Know your risk factors for heart disease so you can help prevent it.

What is heart disease?

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

What are the symptoms of heart disease?

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

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

About 647,000 Americans die from heart disease each year—that’s 1 in every 4 deaths.

What are the risk factors for heart disease?

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

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

What is cardiac rehabilitation?

Cardiac rehabilitation (rehab) is an important program for anyone recovering from a heart attack, heart failure, or some types of heart surgery. Cardiac rehab is a supervised program that includes

• Physical activity
• Education about healthy living, including healthy eating, taking medicine as prescribed, and ways to help you quit smoking
• Counseling to find ways to relieve stress and improve mental health

A team of people may help you through cardiac rehab, including your health care team, exercise and nutrition specialists, physical therapists, and counselors or mental health professionals.

Cardiovascular disease, heart disease, coronary heart disease — what’s the difference? Because these terms sound so similar, people use them interchangeably. This fact sheet will help you understand how these conditions differ.

Cardiovascular Disease
The big umbrella

Cardiovascular disease is the term for all types of diseases that affect the heart or blood vessels, including coronary heart disease (clogged arteries), which can cause heart attacks, stroke, heart failure, and peripheral artery disease.

Heart Disease
A type of cardiovascular disease

“Heart disease” is a catch-all phrase for a variety of conditions that affect the heart’s structure and function. Keep in mind — all heart diseases are cardiovascular diseases, but not all cardiovascular diseases are heart disease. The most common type of heart disease is coronary heart disease. In fact, when people talk about “heart disease” they often mean coronary heart disease.

Coronary Heart Disease
A type of heart disease

Coronary heart disease is often referred to simply as “heart disease,” although it’s not the only type of heart disease. Another term for it is coronary artery disease.

Coronary heart disease occurs when plaque (a combination of fat, cholesterol, calcium, and other substances found in the blood) builds up in your arteries. You may have heard this called clogged arteries or atherosclerosis. The plaque reduces the amount of oxygen-rich blood getting to your heart, which can cause chest pain (also called angina). Plaque can also lead to blood clots, which block blood flow and are the most common cause of a heart attack.

What is aortic aneurysm?

An aortic aneurysm is a balloon-like bulge in the aorta, the large artery that carries blood from the heart through the chest and torso.

Aortic aneurysms can dissect or rupture:

• The force of blood pumping can split the layers of the artery wall, allowing blood to leak in between them. This process is called a dissection.
• The aneurysm can burst completely, causing bleeding inside the body. This is called a rupture.
• Dissections and ruptures are the cause of most deaths from aortic aneurysms.

A thoracic aortic aneurysm happens in the chest. An abdominal aortic aneurysm, which is more common, happens below the chest.

Facts About Aortic Aneurysm in the United States

• Aortic aneurysms or aortic dissections were the cause of 9,904 deaths in 2019.
• In 2019, about 59% of deaths due to aortic aneurysm or aortic dissection happen among men.
• A history of smoking accounts for about 75% of all abdominal aortic aneurysms.
• The U.S. Preventive Services Task Force recommends that men 65 to 75 years old who have ever smoked should get an ultrasound screening for abdominal aortic aneurysms, even if they have no symptoms.

What are the types of aortic aneurysm?

Thoracic Aortic Aneurysms

A thoracic aortic aneurysm happens in the chest. Men and women are equally likely to get thoracic aortic aneurysms, which become more common with increasing age.

Thoracic aortic aneurysms are usually caused by high blood pressure or sudden injury. Sometimes people with inherited connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, get thoracic aortic aneurysms.

Signs and symptoms of thoracic aortic aneurysm can include the following:

• Sharp, sudden pain in the chest or upper back
• Shortness of breath
• Trouble breathing or swallowing

Abdominal Aortic Aneurysms

An abdominal aortic aneurysm occurs below the chest. Abdominal aortic aneurysms happen more often than thoracic aortic aneurysms.

Abdominal aortic aneurysms are more common in men and among people age 65 and older. Abdominal aortic aneurysms are more common among white people than among black people.

Abdominal aortic aneurysms are usually caused by atherosclerosis (hardened arteries), but infection or injury can also cause them.

Abdominal aortic aneurysms often don’t have any symptoms. If an individual does have symptoms, they can include the following:

• Throbbing or deep pain in your back or side.
• Pain in the buttocks, groin, or legs.

Other Types of Aneurysms

Aneurysms can happen in other parts of your body. A ruptured aneurysm in the brain can cause a stroke. Peripheral aneurysms—those found in arteries other than the aorta—can happen in the neck, in the groin, or behind the knees. These aneurysms are less likely to rupture or dissect than aortic aneurysms, but they can form blood clots. These clots can break away and block blood flow through the artery.

What are the risk factors for aortic aneurysm?

Diseases and unhealthy behaviors that damage your heart and blood vessels also increase your risk for aortic aneurysm. Smoking is the most important behavior related to aortic aneurysm.

Other factors include

• High blood pressure
• High blood cholesterol
• Atherosclerosis (hardened arteries)

Some inherited connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, can also increase your risk for aortic aneurysm. Your family may also have a history of aortic aneurysms that can increase your risk.

How are aortic aneurysms treated?

The two main treatments for aortic aneurysms are medicines and surgery. Medicines can lower blood pressure and reduce risk for an aortic aneurysm. Surgery can repair or replace the affected section of the aorta.

What is atrial fibrillation?

Atrial fibrillation, often called AFib or AF, is the most common type of treated heart arrhythmia. An arrhythmia is when the heart beats too slowly, too fast, or in an irregular way.

