Children Adolescents | title = Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report | journal = Pediatrics | volume = 128 | issue = Supplement 5 | pages = S213-56 | date = December 2011 | pmid = 22084329 | pmc = 4536582 | doi = 10.1542/peds.2009-2107C }}</ref> It is hoped that early testing will improve lifestyle factors in those at risk such as diet and exercise.<ref>{{cite journal | vauthors = Saenger AK | title = Universal lipid screening in children and adolescents: a baby step toward primordial prevention? | journal = Clinical Chemistry | volume = 58 | issue = 8 | pages = 1179–81 | date = August 2012 | pmid = 22510399 | doi = 10.1373/clinchem.2012.182287 | doi-access = free }}</ref>

Screening and selection for primary prevention interventions has traditionally been done through absolute risk using a variety of scores (ex. Framingham or Reynolds risk scores).<ref name=":0">{{Cite book|title=Braunwald's heart disease: a textbook of cardiovascular medicine| vauthors = Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E |isbn=978-1-4557-5133-4|edition=Tenth |location=Philadelphia|oclc=890409638 |year=2014}}</ref> This stratification has separated people who receive the lifestyle interventions (generally lower and intermediate risk) from the medication (higher risk). The number and variety of risk scores available for use has multiplied, but their efficacy according to a 2016 review was unclear due to lack of external validation or impact analysis.<ref>{{cite journal | vauthors = Damen JA, Hooft L, Schuit E, Debray TP, Collins GS, Tzoulaki I, Lassale CM, Siontis GC, Chiocchia V, Roberts C, Schlüssel MM, Gerry S, Black JA, Heus P, van der Schouw YT, Peelen LM, Moons KG | title = Prediction models for cardiovascular disease risk in the general population: systematic review | journal = BMJ | volume = 353 | article-number = i2416 | date = May 2016 | pmid = 27184143 | pmc = 4868251 | doi = 10.1136/bmj.i2416|author6-link= Ioanna Tzoulaki }}</ref> Risk stratification models often lack sensitivity for population groups and do not account for the large number of negative events among the intermediate and low risk groups.<ref name=":0" /> As a result, future preventative screening appears to shift toward applying prevention according to randomized trial results of each intervention rather than large-scale risk assessment.

==Prevention==
Up to 90% of cardiovascular disease may be preventable if established risk factors are avoided.<ref name="McGill2008"/><ref>{{cite journal | vauthors = McNeal CJ, Dajani T, Wilson D, Cassidy-Bushrow AE, Dickerson JB, Ory M | title = Hypercholesterolemia in youth: opportunities and obstacles to prevent premature atherosclerotic cardiovascular disease | journal = Current Atherosclerosis Reports | volume = 12 | issue = 1 | pages = 20–8 | date = January 2010 | pmid = 20425267 | doi = 10.1007/s11883-009-0072-0 | s2cid = 37833889 }}</ref> Currently practised measures to prevent cardiovascular disease include:
* Maintaining a [[healthy diet]], such as the [[Mediterranean diet]], a [[Vegetarianism|vegetarian]], [[Veganism|vegan]] or another [[plant-based diet]].<ref name="NHS Direct">{{cite web|date=28 November 2019|title=Heart Attack—Prevention|url=https://www.nhs.uk/conditions/heart-attack/prevention/|publisher=NHS Direct}}</ref><ref name=":5">{{Cite journal|last1=Quek|first1=Jingxuan|last2=Lim|first2=Grace|last3=Lim|first3=Wen Hui|last4=Ng|first4=Cheng Han|last5=So|first5=Wei Zheng|last6=Toh|first6=Jonathan|last7=Pan|first7=Xin Hui|last8=Chin|first8=Yip Han|last9=Muthiah|first9=Mark D.|last10=Chan|first10=Siew Pang|last11=Foo|first11=Roger S. Y.|date=2021-11-05|title=The Association of Plant-Based Diet With Cardiovascular Disease and Mortality: A Meta-Analysis and Systematic Review of Prospect Cohort Studies|journal=Frontiers in Cardiovascular Medicine|volume=8|article-number=756810|doi=10.3389/fcvm.2021.756810|issn=2297-055X|pmc=8604150|pmid=34805312|doi-access=free}}</ref><ref name=":6">{{Cite journal|last1=Gan|first1=Zuo Hua|last2=Cheong|first2=Huey Chiat|last3=Tu|first3=Yu-Kang|last4=Kuo|first4=Po-Hsiu|date=2021-11-05|title=Association between Plant-Based Dietary Patterns and Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis of Prospective Cohort Studies|journal=Nutrients|volume=13|issue=11|page=3952|doi=10.3390/nu13113952|issn=2072-6643|pmc=8624676|pmid=34836208|doi-access=free}}</ref><ref name=":7">{{Cite journal|last1=Benatar|first1=Jocelyne R.|last2=Stewart|first2=Ralph A. H.|date=2018|title=Cardiometabolic risk factors in vegans; A meta-analysis of observational studies|journal=PLOS ONE|volume=13|issue=12|article-number=e0209086|bibcode=2018PLoSO..1309086B|doi=10.1371/journal.pone.0209086|issn=1932-6203|pmc=6301673|pmid=30571724|doi-access=free}}</ref>
* Replacing [[saturated fat]] with healthier choices: Clinical trials show that replacing saturated fat with polyunsaturated vegetable oil reduced CVD by 30%. Prospective observational studies show that in many populations lower intake of saturated fat coupled with higher intake of polyunsaturated and monounsaturated fat is associated with lower rates of CVD.<ref>Frank M. Sacks, Alice H. Lichtenstein, Jason H.Y. Wu, Lawrence J. Appel, Mark A. Creager, [[Penny M. Kris-Etherton]], Michael Miller,

