Let's Talk About the Causes of Heart Disease
When it comes to heart disease, knowledge is power. Understanding what causes harm to your body’s most important muscle is the first step to keeping it healthy.by Matt McMillen Health Writer
We’ve all heard the saying, “He really took it to heart.” Turns out, this is exactly what the body—and sometimes the mind—can do to your ticker. What you eat, how much you drink, how well you manage stress, and how much or little you exercise can all contribute to your heart’s health (plus a whole host of other factors, too). Keep reading to learn more about the causes of heart disease (an umbrella category covering many specific types of heart ailments), and the ways you can lower your risk of getting it, or better manage your symptoms if you’ve already been diagnosed. Deep breath—we’ve got you.
Our Pro Panel
We went to some of the nation's top experts in heart disease to bring you the most up-to-date information possible.
Guy Mintz, M.D.
Director of Cardiovascular Health & Lipidology
Sandra Atlas Bass Heart Hospital
Michael Goyfman M.D., MPH
Director of Clinical Cardiology
Long Island Jewish Forest Hills
David Friedman, M.D.
Director of Heart Failure Services
Northwell Health’s LIJ Valley Stream
Long Island, NY
Turns out, a lot! And it’s never too late to start. If you’re a smoker, for example, quitting results in immediate benefits. Your heart rate drops to normal right way, your heart attack risk goes down in the first few days and weeks, and, within a year, your risk of CAD has been cut in half compared to people who still smoke.
Talk to your doctor, who can review your current health as well as your health history and your family health history. Then, get a physical. You’ll have your blood pressure measured and blood tests will reveal issues such as high cholesterol and high blood sugar levels. Depending on the results, you may need an electrocardiogram, which can reveal abnormalities in your heart.
Medical procedures, medications, and lifestyle changes can help you live a normal life despite your disease, and your cardiologist will walk you through the options and decide what’s best for you. Much of the work will be up to you, however. Treatment for heart disease involves commitment to a heart-healthy lifestyle. It’s worth the effort! You can slow or sometimes halt the progression of your disease. Exercise, for example, can bring down blood pressure and weight.
If you’ve had a heart attack or have heart failure, you may be eligible for cardiac rehabilitation. The same applies if you have had certain heart procedures or surgery. During cardiac rehab, which often lasts about three months, you will meet with a team of medical professionals, including doctors, nutritionists, exercise specialists, and others who will help you make last heart-healthy lifestyle changes, such as exercise and diet, as well as offer you emotional support to help you cope with the anxiety and depression that often accompanies heart disease.
What Is Heart Disease, Anyway?
Despite its name, heart disease is not a single illness. Instead, it’s a broad term for a variety of problems that can affect the body’s most important muscle. Your heart works tirelessly 24/7—never taking a day off—to supply your brain and other vital organs with life-giving blood and oxygen. With that kind of workload, it’s no surprise things can sometimes go wrong, making the heart function less than optimally. Diseases or infections of the heart muscle and valves, or congenital heart defects can also cause heart failure.
“Going wrong” can manifest in many different ways: For example, if your blood vessels become narrowed from smoking cigarettes, heredity, or a poor diet, the heart is forced to work even harder than normal to deliver blood to every cell in your body. If electrical currents between your heart’s chambers send erratic, rather than steady, pulses, your heart’s rhythm and pumping ability are both affected.
Symptoms range widely, too, from the bothersome if benign to the dangerous and even fatal. In fact, this condition is ranked as the leading cause of death for both men and women in the U.S. One in every four Americans die from heart disease each year—and many of those deaths are preventable, according to the American Heart Association. That’s why we’re sharing all we know here about heart disease risk factors and causes to better protect your ticker—and even extend your life.
What Are the Common Types of Heart Disease?
The most common type of heart disease is coronary artery disease, or CAD (some refer to it as coronary heart disease, or CHD), which develops when the arteries in your heart become clogged with a fatty substance called plaque, dangerously narrowing them and straining your heart’s ability to work efficiently. CAD often leads to heart attacks—some with classic, dramatic symptoms like you see on TV, some (surprisingly) without any symptoms at all—which is its own category of heart disease.
Other types of heart disease include:
Congestive heart failure (often just called heart failure), in which the heart can no longer pump an adequate amount of blood and oxygen to the rest of your body.