When a person has AFib, the normal beating in the upper chambers of the heart (the two atria) is irregular, and blood doesn’t flow as well as it should from the atria to the lower chambers of the heart (the two ventricles). AFib may happen in brief episodes, or it may be a permanent condition.

Facts About AFib

• It is estimated that 12.1 million people in the United States will have AFib in 2030.
• In 2019, AFib was mentioned on 183,321 death certificates and was the underlying cause of death in 26,535 of those deaths.
• People of European descent are more likely to have AFib than African Americans.
• Because the number of AFib cases increases with age and women generally live longer than men, more women than men experience AFib.

What are the symptoms of AFib?

Some people who have AFib don’t know they have it and don’t have any symptoms. Others may experience one or more of the following symptoms:

• Irregular heartbeat
• Heart palpitations (rapid, fluttering, or pounding)
• Lightheadedness
• Extreme fatigue
• Shortness of breath
• Chest pain

What are the risk factors for AFib?

The risk for AFib increases with age. High blood pressure, the risk for which also increases with advancing age, accounts for about 1 in 5 cases of AFib.

Risk factors for AFib include

• Advancing age
• High blood pressure
• Obesity
• European ancestry
• Diabetes
• Heart failure
• Ischemic heart disease
• Hyperthyroidism
• Chronic kidney disease
• Moderate to heavy alcohol use
• Smoking
• Enlargement of the chambers on the left side of the heart

How is AFib related to stroke?

AFib increases a person’s risk for stroke. When standard stroke risk factors were accounted for, AFib was associated with an approximately fivefold increased risk of ischemic stroke. AFib causes about 1 in 7 strokes.

Strokes caused by complications from AFib tend to be more severe than strokes with other underlying causes. Strokes happen when blood flow to the brain is blocked by a blood clot or by fatty deposits called plaque in the blood vessel lining.

How is AFib treated?

Treatment for AFib can include

• Medicines to control the heart’s rhythm and rate
• Blood-thinning medicine to prevent blood clots from forming and reduce stroke risk
• Surgery
• Medicine and healthy lifestyle changes to manage AFib risk factors

What are the consequences of AFib?

More than 454,000 hospitalizations with AFib as the primary diagnosis happen each year in the United States.The condition contributes to about 158,000 deaths each year.The death rate from AFib as the primary or a contributing cause of death has been rising for more than two decades.

More than 356,000 people have an out-of-hospital cardiac arrest in the United States every year,and about 60% to 80% of them die before reaching the hospital.

Cardiac arrest occurs when the heart suddenly and unexpectedly stops beating. Blood stops flowing to the rest of the body. People who survive cardiac arrest can have:

• Brain injury.
• Injury to internal organs.
• Psychological distress, like anxiety, post-traumatic stress disorder (PTSD), and depression.

Cardiac arrest is not the same as a heart attack (myocardial infarction), myocarditis (inflammation of the heart muscle), or pericarditis (inflammation of the outer lining of the heart).

Signs of Cardiac Arrest

A person may be in cardiac arrest if they:

• Collapse suddenly and lose consciousness (pass out).
• Are not breathing or are gasping for air.
• Don’t respond to shouting or shaking.
• Don’t have a pulse.

Causes of Cardiac Arrest

Cardiac arrest has several causes, including:

• Cardiomyopathy, which happens when the heart muscle becomes enlarged or stiff, leading to abnormal contractions.
• Coronary artery disease, which restricts the flow of blood to the heart.
• Valvular heart disease.
• An arrhythmia, which is when the heart beats too slowly, too fast, or in an irregular way.

Although rare (fewer than 30 reported cases annually), a forceful blow to the chest, as from a hard ball or steering wheel, can also cause cardiac arrest. This condition is called commotio cordis (agitation of the heart).

Groups at Higher Risk of Cardiac Arrest

People at highest risk for cardiac arrest are older adults and men. Black or African American men and women are more likely to die from out-of-hospital cardiac arrest than White men and women.

Cardiomyopathy represents a collection of diverse conditions of the heart muscle. These diseases have many causes, symptoms, and treatments and can affect people of all ages and races.

When cardiomyopathy occurs, the normal muscle in the heart can thicken, stiffen, thin out, or fill with substances the body produces that do not belong in the heart muscle. As a result, the heart muscle’s ability to pump blood is reduced, which can lead to irregular heartbeats, the backup of blood into the lungs or rest of the body, and heart failure.

Cardiomyopathy can be acquired—developed because of another disease, condition, or factor—or inherited. The cause isn’t always known.

The main types of cardiomyopathy include the following:

• Dilated: where one of the pumping chambers (ventricles) of the heart is enlarged. This is more common in males and is the most common form of cardiomyopathy in children. It can occur at any age and may or may not be inherited.
• Hypertrophic: where the heart muscle is thickened. This often presents in childhood or early adulthood and can cause sudden death in adolescents and young adult athletes. It is often an inherited condition, and a person may not have any symptoms. If there is a family history of this, other family members can be tested and adjust their activities to reduce the risk of sudden death.
• Arrhythmogenic: where the disease causes irregular heartbeats or rhythms. This is often inherited and more common in males.
• Restrictive: where heart muscle is stiff or scarred, or both. It can occur with amyloidosis or hemochromatosis, and other conditions. This is the least common type.

How common is cardiomyopathy?

Cardiomyopathy often goes undiagnosed, so the numbers can vary. As many as 1 of 500 adults may have this condition. Males and females of all ages and races can have cardiomyopathy. Dilated cardiomyopathy is more common in blacks than in whites and in males than in females.