Eric B. Rimm, Lawrence L. Rudel, Jennifer G. Robinson, Neil J. Stone, and Linda V. Van Horn: ''Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association, 15 Jun 2017, https://doi.org/10.1161/CIR.0000000000000510Circulation 2017;136:e1–e23,'' https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000510</ref>
* Decrease body fat if overweight or obese.<ref>{{cite journal|vauthors=McTigue KM, Hess R, Ziouras J|date=September 2006|title=Obesity in older adults: a systematic review of the evidence for diagnosis and treatment|journal=Obesity|volume=14|issue=9|pages=1485–97|doi=10.1038/oby.2006.171|pmid=17030958|doi-access=free|s2cid=45241607}}</ref> The effect of weight loss is often difficult to distinguish from dietary change, and evidence on weight reducing diets is limited.<ref>{{cite journal|vauthors=Semlitsch T, Krenn C, Jeitler K, Berghold A, Horvath K, Siebenhofer A|date=February 2021|title=Long-term effects of weight-reducing diets in people with hypertension|journal=The Cochrane Database of Systematic Reviews|volume=2021|issue=2|article-number=CD008274|doi=10.1002/14651858.CD008274.pub4|pmc=8093137|pmid=33555049}}</ref> In observational studies of people with severe obesity, weight loss following bariatric surgery is associated with a 46% reduction in cardiovascular risk.<ref>{{cite journal|vauthors=Kwok CS, Pradhan A, Khan MA, Anderson SG, Keavney BD, Myint PK, Mamas MA, Loke YK|date=April 2014|title=Bariatric surgery and its impact on cardiovascular disease and mortality: a systematic review and meta-analysis|journal=International Journal of Cardiology|volume=173|issue=1|pages=20–8|doi=10.1016/j.ijcard.2014.02.026|pmid=24636546|hdl-access=free|hdl=2164/3181}}</ref>
* Limit alcohol consumption to the recommended daily limits.<ref name="NHS Direct" /> People who moderately consume alcoholic drinks have a 25–30% lower risk of cardiovascular disease.<ref>{{cite journal|vauthors=Ronksley PE, Brien SE, Turner BJ, Mukamal KJ, Ghali WA|date=February 2011|title=Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis|journal=BMJ|volume=342|pages=d671|doi=10.1136/bmj.d671|pmc=3043109|pmid=21343207}}</ref><ref name="Mostofsky 979–987">{{cite journal|vauthors=Mostofsky E, Chahal HS, Mukamal KJ, Rimm EB, Mittleman MA|date=March 2016|title=Alcohol and Immediate Risk of Cardiovascular Events: A Systematic Review and Dose-Response Meta-Analysis|journal=Circulation|volume=133|issue=10|pages=979–87|doi=10.1161/CIRCULATIONAHA.115.019743|pmc=4783255|pmid=26936862}}</ref> However, people who are genetically predisposed to consume less alcohol have lower rates of cardiovascular disease<ref>{{cite journal|vauthors=Holmes MV, Dale CE, Zuccolo L, Silverwood RJ, Guo Y, Ye Z, Prieto-Merino D, Dehghan A, Trompet S, Wong A, Cavadino A, Drogan D, Padmanabhan S, Li S, Yesupriya A, Leusink M, Sundstrom J, Hubacek JA, Pikhart H, Swerdlow DI, Panayiotou AG, Borinskaya SA, Finan C, Shah S, Kuchenbaecker KB, Shah T, Engmann J, Folkersen L, Eriksson P, Ricceri F, Melander O, Sacerdote C, Gamble DM, Rayaprolu S, Ross OA, McLachlan S, Vikhireva O, Sluijs I, Scott RA, Adamkova V, Flicker L, Bockxmeer FM, Power C, Marques-Vidal P, Meade T, Marmot MG, Ferro JM, Paulos-Pinheiro S, Humphries SE, Talmud PJ, Mateo Leach I, Verweij N, Linneberg A, Skaaby T, Doevendans PA, Cramer MJ, van der Harst P, Klungel OH, Dowling NF, Dominiczak AF, Kumari M, Nicolaides AN, Weikert C, Boeing H, Ebrahim S, Gaunt TR, Price JF, Lannfelt L, Peasey A, Kubinova R, Pajak A, Malyutina S, Voevoda MI, Tamosiunas A, Maitland-van der Zee AH, Norman PE, Hankey GJ, Bergmann MM, Hofman A, Franco OH, Cooper J, Palmen J, Spiering W, de Jong PA, Kuh D, Hardy R, Uitterlinden AG, Ikram MA, Ford I, Hyppönen E, Almeida OP, Wareham NJ, Khaw KT, Hamsten A, Husemoen LL, Tjønneland A, Tolstrup JS, Rimm E, Beulens JW, Verschuren WM, Onland-Moret NC, Hofker MH, Wannamethee SG, Whincup PH, Morris R, Vicente AM, Watkins H, Farrall M, Jukema JW, Meschia J, Cupples LA, Sharp SJ, Fornage M, Kooperberg C, LaCroix AZ, Dai JY, Lanktree MB, Siscovick DS, Jorgenson E, Spring B, Coresh J, Li YR, Buxbaum SG, Schreiner PJ, Ellison RC, Tsai MY, Patel SR, Redline S, Johnson AD, Hoogeveen RC, Hakonarson H, Rotter JI, Boerwinkle E, de Bakker PI, Kivimaki M, Asselbergs FW, Sattar N, Lawlor DA, Whittaker J, Davey Smith G, Mukamal K, Psaty BM, Wilson JG, Lange LA, Hamidovic A, Hingorani AD, Nordestgaard BG, Bobak M, Leon DA, Langenberg C, Palmer TM, Reiner AP, Keating BJ, Dudbridge F, Casas JP|date=July 2014|title=Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data|journal=BMJ|volume=349|article-number=g4164|doi=10.1136/bmj.g4164|pmc=4091648|pmid=25011450}}</ref> suggesting that alcohol itself may not be protective. Excessive alcohol intake increases the risk of cardiovascular disease<ref>{{cite journal|vauthors=Klatsky AL|date=May 2009|title=Alcohol and cardiovascular diseases|journal=Expert Review of Cardiovascular Therapy|volume=7|issue=5|pages=499–506|doi=10.1586/erc.09.22|pmid=19419257|s2cid=23782870}}</ref><ref name="Mostofsky 979–987" /> and consumption of alcohol is associated with increased risk of a cardiovascular event in the day following consumption.<ref name="Mostofsky 979–987" />
* Decrease non-[[High-density lipoprotein|HDL cholesterol]].<ref>{{cite journal|vauthors=McMahan CA, Gidding SS, Malcom GT, Tracy RE, Strong JP, McGill HC|date=October 2006|title=Pathobiological determinants of atherosclerosis in youth risk scores are associated with early and advanced atherosclerosis|journal=Pediatrics|volume=118|issue=4|pages=1447–55|doi=10.1542/peds.2006-0970|pmid=17015535|s2cid=37741456}}</ref><ref>{{cite journal|vauthors=Raitakari OT, Rönnemaa T, Järvisalo MJ, Kaitosaari T, Volanen I, Kallio K, Lagström H, Jokinen E, Niinikoski H, Viikari JS, Simell O|date=December 2005|title=Endothelial function in healthy 11-year-old children after dietary intervention with onset in infancy: the Special Turku Coronary Risk Factor Intervention Project for children (STRIP)|journal=Circulation|volume=112|issue=24|pages=3786–94|doi=10.1161/CIRCULATIONAHA.105.583195|pmid=16330680|doi-access=free}}</ref> [[Statin]] treatment reduces cardiovascular mortality by about 31%.<ref>{{cite journal|vauthors=Chou R, Dana T, Blazina I, Daeges M, Jeanne TL|date=November 2016|title=Statins for Prevention of Cardiovascular Disease in Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force|journal=JAMA|volume=316|issue=19|pages=2008–2024|doi=10.1001/jama.2015.15629|pmid=27838722|doi-access=free}}</ref>
* [[Smoking cessation|Stopping smoking]] and avoidance of second-hand smoke.<ref name="NHS Direct" /> Stopping smoking reduces risk by about 35%.<ref>{{cite journal | vauthors = Critchley J, Capewell S | title = Smoking cessation for the secondary prevention of coronary heart disease | journal = The Cochrane Database of Systematic Reviews | issue = 1 | article-number = CD003041 | date = 2004-01-01 | pmid = 14974003 | doi = 10.1002/14651858.CD003041.pub2 | veditors = Critchley JA }} {{Retracted|doi=10.1002/14651858.CD003041.pub3|pmid=22336785|intentional=yes}}</ref>
* At least 150 minutes (2 hours and 30 minutes) of moderate exercise per week.<ref>{{Cite web|url=https://health.gov/paguidelines/guidelines/chapter4.aspx|title=Chapter 4: Active Adults|website=health.gov|archive-url=https://web.archive.org/web/20170313131518/https://health.gov/paguidelines/guidelines/chapter4.aspx|archive-date=2017-03-13|url-status=live}}</ref><ref>{{Cite web|url=http://www.nhs.uk/Livewell/fitness/Pages/physical-activity-guidelines-for-adults.aspx|title=Physical activity guidelines for adults|date=2018-04-26|website=NHS Choices|archive-url=https://web.archive.org/web/20170219235702/http://www.nhs.uk/Livewell/fitness/Pages/physical-activity-guidelines-for-adults.aspx|archive-date=2017-02-19|url-status=live}}</ref>
* Lower blood pressure, if elevated. A 10&nbsp;mmHg reduction in blood pressure reduces risk by about 20%.<ref name="Ettehad 957–967">{{cite journal | vauthors = Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, Chalmers J, Rodgers A, Rahimi K | title = Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis | journal = Lancet | volume = 387 | issue = 10022 | pages = 957–967 | date = March 2016 | pmid = 26724178 | doi = 10.1016/S0140-6736(15)01225-8 | doi-access = free }}</ref> Lowering blood pressure appears to be effective even at normal blood pressure ranges.<ref>{{cite news |title=Many more people could benefit from blood pressure-lowering medication |url=https://medicalxpress.com/news/2021-04-people-benefit-blood-pressure-lowering-medication.html |access-date=14 June 2021 |work=medicalxpress.com |language=en}}</ref><ref>{{cite web |title=expert reaction to study looking at pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure {{!}} Science Media Centre |url=https://www.sciencemediacentre.org/expert-reaction-to-study-looking-at-pharmacological-blood-pressure-lowering-for-primary-and-secondary-prevention-of-cardiovascular-disease-across-different-levels-of-blood-pressure/ |access-date=14 June 2021}}</ref><ref>{{cite journal | vauthors = Adler A, Agodoa L, Algra A, Asselbergs FW, Beckett NS, Berge E, Black H, Brouwers FP, Brown M, Bulpitt CJ, Byington RP | title = Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis | language = English | journal = Lancet | volume = 397 | issue = 10285 | pages = 1625–1636 | date = May 2021 | pmid = 33933205 | pmc = 8102467 | doi = 10.1016/S0140-6736(21)00590-0 }} [[File:CC-BY icon.svg|50px]] Available under [https://creativecommons.org/licenses/by/4.0/ CC BY 4.0].</ref>
* Not enough sleep also raises the risk of high blood pressure. Adults need about 7–9 hours of sleep. Sleep apnea is also a major risk as it causes breathing to stop briefly, which can put stress on the body which can raise the risk of heart disease.<ref>U.S. National Library of Medicine. (2021, March 24). Heart Disease Prevention. MedlinePlus. https://medlineplus.gov/howtopreventheartdisease.html.</ref><ref>U.S. Department of Health and Human Services. (n.d.). Cardiovascular Disease. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/cardiovascular-disease-and-complementary-health-approaches.</ref>

Most guidelines recommend combining preventive strategies. There is some evidence that interventions aiming to reduce more than one cardiovascular risk factor may have beneficial effects on blood pressure, body mass index and waist circumference; however, evidence was limited and the authors were unable to draw firm conclusions on the effects on cardiovascular events and mortality.<ref>{{cite journal | vauthors = Uthman OA, Hartley L, Rees K, Taylor F, Ebrahim S, Clarke A | title = Multiple risk factor interventions for primary prevention of cardiovascular disease in low- and middle-income countries | journal = The Cochrane Database of Systematic Reviews | issue = 8 | article-number = CD011163 | date = August 2015 | volume = 2015 | pmid = 26272648 | doi = 10.1002/14651858.CD011163.pub2 | pmc = 6999125 | url = https://researchonline.lshtm.ac.uk/2274289/1/Multiple%20risk%20factor%20interventions%20for%20primary_GREEN%20VoR.pdf }}</ref>