Hypertension, a.k.a. high blood pressure (HBP), which makes your heart work harder, increasing your risk of heart failure and stroke.
Heart valve diseases, in which parts of your heart that help regulate blood flow fail to work properly.
Arrhythmias, a blanket term for conditions that cause your heart to beat too fast, too slowly, or erratically. Among them is atrial fibrillation, a.k.a. “Afib,” a disorder in which rather than contracting or squeezing in the rhythmic way they should, your heart’s chambers quiver or fibrillate, causing blood to pool and stagnate, and increasing your risk for blood clotting and stroke.
Stroke, when blood vessels are blocked, or when a blood clot in the heart is released and travels to the brain, causing a sudden interruption of the blood and oxygen supply to the brain. (Though technically not a “type” of heart disease, strokes are a common side effect or result of cardiovascular issues.)
What Causes Heart Disease?
Though there are different kinds of heart disease, they share many common risk factors. One big positive: You can avoid or reverse many of these by changing everyday habits, like what you eat and how much you exercise. Granted, that’s not always easy, but anytime you get a say in the outcome of your health, we call it a win.
Some heart disease causes, however, can’t be avoided, such as advancing age or the genes you inherited from your parents. Also, certain types of heart disease can be caused by other forms of heart disease. For example, if you have atrial fibrillation, the most common type of arrhythmia, you have a higher risk of heart failure. Which is why doing everything you can to avoid and manage any risk factors that you do have control over is so very important.
What Are the Manageable Risk Factors for Heart Disease?
We can’t emphasize this enough: There is likely so much you can do to improve your heart’s health. Read on for the different contributors that can lead to, or worsen, heart disease—and work closely with your doctor to devise a health plan that best protects your ticker going forward.
High Blood Pressure (a.k.a. Hypertension)
When your heart beats, it creates pressure that pushes your blood to the rest of your body via your blood vessels. If that pressure becomes and remains higher than normal, you have high blood pressure. HBP causes your blood vessels to stiffen, and this contributes to atherosclerosis, the leading cause of coronary artery disease and a major risk of heart attack.
HBP also forces your heart to work harder, and over time that can cause your heart to enlarge, causing it to pump blood less efficiently. The frequent result: heart failure. Because of the damage it does to your blood vessels, HBP is also the leading cause of stroke—and the most common cause of Afib, itself a major risk of stroke.
This is the most common cause of the most common type of heart disease, CAD. Atherosclerosis is characterized by the buildup of fatty tissue known as plaque on the inner walls of your heart’s arteries. This causes your arteries to stiffen and narrow. Plaque can eventually rupture or break apart, leading to blood clots—which, in turn, can cause a heart attack (or stroke). Plaque buildup often develops over many years, helped along by smoking, HBP, high cholesterol, diabetes, obesity, and inflammation, all of which damage your arteries’ inner lining and promote the accumulation of plaque.
Both type 1 diabetes and the much more common type 2 diabetes put your heart health at risk. How this occurs in Type 1 diabetes, an autoimmune disease, is not well understood. One explanation may be that elevated blood sugar levels cause an immune response that leads to further damage and, eventually, heart disease.
People with type 2 diabetes frequently have several heart disease risk factors in addition to high blood sugar levels, including obesity, HBP, high cholesterol and triglycerides, and lack of exercise. In addition to CAD, diabetes increases your odds of developing heart failure. In fact, younger adults with type 2 diabetes are five times more likely to have heart failure than those who don’t have diabetes. This condition also makes arrhythmias more likely.
First things, first: There are two types of cholesterol. The “good” kind, known as high density lipoprotein, or HDL, cholesterol, actually provides protection from heart disease. It does this by helping to rid your body of the “bad” kind, called low density lipoprotein (LDL) cholesterol, which contributes to artery-clogging plaque buildups that are part of the recipe for coronary artery disease.
Having high cholesterol means that you have too much total cholesterol relative to the amount of good cholesterol in your bloodstream. Your body produces its own supply of cholesterol, which it uses to make various hormones and to help you absorb vitamin D. You also get cholesterol from the foods in your diet. To keep your cholesterol down, limit foods with saturated fats and trans fats.