Hypertrophic cardiomyopathy is thought to be the most common inherited or genetic heart disease. While this type of cardiomyopathy occurs at many ages, in children and young adults with this condition there may be no symptoms, yet they are at high risk of sudden cardiac death.

Causes

Although the cause of cardiomyopathy is sometimes unknown, certain diseases or conditions can lead to cardiomyopathy. These include the following:

• A family history of cardiomyopathy, heart failure or sudden cardiac arrest.
• Connective tissue disease and other types of autoimmune disease.
• Coronary heart disease or a heart attack.
• Diseases that can damage the heart, such as hemochromatosis, sarcoidosis or amyloidosis.
• Endocrine diseases, including thyroid conditions and diabetes.
• Infections in the heart muscle.
• Long-term alcoholism or cocaine abuse.
• Muscle conditions such as muscular dystrophy.
• Pregnancy.

Symptoms

Some people who have cardiomyopathy never have symptoms, while others may show signs as the disease progresses. These might include the following:

• Shortness of breath or trouble breathing.
• Fatigue.
• Swelling in the ankles and legs.
• Irregular heart beat or palpitations.
• Syncope, the medical term for fainting or briefly passing out.

Treatment and Prevention

The goal of treatment is to slow down the disease, control symptoms, and prevent sudden death. If you are diagnosed with cardiomyopathy, your doctor may tell you to change your diet and physical activity, reduce stress, avoid alcohol and other drugs, and take medicines. Your doctor may also treat you for the conditions that led to cardiomyopathy, if they exist, or recommend surgery. Treatment also depends on which type of cardiomyopathy you have.

Genetic or inherited types of cardiomyopathy cannot be prevented, but adopting or following a healthier lifestyle can help control symptoms and complications. If you have an underlying disease or condition that can cause cardiomyopathy, early treatment of that condition can help prevent the disease from developing.

Pediatric Cardiomyopathy

Cardiomyopathy can occur in children regardless of age, race, and gender. Pediatric cardiomyopathy can be inherited or acquired through a viral infection and sometimes the cause is unknown. It is a frequent cause of sudden cardiac arrest in the young, according to the National Heart, Lung and Blood Institute. Treatment may include medications, changes to physical activity, or surgery.

In many cases, early detection and intervention can help to improve outcomes for children.

What is coronary artery disease?

Coronary artery disease (CAD) is the most common type of heart disease in the United States. It is sometimes called coronary heart disease or ischemic heart disease.

For some people, the first sign of CAD is a heart attack. You and your health care team may be able to help reduce your risk for CAD.

What causes coronary artery disease?

CAD is caused by plaque buildup in the walls of the arteries that supply blood to the heart (called coronary arteries) and other parts of the body.

Plaque is made up of deposits of cholesterol and other substances in the artery. Plaque buildup causes the inside of the arteries to narrow over time, which can partially or totally block the blood flow. This process is called atherosclerosis.

What are the symptoms of coronary artery disease?

Angina, or chest pain and discomfort, is the most common symptom of CAD. Angina can happen when too much plaque builds up inside arteries, causing them to narrow. Narrowed arteries can cause chest pain because they can block blood flow to your heart muscle and the rest of your body.

For many people, the first clue that they have CAD is a heart attack. Symptoms of heart attack include

• Chest pain or discomfort (angina)
• Weakness, light-headedness, nausea (feeling sick to your stomach), or a cold sweat
• Pain or discomfort in the arms or shoulder
• Shortness of breath

Over time, CAD can weaken the heart muscle. This may lead to heart failure, a serious condition where the heart can’t pump blood the way it should.

What are the risks for coronary artery disease?

Overweight, physical inactivity, unhealthy eating, and smoking tobacco are risk factors for CAD. A family history of heart disease also increases your risk for CAD, especially a family history of having heart disease at an early age (50 or younger).

To find out your risk for CAD, your health care team may measure your blood pressure, blood cholesterol, and blood sugar levels.

How is coronary artery disease diagnosed?

If you’re at high risk for heart disease or already have symptoms, your doctor can use several tests to diagnose CAD.

What is cardiac rehabilitation and recovery?

Cardiac rehabilitation (rehab) is an important program for anyone recovering from a heart attack, heart failure, or other heart problem that required surgery or medical care. In these people, cardiac rehab can help improve quality of life and can help prevent another cardiac event. Cardiac rehab is a supervised program that includes

• Physical activity
• Education about healthy living, including healthy eating, taking medicine as prescribed, and ways to help you quit smoking
• Counseling to find ways to relieve stress and improve mental health

A team of people may help you through cardiac rehab, including your health care team, exercise and nutrition specialists, physical therapists, and counselors or mental health professionals.

How can I be healthier if I have coronary artery disease?

If you have CAD, your health care team may suggest the following steps to help lower your risk for heart attack or worsening heart disease:

• Lifestyle changes, such as eating a healthier (lower sodium, lower fat) diet, increasing physical activity, reaching a healthy weight, and quitting smoking
• Medicines to treat risk factors for CAD, such as high cholesterol, high blood pressure, or an irregular heartbeat
• Surgical procedures to help restore blood flow to the heart

What is a heart attack?

A heart attack, also called a myocardial infarction, happens when a part of the heart muscle doesn’t get enough blood.

The more time that passes without treatment to restore blood flow, the greater the damage to the heart muscle.

Coronary artery disease (CAD) is the main cause of heart attack. A less common cause is a severe spasm, or sudden contraction, of a coronary artery that can stop blood flow to the heart muscle.

What are the symptoms of heart attack?