There is additional evidence to suggest that providing people with a cardiovascular disease risk score may reduce risk factors by a small amount compared to usual care.<ref>{{cite journal | vauthors = Karmali KN, Persell SD, Perel P, Lloyd-Jones DM, Berendsen MA, Huffman MD | title = Risk scoring for the primary prevention of cardiovascular disease | journal = The Cochrane Database of Systematic Reviews | volume = 3 | article-number = CD006887 | date = March 2017 | issue = 6 | pmid = 28290160 | pmc = 6464686 | doi = 10.1002/14651858.CD006887.pub4 }}</ref> However, there was some uncertainty as to whether providing these scores had any effect on cardiovascular disease events. It is unclear whether or not dental care in those with [[periodontitis]] affects their risk of cardiovascular disease.<ref>{{Cite journal |last1=Ye |first1=Zelin |last2=Cao |first2=Yubin |last3=Miao |first3=Cheng |last4=Liu |first4=Wei |last5=Dong |first5=Li |last6=Lv |first6=Zongkai |last7=Iheozor-Ejiofor |first7=Zipporah |last8=Li |first8=Chunjie |date=2022-10-04 |title=Periodontal therapy for primary or secondary prevention of cardiovascular disease in people with periodontitis |journal=The Cochrane Database of Systematic Reviews |volume=2022 |issue=10 |article-number=CD009197 |doi=10.1002/14651858.CD009197.pub5 |issn=1469-493X |pmc=9531722 |pmid=36194420}}</ref> According to a 2021 WHO study, working 55+ hours a week raises the risk of stroke by 35% and the risk of dying from heart conditions by 17%, when compared to a 35–40 hours week.<ref>{{Cite journal |last1=Pega |first1=Frank |last2=Náfrádi |first2=Bálint |last3=Momen |first3=Natalie C. |last4=Ujita |first4=Yuka |last5=Streicher |first5=Kai N. |last6=Prüss-Üstün |first6=Annette M. |last7=Descatha |first7=Alexis |last8=Driscoll |first8=Tim |last9=Fischer |first9=Frida M. |last10=Godderis |first10=Lode |last11=Kiiver |first11=Hannah M. |last12=Li |first12=Jian |last13=Magnusson Hanson |first13=Linda L. |last14=Rugulies |first14=Reiner |last15=Sørensen |first15=Kathrine |date=2021-09-01 |title=Global, regional, and national burdens of ischemic heart disease and stroke attributable to exposure to long working hours for 194 countries, 2000–2016: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury |journal=Environment International |volume=154 |article-number=106595 |doi=10.1016/j.envint.2021.106595 |issn=0160-4120|doi-access=free |pmid=34011457 |pmc=8204267 |bibcode=2021EnInt.15406595P }}</ref>

=== Psychological prevention ===
Decrease [[stress (psychological)|psychosocial stress]].<ref>{{cite journal |vauthors=Linden W, Stossel C, Maurice J |date=April 1996 |title=Psychosocial interventions for patients with coronary artery disease: a meta-analysis |journal=Archives of Internal Medicine |volume=156 |issue=7 |pages=745–52 |doi=10.1001/archinte.1996.00440070065008 |pmid=8615707 |s2cid=45312858}}</ref> This measure may be complicated by imprecise definitions of what constitute psychosocial interventions.<ref name="ThompsonSki2013">{{cite journal |vauthors=Thompson DR, Ski CF |date=December 2013 |title=Psychosocial interventions in cardiovascular disease--what are they? |url=https://espace.library.uq.edu.au/view/UQ:304930/Thompson_David_staffdata.pdf |journal=European Journal of Preventive Cardiology |volume=20 |issue=6 |pages=916–7 |doi=10.1177/2047487313494031 |pmid=24169589 |s2cid=35497445}}</ref> Mental stress–induced [[myocardial ischemia]] is associated with an increased risk of heart problems in those with previous heart disease.<ref>{{cite journal |vauthors=Wei J, Rooks C, Ramadan R, Shah AJ, Bremner JD, Quyyumi AA, Kutner M, Vaccarino V |date=July 2014 |title=Meta-analysis of mental stress-induced myocardial ischemia and subsequent cardiac events in patients with coronary artery disease |journal=The American Journal of Cardiology |volume=114 |issue=2 |pages=187–92 |doi=10.1016/j.amjcard.2014.04.022 |pmc=4126399 |pmid=24856319}}</ref> Severe emotional and physical stress leads to a form of heart dysfunction known as [[Takotsubo syndrome]] in some people.<ref>{{cite journal |vauthors=Pelliccia F, Greco C, Vitale C, Rosano G, Gaudio C, Kaski JC |date=August 2014 |title=Takotsubo syndrome (stress cardiomyopathy): an intriguing clinical condition in search of its identity |journal=The American Journal of Medicine |volume=127 |issue=8 |pages=699–704 |doi=10.1016/j.amjmed.2014.04.004 |pmid=24754972 |hdl=11573/562721}}</ref> Specific relaxation therapies are of unclear benefit.<ref name="Relax2006">{{cite journal |vauthors=Dickinson HO, Mason JM, Nicolson DJ, Campbell F, Beyer FR, Cook JV, Williams B, Ford GA |date=February 2006 |title=Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials |journal=Journal of Hypertension |volume=24 |issue=2 |pages=215–33 |doi=10.1097/01.hjh.0000199800.72563.26 |pmid=16508562 |s2cid=9125890}}</ref><ref>{{cite journal |vauthors=Abbott RA, Whear R, Rodgers LR, Bethel A, Thompson Coon J, Kuyken W, Stein K, Dickens C |date=May 2014 |title=Effectiveness of mindfulness-based stress reduction and mindfulness based cognitive therapy in vascular disease: A systematic review and meta-analysis of randomised controlled trials |journal=Journal of Psychosomatic Research |volume=76 |issue=5 |pages=341–51 |doi=10.1016/j.jpsychores.2014.02.012 |pmid=24745774 |doi-access=free |hdl-access=free |hdl=10871/19935}}</ref> Decreasing psychological stress can be accomplished by receiving access to services and support, recognizing signs and symptoms of mental health disorders, awareness of family history, and understanding which mental health disorders increase the risk of cardiovascular disease.<ref>{{Cite web |last=CDC |date=2025-02-19 |title=About Heart Disease and Mental Health |url=https://www.cdc.gov/heart-disease/about/about-heart-disease-and-mental-health.html#cdc_disease_basics_prevention-reducing-risk |access-date=2025-04-23 |website=Heart Disease |language=en-us}}</ref> Psychosocial intervention programs have been shown to improve risk of developing cardiovascular disease in the high-risk population.<ref>{{Cite journal |last1=Levine |first1=Glenn N. |last2=Cohen |first2=Beth E. |last3=Commodore-Mensah |first3=Yvonne |last4=Fleury |first4=Julie |last5=Huffman |first5=Jeff C. |last6=Khalid |first6=Umair |last7=Labarthe |first7=Darwin R. |last8=Lavretsky |first8=Helen |last9=Michos |first9=Erin D. |last10=Spatz |first10=Erica S. |last11=Kubzansky |first11=Laura D. |last12=On behalf of the American Heart Association Council on Clinical Cardiology; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; and Council on Lifestyle and Cardiometabolic Health |date=2021-03-09 |title=Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association |url=https://www.ahajournals.org/doi/10.1161/CIR.0000000000000947 |journal=Circulation |volume=143 |issue=10 |pages=e763–e783 |doi=10.1161/CIR.0000000000000947|pmid=33486973 }}</ref>

===Diet===
{{See also|Lipid hypothesis|Saturated fat and cardiovascular disease|Salt and cardiovascular disease}}
A diet high in fruits and vegetables decreases the risk of cardiovascular disease and [[death]].<ref name="ReferenceB">{{cite journal|vauthors=Wang X, Ouyang Y, Liu J, Zhu M, Zhao G, Bao W, Hu FB|date=July 2014|title=Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies|journal=BMJ|volume=349|article-number=g4490|doi=10.1136/bmj.g4490|pmc=4115152|pmid=25073782}}</ref>

A 2021 review found that [[plant-based diet]]s can provide a risk reduction for CVD if a healthy plant-based diet is consumed. Unhealthy plant-based diets do not provide benefits over diets including meat.<ref name=":5" /> A similar meta-analysis and systematic review also looked into dietary patterns and found "that diets lower in animal foods and unhealthy plant foods, and higher in healthy plant foods are beneficial for CVD prevention".<ref name=":6" /> A 2018 meta-analysis of [[Observational study|observational studies]] concluded that "In most countries, a vegan diet is associated with a more favourable cardio-metabolic profile compared to an omnivorous diet."<ref name=":7" />

Evidence suggests that the [[Mediterranean diet]] may improve cardiovascular outcomes.<ref>{{cite journal|vauthors=Walker C, Reamy BV|date=April 2009|title=Diets for cardiovascular disease prevention: what is the evidence?|journal=American Family Physician|volume=79|issue=7|pages=571–8|pmid=19378874}}</ref> There is also evidence that a Mediterranean diet may be more effective than a [[low-fat diet]] in bringing about long-term changes to cardiovascular risk factors (e.g., lower [[cholesterol level]] and [[blood pressure]]).<ref>{{cite journal|vauthors=Nordmann AJ, Suter-Zimmermann K, Bucher HC, Shai I, Tuttle KR, Estruch R, Briel M|date=September 2011|title=Meta-analysis comparing Mediterranean to low-fat diets for modification of cardiovascular risk factors|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/featuredreviews/mediterraneandiet-2012/%20%20|journal=The American Journal of Medicine|volume=124|issue=9|pages=841–51.e2|doi=10.1016/j.amjmed.2011.04.024|pmid=21854893|archive-url=https://web.archive.org/web/20131220200912/http://www.ncbi.nlm.nih.gov/pubmedhealth/featuredreviews/mediterraneandiet-2012/|archive-date=2013-12-20}}</ref>