To protect your heart, you must make wise choices about what you eat. That means reading nutrition labels and limiting or avoiding foods that contain the following:
Saturated fats, like those found in butter and beef
Trans fats, which are more common in processed foods like cookies, crackers, and margarine
Refined carbs and added sugars, like what you find in many processed breads, pizza dough, pastries, and some breakfast cereals
The bad fats above contribute to cholesterol. Refined carbs and added sugars, meanwhile, contribute to inflammation and cause your blood sugar level to spike. Over time, that can lead to type 2 diabetes, a major risk factor for heart disease. And, of course, fatty and carb-heavy foods add inches to your waistline, and excess weight makes your heart work harder.
Being obese, generally acknowledged as having a Body Mass Index (BMI) of 30.0 or above, forces your heart to work harder because your body requires more of the oxygen and nutrients that your blood supplies. This leads to HBP, and it also can cause your heart’s lower chambers to enlarge and stiffen, eventually leading to heart failure. Excess weight also ups your chances of other risk factors for heart disease, or makes them worse if you already have them, including type 2 diabetes, sleep apnea, and high cholesterol. Obesity also has been linked to atherosclerosis, the leading cause of CAD, and it’s also a risk factor for atrial fibrillation.
Living the couch potato life puts your heart in harm’s way. How? Without exercise, your likelihood of developing major heart disease risk factors like HBP, high cholesterol, obesity, and type 2 diabetes goes up. Lack of physical activity has also been linked to higher risk for heart attack, stroke, and heart failure. The opposite is also true: When you exercise regularly, your heart works more efficiently than when you’re out of shape. Not only does that help keep your blood pressure and bad cholesterol down, it can also keep the numbers on the scale down, and that eases the burden that excess weight puts on your heart.
One more thing: Low- to moderate-intensity exercise reduces the amount of stress hormones your body releases, such as cortisol and adrenaline, which can otherwise strain your heart. Adrenaline boosts your heart rate and blood pressure, while cortisol causes your blood sugar level to rise. All this being said, if you have already been diagnosed with any kind of heart condition, always talk to your doctor to get the green light before undertaking any exercise plan.
Cigarettes are bad habit for so many reasons, not least because of the damage they do to your blood vessels. The toxic chemicals in tobacco smoke are big-time contributors to atherosclerosis, the leading cause of CAD. Smoking also increases your blood pressure and doubles your risk of heart attack. Stubbing out your habit will have immediate and long-term benefits. Visit the American Heart Association to learn how to quit smoking today.
Drinking too much alcohol—and we’ll get into what, exactly, that means in just a moment—harms your heart in both direct and indirect ways. For example:
Alcohol in excess boosts your triglycerides, a type of fat found in your blood that contributes to plaque buildups in your arteries.
Alcohol elevates your blood pressure.
Alcohol has a lot of calories. Overdoing it leads to weight gain and, potentially, obesity. Carrying around a lot of extra weight, especially when it accumulates in and around your belly, puts a heavy burden on your heart.
Alcohol raises both your cholesterol level and your blood pressure while also increasing your odds of developing type 2 diabetes, a major heart disease risk.
Alcohol also contributes to the development of both heart failure and atrial fibrillation, the most common type of arrhythmia.
So if you drink, do so moderately. That means no more than two drinks per day if you’re a man and one per day if you’re a woman (because men and women metabolize alcohol at different rates). One drink equals 12 ounces of beer, five ounces of wine, or 1.5 ounces of hard liquor (like gin or bourbon).
When your body suffers an injury or infection, your immune system responds in an attempt to heal the damage. In the short term, inflammation is designed to help, but if that inflammation becomes chronic, it does more harm rather than good. What does this mean for the heart? Damaged or clogged blood vessels lead to constant inflammation. Not only does this contribute to the buildup of more plaque, it also increases the likelihood that the plaque will rupture or that clots will form, both of which could trigger a heart attack.
This condition momentarily stops your breathing as you sleep. Though episodes are brief, they can occur dozens or even hundreds of times over the course of one night. The most obvious consequence: daytime fatigue due to a restless night. Even more insidious (if less transparent), those interruptions to your breathing starve your heart of oxygen, boost your blood pressure, and up your odds of heart failure, arrhythmia, or stroke.
The link between stress and heart disease is not fully understood, but stress does appear to put your heart health at risk. For example, stress may increase inflammation, elevate your blood pressure and blood sugar, and lower your HDL, or good, cholesterol level, all of which contribute to coronary artery disease, heart attack, and stroke. Stress also impacts your heart in less direct ways. It makes you more likely to turn to habits that are bad for your heart (and the rest of your body!), such as overeating, drinking too much, sleeping too little, and smoking.