The major symptoms of a heart attack are

• Chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest that lasts for more than a few minutes or that goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain.
• Feeling weak, light-headed, or faint. You may also break out into a cold sweat.
• Pain or discomfort in the jaw, neck, or back.
• Pain or discomfort in one or both arms or shoulders.
• Shortness of breath. This often comes along with chest discomfort, but shortness of breath also can happen before chest discomfort.

Other symptoms of a heart attack could include unusual or unexplained tiredness and nausea or vomiting. Women are more likely to have these other symptoms.

Every 40 seconds, someone in the United States has a heart attack.

Call 9-1-1 if you notice symptoms of a heart attack.

If you notice the symptoms of a heart attack in yourself or someone else, call 9-1-1 immediately. The sooner you get to an emergency room, the sooner you can get treatment to reduce the amount of damage to the heart muscle. At the hospital, health care professionals can run tests to find out if a heart attack is happening and decide the best treatment.

In some cases, a heart attack requires cardiopulmonary resuscitation (CPR) or an electrical shock (defibrillation) to the heart to get the heart pumping again. Bystanders trained to use CPR or a defibrillator may be able to help until emergency medical personnel arrive.

Remember, the chances of surviving a heart attack are better the sooner emergency treatment begins.

What are the risk factors for heart attack?

Several health conditions, your lifestyle, and your age and family history can increase your risk for heart disease and heart attack. These are called risk factors. About half of all Americans have at least one of the three key risk factors for heart disease: high blood pressure, high blood cholesterol, and smoking.

Some risk factors cannot be controlled, such as your age or family history. But you can take steps to lower your risk by changing the factors you can control.

What can I do to recover after a heart attack?

If you’ve had a heart attack, your heart may be damaged. This could affect your heart’s rhythm and its ability to pump blood to the rest of the body. You may also be at risk for another heart attack or conditions such as stroke, kidney disorders, and peripheral arterial disease (PAD).

You can lower your chances of having future health problems following a heart attack with these steps:

• Physical activity—Talk with your health care team about the things you do each day in your life and work. Your doctor may want you to limit work, travel, or sexual activity for some time after a heart attack.
• Lifestyle changes—Eating a healthier diet, increasing physical activity, quitting smoking, and managing stress—in addition to taking prescribed medicines—can help improve your heart health and quality of life. Ask your health care team about attending a program called cardiac rehabilitation to help you make these lifestyle changes.
• Cardiac rehabilitation—Cardiac rehabilitation is an important program for anyone recovering from a heart attack, heart failure, or other heart problem that required surgery or medical care. Cardiac rehab is a supervised program that includes
  • Physical activity
  • Education about healthy living, including healthy eating, taking medicine as prescribed, and ways to help you quit smoking
  • Counseling to find ways to relieve stress and improve mental health

A team of people may help you through cardiac rehab, including your health care team, exercise and nutrition specialists, physical therapists, and counselors or mental health professionals.

Heart failure happens when the heart cannot pump enough blood and oxygen to support other organs in your body. Heart failure is a serious condition, but it does not mean that the heart has stopped beating.

Facts About Heart Failure in the United States

• About 6.5 million adults in the United States have heart failure.
• Heart failure was a contributing cause of 1 in 8 deaths in 2017.
• Heart failure costs the nation an estimated $30.7 billion in 2012. This total includes the cost of health care services, medicines to treat heart failure, and missed days of work.

What are the risk factors for heart failure?

Certain medical conditions can increase your risk for heart failure, including

• Coronary artery disease (CAD) (the most common type of heart disease) and heart attacks
• Diabetes
• High blood pressure
• Obesity
• Other Conditions Related to Heart Disease
• Valvular Heart Disease

Unhealthy behaviors can also increase your risk for heart failure, especially for people who have one of the conditions listed above. Unhealthy behaviors include:

• Smoking tobacco
• Eating foods high in fat, cholesterol, and sodium
• Not getting enough physical activity
• Excessive alcohol intake

What are the symptoms of heart failure?

Common symptoms of heart failure include:

• Shortness of breath during daily activities
• Having trouble breathing when lying down
• Weight gain with swelling in the feet, legs, ankles, or stomach
• Generally feeling tired or weak

How is heart failure treated?

Early diagnosis and treatment can improve quality and length of life for people who have heart failure. Treatment usually involves the following:

• Taking medicines
• Reducing sodium in the diet
• Drinking less liquids
• Devices that remove excess salt and water from the blood
• Heart transplant and other surgeries
• Getting daily physical activity

People with heart failure also track their symptoms each day so that they can discuss these symptoms with their health care team.

Blood pressure is the pressure of blood pushing against the walls of your arteries. Arteries carry blood from your heart to other parts of your body.

Blood pressure normally rises and falls throughout the day, but it can damage your heart and cause health problems if it stays high for a long time. Hypertension, also called high blood pressure, is blood pressure that is higher than normal.

Facts About Hypertension in the United States

In 2017, the American College of Cardiology and the American Heart Association published new guidelines for hypertension management and defined high hypertension as a blood pressure at or above 130/80 mm Hg. Stage 2 hypertension is defined as a blood pressure at or above 140/90 mm Hg.

• Having hypertension puts you at risk for heart disease and stroke, which are leading causes of death in the United States.
• In 2017, nearly half a million deaths in the United States included hypertension as a primary or contributing cause.
• Nearly half of adults in the United States (108 million, or 45%) have hypertension defined as a systolic blood pressure ≥ 130 mm Hg or a diastolic blood pressure ≥ 80 mm Hg or are taking medication for hypertension.
• Only about 1 in 4 adults (24%) with hypertension have their condition under control.
• About half of adults (45%) with uncontrolled hypertension have a blood pressure of 140/90 mm Hg or higher. This includes 37 million U.S. adults.
• Half of adults (30 million) with blood pressure ≥140/90 mm Hg who should be taking medication to control their blood pressure aren’t prescribed or aren’t taking medication.
• High blood pressure was a primary or contributing cause of death in 2017 for more than 472,000 people in the United States. That’s nearly 1,300 deaths each day.
• High blood pressure costs the United States about $131 billion each year, averaged over 12 years from 2003 to 2014.