The [[DASH diet]] (high in nuts, fish, fruits and vegetables, and low in sweets, red meat and fat) has been shown to reduce blood pressure,<ref>{{cite journal | vauthors = Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER, Simons-Morton DG, Karanja N, Lin PH | title = Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group | journal = The New England Journal of Medicine | volume = 344 | issue = 1 | pages = 3–10 | date = January 2001 | pmid = 11136953 | doi = 10.1056/NEJM200101043440101 | doi-access = free }}</ref> lower total and low density lipoprotein cholesterol<ref>{{cite journal | vauthors = Obarzanek E, Sacks FM, Vollmer WM, Bray GA, Miller ER, Lin PH, Karanja NM, Most-Windhauser MM, Moore TJ, Swain JF, Bales CW, Proschan MA | title = Effects on blood lipids of a blood pressure-lowering diet: the Dietary Approaches to Stop Hypertension (DASH) Trial | journal = The American Journal of Clinical Nutrition | volume = 74 | issue = 1 | pages = 80–9 | date = July 2001 | pmid = 11451721 | doi = 10.1093/ajcn/74.1.80 | doi-access = free }}</ref>  and improve [[metabolic syndrome]];<ref>{{cite journal | vauthors = Azadbakht L, Mirmiran P, Esmaillzadeh A, Azizi T, Azizi F | title = Beneficial effects of a Dietary Approaches to Stop Hypertension eating plan on features of the metabolic syndrome | journal = Diabetes Care | volume = 28 | issue = 12 | pages = 2823–31 | date = December 2005 | pmid = 16306540 | doi = 10.2337/diacare.28.12.2823 | doi-access = free }}</ref> but the long-term benefits have been questioned.<ref>{{cite journal | vauthors = Logan AG | title = DASH Diet: time for a critical appraisal? | journal = American Journal of Hypertension | volume = 20 | issue = 3 | pages = 223–4 | date = March 2007 | pmid = 17324730 | doi = 10.1016/j.amjhyper.2006.10.006 | doi-access = free }}</ref> A high-[[Dietary fiber|fiber]] diet is associated with lower risks of cardiovascular disease.<ref>{{cite journal | vauthors = Hajishafiee M, Saneei P, Benisi-Kohansal S, Esmaillzadeh A | title = Cereal Fibre Intake and Risk of Mortality From All Causes, CVD, Cancer and Inflammatory Diseases: A Systematic Review and Meta-Analysis of Prospective Cohort Studies | journal = The British Journal of Nutrition | volume = 116 | issue = 2 | pages = 343–52 | date = July 2016 | pmid = 27193606 | doi = 10.1017/S0007114516001938 | doi-access = free }}</ref> <!-- Fat -->

Worldwide, dietary guidelines recommend a reduction in [[saturated fat]],<ref name="BMJ2013">{{cite journal | vauthors = Ramsden CE, Zamora D, Leelarthaepin B, Majchrzak-Hong SF, Faurot KR, Suchindran CM, Ringel A, Davis JM, Hibbeln JR | title = Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis | journal = BMJ | volume = 346 | article-number = e8707 | date = February 2013 | pmid = 23386268 | pmc = 4688426 | doi = 10.1136/bmj.e8707 }}</ref> and although the role of dietary fat in cardiovascular disease is complex and controversial there is a long-standing consensus that replacing saturated fat with unsaturated fat in the diet is sound medical advice.<ref name=":1">{{cite journal | vauthors = Lichtenstein AH | title = Dietary Fat and Cardiovascular Disease: Ebb and Flow Over the Last Half Century | journal = Advances in Nutrition | volume = 10 | issue = Suppl_4 | pages = S332–S339 | date = November 2019 | pmid = 31728492 | pmc = 6855944 | doi = 10.1093/advances/nmz024 | url = }}</ref> Total fat intake has not been found to be associated with cardiovascular risk.<ref>{{cite book | author=Food and Agriculture Organization of the United Nations | title=Fats and fatty acids in human nutrition: report of an expert consultation, 10-14 November 2008, Geneva| publisher=Food and Agriculture Organization of the United Nations | publication-place=Rome | date=2010 | isbn=978-92-5-106733-8 | oclc=712123395 |url=http://www.who.int/nutrition/publications/nutrientrequirements/fatsandfattyacids_humannutrition/en/| archive-url=https://web.archive.org/web/20141228005244/http://www.who.int/nutrition/publications/nutrientrequirements/fatsandfattyacids_humannutrition/en/| archive-date=2014-12-28}}</ref><ref name="Will2012">{{cite journal | vauthors = Willett WC | s2cid = 43493760 | title = Dietary fats and coronary heart disease | journal = Journal of Internal Medicine | volume = 272 | issue = 1 | pages = 13–24 | date = July 2012 | pmid = 22583051 | doi = 10.1111/j.1365-2796.2012.02553.x }}</ref> A 2020 systematic review found moderate quality evidence that reducing saturated fat intake for at least 2 years caused a reduction in cardiovascular events.<ref>{{cite journal |last1=Hooper |first1=Lee |last2=Martin |first2=Nicole |last3=Jimoh |first3=Oluseyi F. |last4=Kirk |first4=Christian |last5=Foster |first5=Eve |last6=Abdelhamid |first6=Asmaa S. |title=Reduction in saturated fat intake for cardiovascular disease |journal=The Cochrane Database of Systematic Reviews |date=21 August 2020 |volume=2020 |issue=8 |article-number=CD011737 |doi=10.1002/14651858.CD011737.pub3 |doi-access=free|pmid=32827219 |pmc=8092457 |issn=1469-493X}}</ref>  A 2015 meta-analysis of observational studies however did not find a convincing association between saturated fat intake and cardiovascular disease.<ref name="BMJ2015">{{cite journal | vauthors = de Souza RJ, Mente A, Maroleanu A, Cozma AI, Ha V, Kishibe T, Uleryk E, Budylowski P, Schünemann H, Beyene J, Anand SS | title = Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies | journal = BMJ | volume = 351 | article-number = h3978 | date = August 2015 | pmid = 26268692 | pmc = 4532752 | doi = 10.1136/bmj.h3978 }}</ref>  Variation in what is used as a substitute for saturated fat may explain some differences in findings.<ref name=":1" /> The benefit from replacement with [[polyunsaturated fat]]s appears greatest,<ref name = "Sacks_2017">{{cite journal | vauthors = Sacks FM, Lichtenstein AH, Wu JH, Appel LJ, Creager MA, Kris-Etherton PM, Miller M, Rimm EB, Rudel LL, Robinson JG, Stone NJ, Van Horn LV | title = Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association | journal = Circulation | volume = 136 | issue = 3 | pages = e1–e23 | date = July 2017 | pmid = 28620111 | doi = 10.1161/CIR.0000000000000510 | s2cid = 367602 | doi-access = free }}</ref>  while replacement of saturated fats with [[carbohydrates]] does not appear to have a beneficial effect.<ref name = "Sacks_2017" /> A diet high in [[trans fatty acids]] is associated with higher rates of cardiovascular disease,<ref name="Chow2014">{{cite journal | vauthors = Chowdhury R, Warnakula S, Kunutsor S, Crowe F, Ward HA, Johnson L, Franco OH, Butterworth AS, Forouhi NG, Thompson SG, Khaw KT, Mozaffarian D, Danesh J, Di Angelantonio E | s2cid = 52013596 | title = Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis | journal = Annals of Internal Medicine | volume = 160 | issue = 6 | pages = 398–406 | date = March 2014 | pmid = 24723079 | doi = 10.7326/M13-1788 }}</ref> and in 2015 the Food and Drug Administration (FDA) determined that there was 'no longer a consensus among qualified experts that partially hydrogenated oils (PHOs), which are the primary dietary source of industrially produced trans fatty acids (IP-TFA), are generally recognized as safe (GRAS) for any use in human food'.<ref>{{cite journal | title = Final Determination Regarding Partially Hydrogenated Oils. Notification; declaratory order; extension of compliance date | journal = Federal Register | volume = 83 | issue = 98 | pages = 23358–9 | date = May 2018 | pmid = 30019869 | last1 = Food Drug Administration | first1 = HHS }}</ref> There is conflicting evidence concerning whether dietary supplements of [[omega-3 fatty acid]]s (a type of polyunsaturated essential fatty acid) added to diet improve cardiovascular risk.<ref>{{cite journal | vauthors = Abdelhamid AS, Brown TJ, Brainard JS, Biswas P, Thorpe GC, Moore HJ, Deane KH, Summerbell CD, Worthington HV, Song F, Hooper L | title = Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | issue = 3 | article-number = CD003177 | date = February 2020 | pmid = 32114706 | pmc = 7049091 | doi = 10.1002/14651858.CD003177.pub5 }}</ref><ref>{{cite journal | vauthors = Aung T, Halsey J, Kromhout D, Gerstein HC, Marchioli R, Tavazzi L, Geleijnse JM, Rauch B, Ness A, Galan P, Chew EY, Bosch J, Collins R, Lewington S, Armitage J, Clarke R | title = Associations of Omega-3 Fatty Acid Supplement Use With Cardiovascular Disease Risks: Meta-analysis of 10 Trials Involving 77 917 Individuals | journal = JAMA Cardiology | volume = 3 | issue = 3 | pages = 225–234 | date = March 2018 | pmid = 29387889 | pmc = 5885893 | doi = 10.1001/jamacardio.2017.5205 }}</ref>