What Are Heart Disease Risk Factors You Can’t Change?
Let’s back into this one by saying, the list for what you can change far outweighs the list for what you can’t. So do try to focus on what you’ve just read! As far as what’s beyond your control, read on:
If you’re a man, you’re likely to develop heart disease at an earlier age than women. First heart attacks, for example, strike men at age 65, on average, compared to age 72 for women. Why? Estrogen likely explains the difference. Women have this hormone in much greater abundance than men, and it’s thought that it may at least partially shield them from heart disease. However, estrogen declines during menopause. By age 65, a woman’s risk of heart disease has caught up with men’s risk. Overall, heart disease is the number-one cause of death for both sexes.
Genetics and Family History
Heart disease runs in the family, so it’s important to know whether your dad or brother developed the condition before the age of 55 or if your mom or sister was diagnosed before turning 65. If either is the case, your own risk may be more than double that of people without a family history of heart disease, according to a 2019 study in the Journal of the American Heart Association. One example of a common genetic disorder is called familial hypercholesterolemia. This condition increases your levels of LDL, or “bad”, cholesterol. Most often, this is caused by a mutation in the LDLR gene, which helps control the production of LDL, or bad, cholesterol. Other genes that can contribute to heart disease include APOB, LDLRAP1, and PCSK9 genes.
But it’s not just genetics that can influence your health. Think about your family environment, too. If you grew up with parents who were heavy smokers, for example, or if everyone in your family is obese from years of poor eating habits that they’ve passed on to you, your risk of heart disease may be higher than, say, your friend who grew up in a nonsmoking household that usually served healthy meals.
This one’s pretty straightforward. As you age, your risk of heart disease rises. In fact, more than four out of five people who die from heart disease are over the age of 65. Your heart, just like the rest of your body, weakens as you progress into your golden years. That leaves it less capable of doing its job.
For example, when you exercise, your heart can’t beat as fast as it did when you were younger, so it can no longer keep up with the same amount of activity. Your heart’s electrical circuitry also changes with age, increasing your chances of developing arrhythmias like atrial fibrillation. And your heart’s valves, which help control the flow of blood through your heart, may thicken or become stiffer. That can cause leaks or limit the flow of blood to the rest of your body. Finally, with older age often comes HBP.
That said, your heart is a muscle, and like any muscle, the more you use it—with your doctor’s OK, of course—the longer you’ll be able to stave off some of the less-than-golden aspects of aging. As you reach your middle years and beyond, do your best to move your body each and every day: regular walking, swimming, yoga, and other low-impact activities are great options. Eat well, limit alcohol, manage your stress levels, do everything in your power to lose excess weight and quit smoking, and sleep roughly 7 to 9 hours each night to keep your body as healthy as possible, for as long as possible. Your heart will thank you!
- Heart Disease and Atherosclerosis: National Heart, Lung, and Blood Institute. (n.d.). “Atherosclerosis.” nhlbi.nih.gov/health-topics/atherosclerosis
- Heart Disease and Alcohol: Alcohol Research. (2017). “Alcohol’s Effects on the Cardiovascular System.” ncbi.nlm.nih.gov/pmc/articles/PMC5513687/
- Heart Disease and High Blood Pressure: Mayo Clinic. (2018). “High Blood Pressure (Hypertension).” mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410
- Heart Disease and Inflammation: American Heart Association. (2015). “Inflammation and Heart Disease.” heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/inflammation-and-heart-disease
- Heart Disease and Stress: American Heart Association. (2014). “Stress and Heart Health.” heart.org/en/healthy-living/healthy-lifestyle/stress-management/stress-and-heart-health
- Heart Disease and Cholesterol: Mayo Clinic. (2019). “High cholesterol.” mayoclinic.org/diseases-conditions/high-blood-cholesterol/symptoms-causes/syc-20350800
- Heart Disease and Dietary Fat: Harvard Medical School. (2019). “The truth about fats: the good, the bad, and the in-between.” health.harvard.edu/staying-healthy/the-truth-about-fats-bad-and-good
- Heart Disease and Aging: National Institute on Aging. (2018). “Heart Health and Aging.” nia.nih.gov/health/heart-health-and-aging