Rates of High Blood Pressure Control Vary by Sex and Race

Uncontrolled high blood pressure is common; however, certain groups of people are more likely to have control over their high blood pressure than others.

• A greater percent of men (47%) have high blood pressure than women (43%).
• High blood pressure is more common in non-Hispanic black adults (54%) than in non-Hispanic white adults (46%), non-Hispanic Asian adults (39%), or Hispanic adults (36%).
• Among those recommended to take blood pressure medication, blood pressure control is higher among non-Hispanic white adults (32%) than in non-Hispanic black adults (25%), non-Hispanic Asian adults (19%), or Hispanic adults (25%).

Rates of High Blood Pressure Vary by Geography

High blood pressure is more common in some areas of the United States than in others. Below is a map showing the self-reported rate of hypertension by state in 2011 (using a definition of hypertension as a blood pressure ≥140/≥90 mm Hg). However, this map likely underreports the true effect of hypertension in each state, because about 1 in 5 adults with high blood pressure is unaware of it and would not report having it.

What is Marfan syndrome?

Marfan syndrome is a genetic condition that affects connective tissue, which provides support for the body and organs. Marfan syndrome can damage the blood vessels, heart, eyes, skin, lungs, and the bones of the hips, spine, feet, and rib cage. Some complications of Marfan syndrome can be treated or prevented, including heart disease, bone deformities such as a curved spine, eye conditions, crooked teeth, and collapsed lungs.

Some complications of Marfan syndrome can be very serious, like an aneurysm (bulge) of the aorta, the main artery that takes blood away from the heart. An aortic aneurysm can cause the walls of the aorta to tear apart (dissect) and blood to leak in the space created by the tear. An aortic aneurysm can be life threatening.

What causes Marfan syndrome?

Marfan syndrome is rare, happening in about 1 in 5,000 people.Marfan syndrome is caused by a mutation in a gene called FBN1. The mutation limits the body’s ability to make proteins needed to build connective tissue. One in four people with Marfan syndrome develops the condition for unknown reasons. A person with Marfan syndrome has a 1 in 2 chance of passing it on to their child.

How is Marfan syndrome diagnosed?

Recognizing the signs of Marfan syndrome is important for prevention and treatment of serious and even life-threatening complications. People with Marfan syndrome are often tall and thin, with very long arms, legs, fingers, and toes. People who might have Marfan syndrome should be evaluated to help reduce the risk of potential heart problems. It isn’t always easy to diagnose Marfan syndrome because it affects everyone a little differently. Some people with Marfan syndrome don’t show signs of it until later in childhood or in adulthood.

Testing for Marfan syndrome may include

• Physical exam
• Family history
• Eye exam
• Echocardiogram (using sound waves to look for problems with the aorta and heart valves)
• Genetic testing

How is Marfan syndrome treated?

Not everyone with Marfan syndrome has all of the complications. People with Marfan syndrome must be closely followed by their doctor to watch for the following complications:

• Heart disease, including aortic aneurysms and problems with heart valves
• Bone deformities such as scoliosis (a curved spine) or a breastbone that is sunken or sticks out
• Eye conditions that can lead to blurred vision or loss of sight, such as a retinal detachment (where the retina—the part of the eye that senses light in the back of the eye—peels away from its supporting tissue) or dislocation of the lens (where the lens shifts out of place)
• Teeth that are crooked or crowded together, which might require dental procedures
• A collapsed lung, which makes breathing difficult

Treatment depends on which parts of the body are affected. An aortic aneurysm may be treated with medicine or medicine plus surgery. Medicine is used to lower blood pressure to help prevent an aneurysm from rupturing and causing a dissection of the aorta.

Severe scoliosis and breastbone problems may require surgery. Eye conditions may also require surgery.

Peripheral Arterial Disease (PAD)

Peripheral arterial disease (PAD) in the legs or lower extremities is the narrowing or blockage of the vessels that carry blood from the heart to the legs. It is primarily caused by the buildup of fatty plaque in the arteries, which is called atherosclerosis. PAD can happen in any blood vessel, but it is more common in the legs than the arms.

Prevalence of PAD (%) by Age Group (years)

What are the risk factors for PAD?

• Smoking
• High blood pressure
• Atherosclerosis
• Diabetes
• High cholesterol
• Age above 60 years

Both men and woman are affected by PAD; however, African Americans have an increased risk of PAD. Hispanics may have similar to slightly higher rates of PAD compared with non-Hispanic white people. Approximately 6.5 million people age 40 and older in the United States have PAD.

Other health conditions and disorders of arteries can mimic the symptoms of PAD, and not all PAD is due to atherosclerosis.

If you have PAD, you are at risk for developing coronary artery disease and cerebrovascular disease, which could lead to a heart attack or stroke.

The image on the left shows a normal artery. The right shows an artery narrowed by atherosclerosis, causing PAD.

What are the signs and symptoms of PAD?