<!-- Salt -->
The benefits of recommending a [[low-salt diet]] in people with high or normal blood pressure are not clear.<ref>{{cite journal | vauthors = Adler AJ, Taylor F, Martin N, Gottlieb S, Taylor RS, Ebrahim S | title = Reduced dietary salt for the prevention of cardiovascular disease | journal = The Cochrane Database of Systematic Reviews | issue = 12 | article-number = CD009217 | date = December 2014 | volume = 2014 | pmid = 25519688 | pmc = 6483405 | doi = 10.1002/14651858.CD009217.pub3 }}</ref> In those with heart failure, after one study was left out, the rest of the trials show a trend to benefit.<ref name=He2011>{{cite journal | vauthors = He FJ, MacGregor GA | title = Salt reduction lowers cardiovascular risk: meta-analysis of outcome trials | journal = Lancet | volume = 378 | issue = 9789 | pages = 380–2 | date = July 2011 | pmid = 21803192 | doi = 10.1016/S0140-6736(11)61174-4 | s2cid = 43795786 | url = http://www.actiononsalt.org.uk/news/Salt%20in%20the%20news/2011/58301.pdf | archive-url = https://web.archive.org/web/20131220235208/http://www.actiononsalt.org.uk/news/Salt%20in%20the%20news/2011/58301.pdf | archive-date = 2013-12-20 | access-date = 2013-08-23 }}</ref><ref name=Paterna2008>{{cite journal | vauthors = Paterna S, Gaspare P, Fasullo S, Sarullo FM, Di Pasquale P | s2cid = 2248777 | title = Normal-sodium diet compared with low-sodium diet in compensated congestive heart failure: is sodium an old enemy or a new friend? | journal = Clinical Science | volume = 114 | issue = 3 | pages = 221–30 | date = February 2008 | pmid = 17688420 | doi = 10.1042/CS20070193 | url = https://hal.science/hal-00479386/file/PEER_stage2_10.1042%252FCS20070193.pdf }}{{Expression of Concern|doi=10.1042/CS-20070193_EOC|pmid=32677681}}</ref> Another review of dietary salt concluded that there is strong evidence that high dietary salt intake increases blood pressure and worsens hypertension, and that it increases the number of cardiovascular disease events; both as a result of the increased blood pressure ''and'' probably through other mechanisms.<ref name=Bochud2011>{{cite journal| vauthors = Bochud M, Marques-Vidal P, Burnier M, Paccaud F |title=Dietary Salt Intake and Cardiovascular Disease: Summarizing the Evidence|journal=Public Health Reviews|year=2012|volume=33|issue=2|pages=530–52|url=http://www.publichealthreviews.eu/show/f/85|url-status=live|archive-url=https://web.archive.org/web/20131221091620/http://www.publichealthreviews.eu/show/f/85|archive-date=2013-12-21|doi=10.1007/BF03391649|doi-access=free}}</ref><ref name=Cook2007>{{cite journal | vauthors = Cook NR, Cutler JA, Obarzanek E, Buring JE, Rexrode KM, Kumanyika SK, Appel LJ, Whelton PK | title = Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP) | journal = BMJ | volume = 334 | issue = 7599 | pages = 885–8 | date = April 2007 | pmid = 17449506 | pmc = 1857760 | doi = 10.1136/bmj.39147.604896.55 }}</ref> Moderate evidence was found that high salt intake increases cardiovascular mortality; and some evidence was found for an increase in overall mortality, strokes, and [[left ventricular hypertrophy]].<ref name=Bochud2011/>

==== Intermittent fasting ====

Overall, the current body of scientific evidence is uncertain on whether [[intermittent fasting]] could prevent cardiovascular disease.<ref name=":52">{{cite journal | vauthors = Allaf M, Elghazaly H, Mohamed OG, Fareen MF, Zaman S, Salmasi AM, Tsilidis K, Dehghan A | title = Intermittent fasting for the prevention of cardiovascular disease | journal = The Cochrane Database of Systematic Reviews | volume = 1 | issue = 3 | article-number = CD013496 | date = January 2021 | pmid = 33512717 | pmc = 8092432 | doi = 10.1002/14651858.CD013496.pub2 | collaboration = Cochrane Heart Group }}</ref> Intermittent fasting may help people lose more weight than regular eating patterns, but was not different from energy restriction diets.<ref name=":52" />

===Medication===
Blood pressure medication reduces cardiovascular disease in people at risk,<ref name="Ettehad 957–967"/> irrespective of age,<ref>{{cite journal | vauthors = Turnbull F, Neal B, Ninomiya T, Algert C, Arima H, Barzi F, Bulpitt C, Chalmers J, Fagard R, Gleason A, Heritier S, Li N, Perkovic V, Woodward M, MacMahon S | title = Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials | journal = BMJ | volume = 336 | issue = 7653 | pages = 1121–3 | date = May 2008 | pmid = 18480116 | pmc = 2386598 | doi = 10.1136/bmj.39548.738368.BE }}</ref> the baseline level of cardiovascular risk,<ref>{{cite journal | title = Blood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data | journal = Lancet | volume = 384 | issue = 9943 | pages = 591–598 | date = August 2014 | pmid = 25131978 | doi = 10.1016/S0140-6736(14)61212-5 | author1 = Blood Pressure Lowering Treatment Trialists' Collaboration | s2cid = 19951800 }}</ref> or baseline blood pressure.<ref>{{cite journal | vauthors = Czernichow S, Zanchetti A, Turnbull F, Barzi F, Ninomiya T, Kengne AP, Lambers Heerspink HJ, Perkovic V, Huxley R, Arima H, Patel A, Chalmers J, Woodward M, MacMahon S, Neal B | title = The effects of blood pressure reduction and of different blood pressure-lowering regimens on major cardiovascular events according to baseline blood pressure: meta-analysis of randomized trials | journal = Journal of Hypertension | volume = 29 | issue = 1 | pages = 4–16 | date = January 2011 | pmid = 20881867 | doi = 10.1097/HJH.0b013e32834000be | s2cid = 10374187 }}</ref> The commonly used drug regimens have similar efficacy in reducing the risk of all major cardiovascular events, although there may be differences between drugs in their ability to prevent specific outcomes.<ref name=":02">{{cite journal | vauthors = Turnbull F | title = Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials | journal = Lancet | volume = 362 | issue = 9395 | pages = 1527–35 | date = November 2003 | pmid = 14615107 | doi = 10.1016/s0140-6736(03)14739-3 | s2cid = 10730075 | url = https://lirias.kuleuven.be/handle/123456789/270351 | type = Submitted manuscript | url-access = subscription }}</ref> Larger reductions in blood pressure produce larger reductions in risk,<ref name=":02" /> and most people with high blood pressure require more than one drug to achieve adequate reduction in blood pressure.<ref>{{cite journal | vauthors = Go AS, Bauman MA, Coleman King SM, Fonarow GC, Lawrence W, Williams KA, Sanchez E | title = An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention | journal = Hypertension | volume = 63 | issue = 4 | pages = 878–85 | date = April 2014 | pmid = 24243703 | doi = 10.1161/HYP.0000000000000003 | pmc = 10280688 | doi-access = free }}</ref> Adherence to medications is often poor, and while mobile phone text messaging has been tried to improve adherence, there is insufficient evidence that it alters secondary prevention of cardiovascular disease.<ref>{{Cite journal |last1=Redfern |first1=Julie |last2=Tu |first2=Qiang |last3=Hyun |first3=Karice |last4=Hollings |first4=Matthew A. |last5=Hafiz |first5=Nashid |last6=Zwack |first6=Clara |last7=Free |first7=Caroline |last8=Perel |first8=Pablo |last9=Chow |first9=Clara K. |date=2024-03-27 |title=Mobile phone text messaging for medication adherence in secondary prevention of cardiovascular disease |journal=The Cochrane Database of Systematic Reviews |volume=2024 |issue=3 |article-number=CD011851 |doi=10.1002/14651858.CD011851.pub3 |issn=1469-493X |pmc=10966941 |pmid=38533994}}</ref>