The classic symptom of PAD is pain in the legs with physical activity, such as walking, that gets better after rest. However, up to 4 in 10 people with PAD have no leg pain.¹ Symptoms of pain, aches, or cramps with walking (claudication) can happen in the buttock, hip, thigh, or calf.²

Physical signs in the leg that may indicate PAD include muscle atrophy (weakness); hair loss; smooth, shiny skin; skin that is cool to the touch, especially if accompanied by pain while walking (that is relieved by stopping walking); decreased or absent pulses in the feet; sores or ulcers in the legs or feet that don’t heal; and cold or numb toes.

How can I prevent PAD?

• Get plenty of physical activity to help prevent PAD or improve symptoms of PAD.
• Do not use tobacco. Smoking increases the risk of PAD and makes PAD symptoms worse.
• Control high blood pressure and manage high blood cholesterol and diabetes.

If you have PAD, participating in supervised exercise training programs can improve and prolong your ability to walk longer distances.

How is PAD diagnosed?

If you have symptoms of PAD, your doctor may do an ankle brachial index (ABI), which is a noninvasive test that measures the blood pressure in the ankles and compares it with the blood pressure in the arms at rest and after exercise. Your doctor may also do imaging tests such as ultrasound, magnetic resonance angiography (MRA), and computed tomographic (CT) angiography.

How is PAD treated?

• Your doctor may recommend that you take aspirin or other similar antiplatelet medicines to prevent serious complications from PAD and associated atherosclerosis. You may also need to take medicine to reduce your blood cholesterol.^2,4
• If you smoke, quit. Talk with your doctor about ways to help you quit smoking.
• You may need surgery to bypass blocked arteries.

What is pulmonary hypertension?

Pulmonary hypertension happens when the pressure in the blood vessels leading from the heart to the lungs is too high.

With pulmonary hypertension, the blood vessels to the lungs develop an increased amount of muscle in the wall of the blood vessels. The heart pumps blood from the right ventricle to the lungs to get oxygen. Because the blood does not have to travel very far, the pressure in this side of the heart and in the artery taking blood from the right ventricle to the lungs is normally low—usually much lower than systolic or diastolic blood pressure.

When the pressure in this artery gets too high, the arteries in the lungs can narrow and then the blood does not flow as well as it should, resulting in less oxygen in the blood.

What causes pulmonary hypertension?

Some common underlying causes of pulmonary hypertension include high blood pressure in the lungs’ arteries due to some types of congenital heart disease, connective tissue disease, coronary artery disease, high blood pressure, liver disease (cirrhosis), blood clots to the lungs, and chronic lung diseases like emphysema. Genetics also play a role.

Pulmonary hypertension can happen in association with many other diseases, such as lung disease and heart disease. Heart failure is common in pulmonary hypertension.

What are the risk factors for pulmonary hypertension?

• Pulmonary hypertension happens at all ages, including children, and its incidence increases with age.
• Pulmonary hypertension is more common among women, non-Hispanic black people, and people age 75 or older.

What are the signs and symptoms of pulmonary hypertension?

The symptoms of pulmonary hypertension during the initial stage of the disease are common to many other medical conditions (e.g., difficulty breathing, fatigue). This often results in a delayed diagnosis until more severe symptoms arise, such as dizziness, chest pain, ankle swelling, or feeling the heart race or pound (palpitations).

How is pulmonary hypertension treated?

There is no cure for pulmonary hypertension. However, there are many different types of treatments, including

• Inhaled medicine
• Medicine given through the veins under the skin
• Medicine to reduce swelling in the feet (diuretics)
• Oxygen therapy

How can I prevent pulmonary hypertension?

While not all pulmonary hypertension can be prevented, you can take steps to prevent it by making healthy lifestyle changes and managing high blood pressure, coronary heart disease, chronic liver disease, and chronic lung disease from tobacco use.

What is valvular heart disease?

Valvular heart disease is when any valve in the heart has damage or is diseased. There are several causes of valve disease.

• The normal heart has four chambers (right and left atria, and right and left ventricles) and four valves (Figure 1).
• The mitral valve, also called the bicuspid valve, allows blood to flow from the left atrium to the left ventricle.
• The tricuspid valve allows blood to flow from the right atrium to the right ventricle.
• The aortic valve allows blood to flow from the left ventricle to the aorta.
• The pulmonary valve allows blood to flow from the right ventricle to the pulmonary artery.

The valves open and close to control or regulate the blood flowing into the heart and then away from the heart. Three of the heart valves are composed of three leaflets or flaps that work together to open and close to allow blood to flow across the opening. The mitral valve only has two leaflets (Figure 2).

Healthy heart valve leaflets are able to fully open and close the valve during the heartbeat, but diseased valves might not fully open and close. Any valve in the heart can become diseased, but the aortic valve is most commonly affected.

Diseased valves can become “leaky” where they don’t completely close; this is called regurgitation. If this happens, blood leaks back into the chamber that it came from and not enough blood can be pushed forward through the heart.

The other common type of heart valve condition happens when the opening of the valve is narrowed and stiff and the valve is not able to open fully when blood is trying to pass through; this is called stenosis (Figure 2).

Sometimes the valve may be missing a leaflet—this more commonly involves the aortic valve. If the heart valves are diseased, the heart can’t effectively pump blood throughout the body and has to work harder to pump, either while the blood is leaking back into the chamber or against a narrowed opening. This can lead to heart failure, sudden cardiac arrest (when the heart stops beating), and death.