[[Statins]] are effective in preventing further cardiovascular disease in people with a history of cardiovascular disease.<ref name="Statins20122">{{cite journal | vauthors = Gutierrez J, Ramirez G, Rundek T, Sacco RL | title = Statin therapy in the prevention of recurrent cardiovascular events: a sex-based meta-analysis | journal = Archives of Internal Medicine | volume = 172 | issue = 12 | pages = 909–19 | date = June 2012 | pmid = 22732744 | doi = 10.1001/archinternmed.2012.2145 | doi-access = free }}</ref> As the event rate is higher in men than in women, the decrease in events is more easily seen in men than women.<ref name="Statins20122" /> In those at risk, but without a history of cardiovascular disease (primary prevention), statins decrease the risk of death and combined fatal and non-fatal cardiovascular disease.<ref>{{cite journal | vauthors = Taylor F, Huffman MD, Macedo AF, Moore TH, Burke M, Davey Smith G, Ward K, Ebrahim S | title = Statins for the primary prevention of cardiovascular disease | journal = The Cochrane Database of Systematic Reviews | volume = 1 | issue = 1 | article-number = CD004816 | date = January 2013 | pmid = 23440795 | pmc = 6481400 | doi = 10.1002/14651858.CD004816.pub5 | url = http://researchonline.lshtm.ac.uk/1496197/1/bmj.g280.full.pdf }}</ref> The benefit, however, is small.<ref>{{cite journal |title=Statins in primary cardiovascular prevention? |journal=Prescrire International |date=July–August 2018 |volume=27 |issue=195 |page=183 |url=http://english.prescrire.org/en/81/168/55118/0/NewsDetails.aspx |access-date=4 August 2018}}</ref> A United States guideline recommends statins in those who have a 12% or greater risk of cardiovascular disease over the next ten years.<ref>{{cite journal | vauthors = Downs JR, O'Malley PG | title = Management of dyslipidemia for cardiovascular disease risk reduction: synopsis of the 2014 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline | journal = Annals of Internal Medicine | volume = 163 | issue = 4 | pages = 291–7 | date = August 2015 | pmid = 26099117 | doi = 10.7326/m15-0840 | doi-access = free }}</ref>  [[Niacin (nutrient)|Niacin]], [[fibrates]] and [[CETP Inhibitors]], while they may increase [[HDL cholesterol]] do not affect the risk of cardiovascular disease in those who are already on statins.<ref>{{cite journal | vauthors = Keene D, Price C, Shun-Shin MJ, Francis DP | title = Effect on cardiovascular risk of high density lipoprotein targeted drug treatments niacin, fibrates, and CETP inhibitors: meta-analysis of randomised controlled trials including 117,411 patients | journal = BMJ | volume = 349 | article-number = g4379 | date = July 2014 | pmid = 25038074 | pmc = 4103514 | doi = 10.1136/bmj.g4379 }}</ref> Fibrates lower the risk of cardiovascular and coronary events, but there is no evidence to suggest that they reduce all-cause mortality.<ref>{{cite journal | vauthors = Jakob T, Nordmann AJ, Schandelmaier S, Ferreira-González I, Briel M | title = Fibrates for primary prevention of cardiovascular disease events | journal = The Cochrane Database of Systematic Reviews | volume = 11 | article-number = CD009753 | date = November 2016 | issue = 3 | pmid = 27849333 | pmc = 6464497 | doi = 10.1002/14651858.CD009753.pub2 | collaboration = Cochrane Heart Group }}</ref>

[[Anti-diabetic medication]] may reduce cardiovascular risk in people with Type 2 diabetes, although evidence is not conclusive.<ref>{{cite journal | vauthors = Holman RR, Sourij H, Califf RM | title = Cardiovascular outcome trials of glucose-lowering drugs or strategies in type 2 diabetes | journal = Lancet | volume = 383 | issue = 9933 | pages = 2008–17 | date = June 2014 | pmid = 24910232 | doi = 10.1016/s0140-6736(14)60794-7 | s2cid = 5064731 }}</ref> A meta-analysis in 2009 including 27,049 participants and 2,370 major vascular events showed a 15% [[relative risk reduction]] in cardiovascular disease with more-intensive glucose lowering over an average follow-up period of 4.4 years, but an increased risk of major [[hypoglycemia]].<ref>{{cite journal | vauthors = Turnbull FM, Abraira C, Anderson RJ, Byington RP, Chalmers JP, Duckworth WC, Evans GW, Gerstein HC, Holman RR, Moritz TE, Neal BC, Ninomiya T, Patel AA, Paul SK, Travert F, Woodward M | title = Intensive glucose control and macrovascular outcomes in type 2 diabetes | journal = Diabetologia | volume = 52 | issue = 11 | pages = 2288–98 | date = November 2009 | pmid = 19655124 | doi = 10.1007/s00125-009-1470-0 | doi-access = free }}</ref>

[[Aspirin]] has been found to be of only modest benefit in those at low risk of heart disease, as the risk of serious bleeding is almost equal to the protection against cardiovascular problems.<ref>{{cite journal|author5-link=William R. Hiatt | vauthors = Berger JS, Lala A, Krantz MJ, Baker GS, Hiatt WR | title = Aspirin for the prevention of cardiovascular events in patients without clinical cardiovascular disease: a meta-analysis of randomized trials | journal = American Heart Journal | volume = 162 | issue = 1 | pages = 115–24.e2 | date = July 2011 | pmid = 21742097 | doi = 10.1016/j.ahj.2011.04.006 }}</ref> In those at very low risk, including those over the age of 70, it is not recommended.<ref>{{cite web|url=http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/aspirin-for-the-prevention-of-cardiovascular-disease-preventive-medication|title=Final Recommendation Statement Aspirin for the Prevention of Cardiovascular Disease: Preventive Medication|date=March 2009|access-date=15 January 2015|url-status=live|archive-url=https://web.archive.org/web/20150110041518/http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/aspirin-for-the-prevention-of-cardiovascular-disease-preventive-medication|archive-date=10 January 2015}}</ref><ref>{{cite journal | vauthors = Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED, Miedema MD, Muñoz D, Smith SC, Virani SS, Williams KA, Yeboah J, Ziaeian B | title = 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 | journal = Journal of the American College of Cardiology | volume = 74 | issue = 10 | pages = e177–e232 | date = March 2019 | pmid = 30894318 | doi = 10.1016/j.jacc.2019.03.010 | pmc = 7685565 | doi-access = free }}</ref> The [[United States Preventive Services Task Force]] recommends against use of aspirin for prevention in women less than 55 and men less than 45 years old; however, it is recommended for some older people.<ref>{{cite journal | title = Aspirin for the prevention of cardiovascular disease: U.S. Preventive Services Task Force recommendation statement | journal = Annals of Internal Medicine | volume = 150 | issue = 6 | pages = 396–404 | date = March 2009 | pmid = 19293072 | doi = 10.7326/0003-4819-150-6-200903170-00008 | author1 = US Preventive Services Task Force | doi-access = free }}</ref>

The use of [[vasoactive]] agents for people with pulmonary hypertension with left heart disease or hypoxemic lung diseases may cause harm and unnecessary expense.<ref name="ACCPandATSfive2">{{Citation|title=Five Things Physicians and Patients Should Question|date=September 2013|url=http://www.choosingwisely.org/doctor-patient-lists/american-college-of-chest-physicians-and-american-thoracic-society/|author1=American College of Chest Physicians|author2=American Thoracic Society|author1-link=American College of Chest Physicians|author2-link=American Thoracic Society|work=[[Choosing Wisely]]: an initiative of the [[ABIM Foundation]]|publisher=American College of Chest Physicians and American Thoracic Society|access-date=6 January 2013|url-status=live|archive-url=https://web.archive.org/web/20131103063427/http://www.choosingwisely.org/doctor-patient-lists/american-college-of-chest-physicians-and-american-thoracic-society/|archive-date=3 November 2013}}</ref>

'''Antibiotics for secondary prevention of coronary heart disease'''

Antibiotics may help patients with coronary disease to reduce the risk of heart attacks and strokes.<ref name=":4">{{cite journal | vauthors = Sethi NJ, Safi S, Korang SK, Hróbjartsson A, Skoog M, Gluud C, Jakobsen JC | title = Antibiotics for secondary prevention of coronary heart disease | journal = The Cochrane Database of Systematic Reviews | volume = 2 | issue = 5 | article-number = CD003610 | date = February 2021 | pmid = 33704780 | pmc = 8094925 | doi = 10.1002/14651858.CD003610.pub4 | collaboration = Cochrane Heart Group }}</ref> However, evidence in 2021 suggests that antibiotics for secondary prevention of coronary heart disease are harmful, with increased mortality and occurrence of stroke;<ref name=":4" /> the use of antibiotics is not supported for preventing secondary coronary heart disease.