Facts About Valvular Heart Disease

• About 2.5% of the U.S. population has valvular heart disease, but it is more common in older adults. About 13% of people born before 1943 have valvular heart disease.
• Rheumatic heart disease most commonly affects the mitral valve (which has only two leaflets; Figure 2) or the aortic valve, but any valve can be affected, and more than one can be involved.
• Bicuspid aortic valve (having only two leaflets rather than the normal three) happens in about 1% to 2% of the population and is more common among men.
• In 2017, there were 3,046 deaths due to rheumatic valvular heart disease and 24,811 deaths due to non-rheumatic valvular heart disease in the United States.
• Nearly 25,000 deaths in the U.S. each year are due to heart valve disease from causes other than rheumatic disease.
• Valvular heart disease deaths are more commonly due to aortic valve disease

What causes valvular heart disease?

There are several causes of valvular heart disease, including congenital conditions (being born with it), infections, degenerative conditions (wearing out with age), and conditions linked to other types of heart disease.

• Rheumatic disease can happen after an infection from the bacteria that causes strep throat is not treated with antibiotics. The infection can cause scarring of the heart valve. This is the most common cause of valve disease worldwide, but it is much less common in the United States, where most strep infections are treated early with antibiotics. It is, however, more common in the United States among people born before 1943.
• Endocarditis is an infection of the inner lining of the heart caused by a severe infection in the blood. The infection can settle on the heart valves and damage the leaflets. Intravenous drug use can also lead to endocarditis and cause heart valve disease.
• Congenital heart valve disease is malformations of the heart valves, such as missing one of its leaflets. The most commonly affected valve with a congenital defect is a bicuspid aortic valve, which has only two leaflets rather than three.
• Other types of heart disease:
  • Heart failure. Heart failure happens when the heart cannot pump enough blood and oxygen to support other organs in your body.
  • Atherosclerosis of the aorta where it attaches to the heart. Atherosclerosis refers to a buildup of plaque on the inside of the blood vessel. Plaque is made up of fat, calcium, and cholesterol.
  • Thoracic aortic aneurysm, a bulge or ballooning where the aorta attaches to the heart.
  • High blood pressure.
  • A heart attack (also known as myocardial infarction or MI), which can damage the muscles that control the opening and closing of the valve.
• Other:
  • Autoimmune disease, such as lupus.
  • Marfan syndrome, a disease of connective tissue that can affect heart valves.
  • Exposure to high-dose radiation, which may lead to calcium deposits on the valve.
  • The aging process, which can cause calcium deposits to develop on the heart valves, making them stiff or thickened and less efficient with age.

What are the symptoms of valvular heart disease?

Heart valve disease can develop quickly or over a long period. When valve disease develops more slowly, there may be no symptoms until the condition is quite advanced. When it develops more suddenly, people may experience the following symptoms:

• Shortness of breath
• Chest pain
• Fatigue
• Dizziness or fainting
• Fever
• Rapid weight gain
• Irregular heartbeat

How is valvular heart disease diagnosed?

The doctor may hear a heart murmur (an unusual sound) when listening to your heartbeat. Depending on the location of the murmur, how it sounds, and its rhythm, the doctor may be able to determine which valve is affected and what type of problem it is (regurgitation or stenosis).

A doctor may also use an echocardiography, a test that uses sound waves to create a movie of the valves to see if they are working correctly.

How is valvular heart disease treated?

If the condition isn’t too severe, it might be managed with medicines to treat the symptoms. If the valve is more seriously diseased and causing more severe symptoms, surgery may be recommended. The type of surgery will depend on the valve involved and the cause of the disease. For some conditions, the valve will need to be replaced by either opening the heart during surgery or replacing the valve without having to open the heart during surgery.

Coronary artery disease, also called coronary heart disease or ischemic heart disease, is the most common type of heart disease, but there are many other conditions that affect the heart.

Acute coronary syndrome is a term that includes heart attack and unstable angina.

Angina, a symptom of coronary artery disease, is chest pain or discomfort that happens when the heart muscle is not getting enough blood. Angina may feel like pressure or a squeezing pain in the chest. The pain also may occur in the shoulders, arms, neck, jaw, or back. It may feel like indigestion.

There are two forms of angina—stable or unstable:

• Stable angina happens during physical activity or under mental or emotional stress.
• Unstable angina is chest pain that occurs even while at rest, without apparent reason. This type of angina is a medical emergency.

Aortic aneurysm and dissection are conditions that can affect the aorta, the major artery that carries blood from the heart to the body. An aneurysm is an enlargement in the aorta that can rupture or burst. A dissection is a tear in the aorta, which is a medical emergency.

Arrhythmias are irregular or unusually fast or slow heartbeats. Arrhythmias can be serious. One example is called ventricular fibrillation. This type of arrhythmia causes an abnormal heart rhythm that leads to death unless treated right away with an electrical shock to the heart (called defibrillation). Other arrhythmias are less severe but can develop into more serious conditions, such as atrial fibrillation, which can cause a stroke.

Atherosclerosis happens when plaque builds up in the arteries that supply blood to the heart (called coronary arteries). Plaque is made up of cholesterol deposits. Plaque buildup causes arteries to narrow over time.

Atrial fibrillation is a type of arrhythmia that can cause rapid, irregular beating of the heart’s upper chambers. Blood may pool and clot inside the heart, increasing the risk for heart attack and stroke.

Cardiomyopathy happens when the heart muscle becomes enlarged or stiff. This can lead to inadequate heart pumping (or weak heart pump) or other problems. Cardiomyopathy has many causes, including family history of the disease, prior heart attacks, uncontrolled high blood pressure, and viral or bacterial infections.

Congenital heart defects are problems with the heart that are present at birth. They are the most common type of major birth defect. Examples include abnormal heart valves or holes in the heart’s walls that divide the heart’s chambers. Congenital heart defects range from minor to severe.