=== Physical activity ===
Exercise-based [[cardiac rehabilitation]] following a heart attack reduces the risk of death from cardiovascular disease and leads to less hospitalizations.<ref name="AndersonThompson2021">{{cite journal |last1=Dibben |first1=Grace |last2=Faulkner |first2=James |last3=Oldridge |first3=Neil |last4=Rees |first4=Karen |last5=Thompson |first5=David R. |last6=Zwisler |first6=Ann-Dorthe |last7=Taylor |first7=Rod S. |title=Exercise-based cardiac rehabilitation for coronary heart disease |journal=The Cochrane Database of Systematic Reviews |date=6 November 2021 |volume=2021 |issue=11 |article-number=CD001800 |doi=10.1002/14651858.CD001800.pub4 |doi-access=free|pmid=34741536 |pmc=8571912 |issn=1469-493X}}</ref> There have been few high-quality studies of the benefits of exercise training in people with increased cardiovascular risk but no history of cardiovascular disease.<ref>{{cite journal | vauthors = Seron P, Lanas F, Pardo Hernandez H, Bonfill Cosp X | title = Exercise for people with high cardiovascular risk | journal = The Cochrane Database of Systematic Reviews | issue = 8 | article-number = CD009387 | date = August 2014 | volume = 2014 | pmid = 25120097 | doi = 10.1002/14651858.CD009387.pub2 | pmc = 6669260 }}</ref>

A systematic review estimated that inactivity is responsible for 6% of the burden of disease from coronary heart disease worldwide.<ref>{{cite journal | vauthors = Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT | title = Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy | journal = Lancet | volume = 380 | issue = 9838 | pages = 219–29 | date = July 2012 | pmid = 22818936 | pmc = 3645500 | doi = 10.1016/S0140-6736(12)61031-9 }}</ref> The authors estimated that 121,000 deaths from coronary heart disease could have been averted in Europe in 2008 if people had not been physically inactive. Low-quality evidence from a limited number of studies suggest that yoga has beneficial effects on blood pressure and cholesterol.<ref>{{cite journal | vauthors = Hartley L, Dyakova M, Holmes J, Clarke A, Lee MS, Ernst E, Rees K | title = Yoga for the primary prevention of cardiovascular disease | journal = The Cochrane Database of Systematic Reviews | issue = 5 | article-number = CD010072 | date = May 2014 | volume = 2014 | pmid = 24825181 | doi = 10.1002/14651858.CD010072.pub2 | pmc = 10075056 | url = http://wrap.warwick.ac.uk/61873/1/WRAP_Clarke_CD010072.pdf }}</ref> Tentative evidence suggests that home-based exercise programs may be more efficient at improving exercise adherence.<ref>{{cite journal | vauthors = Ashworth NL, Chad KE, Harrison EL, Reeder BA, Marshall SC | title = Home versus center based physical activity programs in older adults | journal = The Cochrane Database of Systematic Reviews | issue = 1 | article-number = CD004017 | date = January 2005 | volume = 2005 | pmid = 15674925 | pmc = 6464851 | doi = 10.1002/14651858.cd004017.pub2 }}</ref>

===Dietary supplements===
While a [[healthy diet]] is beneficial, the effect of [[antioxidant]] supplementation ([[vitamin E]], [[vitamin C]], etc.) or vitamins has not been shown to protect against cardiovascular disease and in some cases may possibly result in harm.<ref>{{cite journal | vauthors = Al-Khudairy L, Flowers N, Wheelhouse R, Ghannam O, Hartley L, Stranges S, Rees K | title = Vitamin C supplementation for the primary prevention of cardiovascular disease | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | article-number = CD011114 | date = March 2017 | issue = 3 | pmid = 28301692 | pmc = 6464316 | doi = 10.1002/14651858.CD011114.pub2 }}</ref><ref>{{cite journal | vauthors = Bhupathiraju SN, Tucker KL | title = Coronary heart disease prevention: nutrients, foods, and dietary patterns | journal = Clinica Chimica Acta; International Journal of Clinical Chemistry | volume = 412 | issue = 17–18 | pages = 1493–514 | date = August 2011 | pmid = 21575619 | pmc = 5945285 | doi = 10.1016/j.cca.2011.04.038 }}</ref><ref>{{cite journal | vauthors = Myung SK, Ju W, Cho B, Oh SW, Park SM, Koo BK, Park BJ | title = Efficacy of vitamin and antioxidant supplements in prevention of cardiovascular disease: systematic review and meta-analysis of randomised controlled trials | journal = BMJ | volume = 346 | pages = f10 | date = January 2013 | pmid = 23335472 | pmc = 3548618 | doi = 10.1136/bmj.f10 }}</ref><ref>{{cite journal | vauthors = Kim J, Choi J, Kwon SY, McEvoy JW, Blaha MJ, Blumenthal RS, Guallar E, Zhao D, Michos ED | title = Association of Multivitamin and Mineral Supplementation and Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis | journal = Circulation: Cardiovascular Quality and Outcomes | volume = 11 | issue = 7 | article-number = e004224 | date = July 2018 | pmid = 29991644 | doi = 10.1161/CIRCOUTCOMES.117.004224 | s2cid = 51615818 | doi-access = free }}</ref> Mineral supplements have also not been found to be useful.<ref>{{cite journal | vauthors = Fortmann SP, Burda BU, Senger CA, Lin JS, Whitlock EP | title = Vitamin and mineral supplements in the primary prevention of cardiovascular disease and cancer: An updated systematic evidence review for the U.S. Preventive Services Task Force | journal = Annals of Internal Medicine | volume = 159 | issue = 12 | pages = 824–34 | date = December 2013 | pmid = 24217421 | doi = 10.7326/0003-4819-159-12-201312170-00729 | doi-access = free }}</ref> [[Niacin (nutrient)|Niacin]], a type of vitamin B3, may be an exception with a modest decrease in the risk of cardiovascular events in those at high risk.<ref>{{cite journal | vauthors = Bruckert E, Labreuche J, Amarenco P | title = Meta-analysis of the effect of nicotinic acid alone or in combination on cardiovascular events and atherosclerosis | journal = Atherosclerosis | volume = 210 | issue = 2 | pages = 353–61 | date = June 2010 | pmid = 20079494 | doi = 10.1016/j.atherosclerosis.2009.12.023 }}</ref><ref>{{cite journal | vauthors = Lavigne PM, Karas RH | title = The current state of niacin in cardiovascular disease prevention: a systematic review and meta-regression | journal = Journal of the American College of Cardiology | volume = 61 | issue = 4 | pages = 440–446 | date = January 2013 | pmid = 23265337 | doi = 10.1016/j.jacc.2012.10.030 | doi-access = free }}</ref> [[Magnesium]] supplementation lowers high blood pressure in a dose-dependent manner.<ref name="Jee2002">{{cite journal | vauthors = Jee SH, Miller ER, Guallar E, Singh VK, Appel LJ, Klag MJ | title = The effect of magnesium supplementation on blood pressure: a meta-analysis of randomized clinical trials | journal = American Journal of Hypertension | volume = 15 | issue = 8 | pages = 691–6 | date = August 2002 | pmid = 12160191 | doi = 10.1016/S0895-7061(02)02964-3 | doi-access = free }}</ref> Magnesium therapy is recommended for people with ventricular [[Heart arrhythmia|arrhythmia]] associated with [[torsades de pointes]] who present with [[long QT syndrome]], and for the treatment of people with digoxin intoxication-induced arrhythmias.<ref name="Zipes2006">{{cite journal | vauthors = Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, Gregoratos G, Klein G, Moss AJ, Myerburg RJ, Priori SG, Quinones MA, Roden DM, Silka MJ, Tracy C, Smith SC, Jacobs AK, Adams CD, Antman EM, Anderson JL, Hunt SA, Halperin JL, Nishimura R, Ornato JP, Page RL, Riegel B, Blanc JJ, Budaj A, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL | title = ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society | journal = Circulation | volume = 114 | issue = 10 | pages = e385-484 | date = September 2006 | pmid = 16935995 | doi = 10.1161/CIRCULATIONAHA.106.178233 | doi-access = free }}</ref> There is no evidence that [[omega-3 fatty acid]] supplementation is beneficial.<ref>{{cite journal | vauthors = Kwak SM, Myung SK, Lee YJ, Seo HG | title = Efficacy of omega-3 fatty acid supplements (eicosapentaenoic acid and docosahexaenoic acid) in the secondary prevention of cardiovascular disease: a meta-analysis of randomized, double-blind, placebo-controlled trials | journal = Archives of Internal Medicine | volume = 172 | issue = 9 | pages = 686–94 | date = May 2012 | pmid = 22493407 | doi = 10.1001/archinternmed.2012.262 | doi-access = free }}</ref> A 2022 [[scientific review|review]] found that some [[dietary supplement]]s, including [[micronutrient]]s, may reduce risk factors for cardiovascular disease.<ref>{{cite journal|last1=An |first1=Peng |last2=Wan |first2=Sitong |last3=Luo |first3=Yongting |last4=Luo |first4=Junjie |last5=Zhang |first5=Xu |last6=Zhou |first6=Shuaishuai |last7=Xu |first7=Teng |last8=He |first8=Jingjing |last9=Mechanick |first9=Jeffrey I. |last10=Wu |first10=Wen-Chih |last11=Ren |first11=Fazheng |last12=Liu |first12=Simin |title=Micronutrient supplementation to reduce cardiovascular risk |journal=Journal of the American College of Cardiology |date=13 December 2022 |volume=80 |issue=24 |pages=2269–2285 |doi=10.1016/j.jacc.2022.09.048 |pmid=36480969 |s2cid=254343574 |language=en |issn=0735-1097|doi-access=free }}</ref>

==Management==
Cardiovascular disease is treatable with initial treatment primarily focused on diet and lifestyle interventions.<ref name=WHO2011/> [[Influenza]] may make heart attacks and strokes more likely and therefore [[influenza vaccination]] may decrease the chance of cardiovascular events and death in people with heart disease.<ref>{{cite journal | vauthors = Clar C, Oseni Z, Flowers N, Keshtkar-Jahromi M, Rees K | s2cid = 205176857 | title = Influenza vaccines for preventing cardiovascular disease | journal = The Cochrane Database of Systematic Reviews | issue = 5 | article-number = CD005050 | date = May 2015 | volume = 2015 | pmid = 25940444 | doi = 10.1002/14651858.CD005050.pub3 | pmc = 8511741 }}</ref>

Proper CVD management necessitates a focus on MI and stroke cases due to their combined high mortality rate, keeping in mind the cost-effectiveness of any intervention, especially in developing countries with low or middle-income levels.<ref name=":0" /> Regarding MI, strategies using aspirin, atenolol, streptokinase or tissue plasminogen activator have been compared for quality-adjusted life-year (QALY) in regions of low and middle income. The costs for a single QALY for aspirin and atenolol were less than [[US$]]25, streptokinase was about $680, and t-PA was $16,000.<ref name=Zip2018/> Aspirin, ACE inhibitors, beta-blockers, and statins used together for secondary CVD prevention in the same regions showed single QALY costs of $350.<ref name=Zip2018>{{cite book | vauthors = Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF |title=Braunwald's Heart Disease E-Book: A Textbook of Cardiovascular Medicine |date=2018 |publisher=Elsevier Health Sciences |isbn=978-0-323-55593-7 |page=15 |url=https://books.google.com/books?id=LwBGDwAAQBAJ&pg=PA15 |language=en}}</ref>

There are also surgical or procedural interventions that can save someone's life or prolong it. For heart valve problems, a person could have surgery to replace the valve. For arrhythmias, a [[Artificial cardiac pacemaker|pacemaker]] can be put in place to help reduce abnormal heart rhythms and for a heart attack, there are multiple options two of these are a [[coronary angioplasty]] and a [[coronary artery bypass surgery]].<ref>{{Cite web |title=What is Cardiovascular Disease? |url=https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease |date=31 May 2017|website=www.heart.org |language=en}}</ref>

There is probably no additional benefit in terms of mortality and serious adverse events when blood pressure targets were lowered to ≤ 135/85 mmHg from ≤ 140 to 160/90 to 100 mmHg.<ref>{{Cite journal |last1=Saiz |first1=Luis Carlos |last2=Gorricho |first2=Javier |last3=Garjón |first3=Javier |last4=Celaya |first4=Concepcion |last5=Erviti |first5=Juan |last6=Leache |first6=Leire |date=2022-11-18 |title=Blood pressure targets for the treatment of people with hypertension and cardiovascular disease |journal=The Cochrane Database of Systematic Reviews |volume=2022 |issue=11 |article-number=CD010315 |doi=10.1002/14651858.CD010315.pub5 |issn=1469-493X |pmc=9673465 |pmid=36398903}}</ref>

==Epidemiology==
{{owidslider
|start        = 2021
|list         = Template:OWID/cardiovascular disease death rates#gallery
|location      = commons
|caption      =
|title        =
|language     =
|file         = [[File:cardiovascular-disease-death-rates,World,2021.svg|link=|thumb|upright=1.6|cardiovascular-disease-death-rates]]
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[[File:Cardiovascular diseases world map - DALY - WHO2004.svg|thumb|upright=1.3|Disability-adjusted life year for cardiovascular diseases per 100,000&nbsp;inhabitants in 2004<ref name="World Health Organization"/>{{Div col|small=yes|colwidth=10em}}
{{legend|#b3b3b3|no data}}
{{legend|#ffff65|<900}}
{{legend|#fff200|900–1650}}
{{legend|#ffdc00|1650–2300}}
{{legend|#ffc600|2300–3000}}
{{legend|#ffb000|3000–3700}}
{{legend|#ff9a00|3700–4400}}
{{legend|#ff8400|4400–5100}}
{{legend|#ff6e00|5100–5800}}
{{legend|#ff5800|5800–6500}}
{{legend|#ff4200|6500–7200}}
{{legend|#ff2c00|7200–7900}}
{{legend|#cb0000|>7900}}
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Cardiovascular diseases are the leading cause of death worldwide and in all regions except Africa.<ref name="WHO2011" /> In 2008, 30% of all global death was attributed to cardiovascular diseases. Death caused by cardiovascular diseases are also higher in low- and middle-income countries as over 80% of all global deaths caused by cardiovascular diseases occurred in those countries. It is also estimated that by 2030, over 23 million people will die from cardiovascular diseases each year.

It is estimated that 60% of the world's cardiovascular disease burden will occur in the South Asian subcontinent despite only accounting for 20% of the world's population. This may be secondary to a combination of genetic predisposition and environmental factors. Organizations such as the [[Indian Heart Association]] are working with the [[World Heart Federation]] to raise awareness about this issue.<ref name="Indian Heart">{{cite web| vauthors = Roo S |publisher=Indian Heart Association|title= Cardiac Disease Among South Asians: A Silent Epidemic|url=http://indianheartassociation.org/why-indians-why-south-asians/overview/  |access-date=2018-12-31 |url-status=live |archive-url=https://web.archive.org/web/20150518111218/http://indianheartassociation.org/why-indians-why-south-asians/overview/ |archive-date=2015-05-18 }}</ref>

==Research==
{{See also|Heart-on-a-chip|Vessel-on-a-chip}}
There is evidence that cardiovascular disease existed in pre-history,<ref>{{cite journal | vauthors = Thompson RC, Allam AH, Lombardi GP, Wann LS, Sutherland ML, Sutherland JD, Soliman MA, Frohlich B, Mininberg DT, Monge JM, Vallodolid CM, Cox SL, Abd el-Maksoud G, Badr I, Miyamoto MI, el-Halim Nur el-Din A, Narula J, Finch CE, Thomas GS | title = Atherosclerosis across 4000 years of human history: the Horus study of four ancient populations | journal = Lancet | volume = 381 | issue = 9873 | pages = 1211–22 | date = April 2013 | pmid = 23489753 | doi = 10.1016/s0140-6736(13)60598-x | s2cid = 16928278 }}</ref> and research into cardiovascular disease dates from at least the 18th century.<ref>{{Cite journal| vauthors = Alberti FB |date=2013-05-01|title=John Hunter's Heart|journal=The Bulletin of the Royal College of Surgeons of England|volume=95|issue=5|pages=168–69|doi=10.1308/003588413X13643054409261|issn=1473-6357|doi-access=free}}</ref>  The causes, prevention, and/or treatment of all forms of cardiovascular disease remain active fields of [[biomedical research]], with hundreds of scientific studies being published on a weekly basis.

Recent areas of research include the link between inflammation and atherosclerosis<ref>{{cite journal | vauthors = Ruparelia N, Chai JT, Fisher EA, Choudhury RP | title = Inflammatory processes in cardiovascular disease: a route to targeted therapies | journal = Nature Reviews. Cardiology | volume = 14 | issue = 3 | pages = 133–144 | date = March 2017 | pmid = 27905474 | pmc = 5525550 | doi = 10.1038/nrcardio.2016.185 }}</ref><ref>{{cite journal |last1=Mason |first1=J. C. |last2=Libby |first2=P. |title=Cardiovascular disease in patients with chronic inflammation: mechanisms underlying premature cardiovascular events in rheumatologic conditions |journal=European Heart Journal |date=2 February 2015 |volume=36 |issue=8 |pages=482–489 |doi=10.1093/eurheartj/ehu403}}</ref> the potential for novel therapeutic interventions,<ref>{{cite journal | vauthors = Tang WH, Hazen SL | title = Atherosclerosis in 2016: Advances in new therapeutic targets for atherosclerosis | journal = Nature Reviews. Cardiology | volume = 14 | issue = 2 | pages = 71–72 | date = January 2017 | pmid = 28094270 | pmc = 5880294 | doi = 10.1038/nrcardio.2016.216 }}</ref> and the genetics of coronary heart disease.<ref>{{cite journal | vauthors = Swerdlow DI, Humphries SE | title = Genetics of CHD in 2016: Common and rare genetic variants and risk of CHD | journal = Nature Reviews. Cardiology | volume = 14 | issue = 2 | pages = 73–74 | date = February 2017 | pmid = 28054577 | doi = 10.1038/nrcardio.2016.209 | s2cid = 13738641 }}</ref>
{{-}}

== References ==
{{Reflist}}

== External links ==
* [https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds) WHO fact sheet on cardiovascular diseases]
* [https://academic.oup.com/eurheartj/article-pdf/42/34/3227/40326030/ehab484.pdf 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice]
* [http://www.medicinenet.com/heart_disease_coronary_artery_disease/article.htm Heart Disease] [[MedicineNet]] Slides, photos, descriptions
* [https://www.mdcalc.com/framingham-risk-score-hard-coronary-heart-disease Risk calculator]
* [https://kennis-research.shinyapps.io/CVRisk-App/ Interactive CV Risk Calculator]

{{Medical condition classification and resources
| DiseasesDB     = 28808
| ICD10          = {{ICD10|I|51|6|i|30}}
| ICD9           = {{ICD9|429.2}}
| ICDO           =
| OMIM           =
| MedlinePlus    =
| eMedicineSubj  =
| eMedicineTopic =
| MeshID         = D002318
}}
{{Circulatory system pathology}}
{{Vascular diseases}}
{{Certain conditions originating in the perinatal period}}
{{Cardiovascular system symptoms and signs}}
{{Disease groups}}
{{Authority control}}

{{DEFAULTSORT:Cardiovascular Disease}}
[[Category:Aging-associated diseases]]
[[Category:Cardiovascular diseases]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:Wikipedia emergency medicine articles ready to translate]]