Heart failure is often called congestive heart failure because of fluid buildup in the lungs, liver, legs, and feet. Heart failure is a serious condition that occurs when the heart can’t pump enough blood to meet the body’s needs. It does not mean that the heart has stopped but that muscle is too weak to pump enough blood. Most of heart failure cases are chronic, or long-term heart failures.

The only cure for heart failure is a heart transplant. However, heart failure can be managed with medications or medical procedures. For more information, see the heart failure fact sheet.

Marfan syndrome. Marfan syndrome is a genetic condition that affects connective tissue, which provides support for the body and organs. It can damage the blood vessels, heart, eyes, skin, lungs, and the bones of the hips, spine, feet, and rib cage.

Peripheral arterial disease (PAD) happens when the arteries that supply blood to the arms and legs (the periphery) become narrow or stiff. PAD usually results from atherosclerosis, the buildup of plaque and narrowing of the arteries. With this condition, blood flow and oxygen to the arm and leg muscles are low or even fully blocked. Signs and symptoms include leg, calf, buttock, hip, or thigh pain, and numbness in the feet.

Pulmonary hypertension happens when the pressure in the arteries leading from the heart to the lungs is too high. There are many conditions that lead to pulmonary hypertension, including connective tissue disease, liver disease, emphysema, and chronic blood clots in the lungs. Symptoms of pulmonary hypertension include shortness of breath and fatigue.

Rheumatic heart disease is a complication of rheumatic fever. Rheumatic fever can develop after a sore throat caused by streptococcal bacteria. The infection can cause damage to the heart valves.

Valvular heart disease. Healthy heart valve leaflets can fully open and close the valve during the heartbeat, but diseased valves might not fully open and close. If the heart valves are diseased, the heart can’t effectively pump blood throughout the body and must work harder to pump, either while the blood is leaking back into the chamber or against a narrowed opening. This can lead to heart failure, sudden cardiac arrest (when the heart stops beating), heart palpitations (rapid, fluttering, or pounding), shortness of breath, or swelling in your legs and feet.

By living a healthy lifestyle, you can help keep your blood pressure, cholesterol, and blood sugar levels normal and lower your risk for heart disease and heart attack.

Choose Healthy Habits

You can choose healthy habits to help prevent heart disease.

Choose Healthy Foods and Drinks

Choose healthy meals and snacks to help prevent heart disease and its complications. Be sure to eat plenty of fresh fruits and vegetables and fewer processed foods.

• Eating lots of foods high in saturated fat and trans fat may contribute to heart disease.
• Eating foods high in fiber and low in saturated fats, trans fat, and cholesterol can help prevent high cholesterol.
  • Limiting salt (sodium) in your diet can also lower your blood pressure.
  • Limiting sugar in your diet can lower your blood sugar level to prevent or help control diabetes.
• Do not drink too much alcohol, which can raise your blood pressure. Men should have no more than 2 drinks per day, and women no more than 1 drink per day.

Keep a Healthy Weight

People with overweight or obesity have a higher risk for heart disease. Carrying extra weight can put extra stress on the heart and blood vessels.

Get Regular Physical Activity

Physical activity can help you maintain a healthy weight and lower your blood pressure, blood cholesterol, and blood sugar levels. For adults, the Surgeon General recommends 2 hours and 30 minutes of moderate-intensity exercise, like brisk walking or bicycling, every week. Children and adolescents should get 1 hour of physical activity every day.

Don’t Smoke

Cigarette smoking greatly increases your risk for heart disease. If you don’t smoke, don’t start. If you do smoke, quitting will lower your risk for heart disease. Your doctor can suggest ways to help you quit.

Take Charge of Your Medical Conditions

If you have high cholesterol, high blood pressure, or diabetes, you can take steps to lower your risk for heart disease.

Check Your Cholesterol

Your health care team should test your blood levels of cholesterol at least once every 4 to 6 years. If you have already been diagnosed with high cholesterol or have a family history of the condition, you may need to have your cholesterol checked more often. Talk with your health care team about this simple blood test. If you have high cholesterol, medicines and lifestyle changes can help reduce your risk for heart disease.

Control Your Blood Pressure

High blood pressure usually has no symptoms, so have it checked on a regular basis. Your health care team should measure your blood pressure at least once every 2 years if you have never had high blood pressure or other risk factors for heart disease.

If you have been diagnosed with high blood pressure, also called hypertension, your health care team will measure your blood pressure more often to make sure you have the condition under control. Talk with your health care team about how often you should check your blood pressure. You can check it at a doctor’s office, at a pharmacy, or at home.

If you have high blood pressure, your health care team might recommend some changes in your lifestyle, such as lowering the sodium in your diet; your doctor may also prescribe medicine to help lower your blood pressure.

Manage Your Diabetes

If you have diabetes, monitor your blood sugar levels carefully. Talk with your health care team about treatment options. Your doctor may recommend certain lifestyle changes to help keep your blood sugar under control. These actions will help reduce your risk for heart disease.

Take Your Medicines as Directed

If you take medicine to treat high blood cholesterol, high blood pressure, or diabetes, follow your doctor’s instructions carefully. Always ask questions if you don’t understand something. Never stop taking your medicine without first talking to your doctor, nurse, or pharmacist.

Work with Your Health Care Team

You and your health care team can work together to prevent or treat the medical conditions that lead to heart disease. Discuss your treatment plan regularly, and bring a list of questions to your appointments.

If you’ve already had a heart attack, your health care team will work with you to prevent another one. Your treatment plan may include medicines or surgery and lifestyle changes to reduce your risk. Be sure to take your medicines as directed and follow your doctor’s instructions.