Cardiovascular disease (CVD) is a group of disorders affecting the heart and blood vessels. It is the leading cause of death worldwide, and it encompasses several distinct conditions: coronary heart disease (affecting the vessels that supply the heart), cerebrovascular disease (affecting vessels that supply the brain, including stroke), peripheral arterial disease (affecting vessels in the arms and legs), rheumatic heart disease, congenital heart disease, and deep vein thrombosis or pulmonary embolism (blood clots in the veins that can travel to the heart or lungs).
What ties most of these conditions together is a shared underlying process: the gradual buildup of fatty deposits in artery walls, which narrows and stiffens blood vessels over years or decades.
How Arteries Become Damaged
The process behind most cardiovascular disease is called atherosclerosis, and it begins with damage to the inner lining of an artery. This lining, the endothelium, normally keeps blood flowing smoothly, regulates blood vessel tone, and prevents harmful substances from penetrating the artery wall. When the lining is disrupted by factors like high blood pressure, high cholesterol, or smoking, it stops functioning properly.
Once that lining is compromised, LDL cholesterol (the “bad” cholesterol) begins to infiltrate the artery wall and becomes chemically modified. The body treats this as an injury and sends immune cells to clean it up. These immune cells absorb the modified cholesterol and swell into what scientists call “foam cells,” forming a fatty streak beneath the artery surface. This is the earliest visible sign of atherosclerosis, and it can begin as early as adolescence.
Over time, the fatty streak grows. Fibrous tissue and calcium deposits accumulate, creating a hardened plaque that progressively narrows the artery. The artery loses its ability to relax and expand when blood flow demand increases. Plaques tend to form in areas where blood flow is turbulent or slow, like branches and curves in the arterial system, because these spots are especially vulnerable to lining damage. If a plaque ruptures, it can trigger a blood clot that suddenly blocks the artery, cutting off blood supply to the heart (heart attack) or the brain (stroke).
Major Risk Factors
Most cardiovascular disease risk comes from a handful of modifiable factors. High blood pressure is one of the most significant. The American College of Cardiology and American Heart Association define high blood pressure as 130/80 mmHg or above, yet at least 30 million adults in the U.S. who need blood pressure medication are either not prescribed it or not taking it.
High LDL cholesterol drives plaque formation directly. Some people have a genetic condition called familial hypercholesterolemia that causes severely elevated LDL levels (typically 190 mg/dL or higher), making early and aggressive treatment essential. But even moderately elevated cholesterol over many years contributes to disease progression.
The remaining major risk factors include:
- Smoking and tobacco use, which damages artery linings and promotes clotting
- Physical inactivity
- Poor diet, particularly one high in sodium, added sugars, and saturated fat
- High blood sugar and diabetes, which accelerate artery damage
- Obesity
- Kidney dysfunction, which affects blood pressure regulation and fluid balance
Non-modifiable risk factors include older age, family history, genetics, and sex. These don’t cause cardiovascular disease on their own, but they raise the baseline risk that lifestyle and clinical factors build on.
Warning Signs of Heart Attack and Stroke
Cardiovascular disease often progresses silently for years. When it does produce an emergency, recognizing the symptoms quickly can be lifesaving.
A heart attack typically causes uncomfortable pressure, squeezing, fullness, or pain in the chest. Pain can also radiate to one or both arms, the back, neck, jaw, or stomach. Shortness of breath may occur with or without chest discomfort. Other signs include breaking out in a cold sweat, nausea, or lightheadedness. Not everyone experiences the classic crushing chest pain, and symptoms can be subtler, particularly in women.
Stroke symptoms follow a pattern captured by the acronym B.E. F.A.S.T.: sudden loss of balance or coordination, sudden vision changes (blurred or double vision, or vision loss in one or both eyes), face drooping on one side, weakness or numbness in one arm, and slurred or difficult speech. The “T” stands for time: calling emergency services immediately improves outcomes dramatically.
How CVD Affects Women Differently
Cardiovascular disease is sometimes thought of as a condition that primarily affects men, but this is misleading. Stroke is actually more common in women (3.3% prevalence) than men (2.7%). High blood pressure rates in women over 65 exceed those in men, with the highest rates, around 44%, found in Black women.
Women’s hearts and blood vessels tend to be smaller, which makes them more prone to plaque buildup and increases the technical difficulty of procedures like catheterization. Women are also more likely to present with isolated high blood pressure and to experience atypical symptoms during a heart attack, which can lead to delayed diagnosis. Hormonal shifts across a woman’s life, particularly the decline of estrogen after menopause, alter cardiovascular risk in ways that don’t have an equivalent in men. Traditional risk factors like diabetes and smoking may carry different weight in women compared to men, and women are less likely to receive invasive treatments partly because of higher complication rates related to smaller vessel size and more advanced disease at the time of diagnosis.
How CVD Is Diagnosed
If your doctor suspects cardiovascular disease, the first steps are usually straightforward. Blood tests can measure cholesterol levels, blood sugar, and markers of inflammation like C-reactive protein. After a heart attack, specific heart proteins leak into the blood and can be detected through blood testing.
An electrocardiogram (ECG) records the heart’s electrical activity and can identify irregular rhythms, evidence of a prior heart attack, or signs of strain. It takes just a few minutes and is painless. If irregular rhythms are suspected but don’t show up during a brief office visit, you may wear a portable ECG monitor (called a Holter monitor) for a day or more to capture your heart’s activity during normal life.
An echocardiogram uses ultrasound to create moving images of the heart, showing how well valves open and close, how strongly the heart pumps, and whether chambers are enlarged. Stress tests involve walking on a treadmill or riding a stationary bike while your heart is monitored, revealing how the heart responds to exertion and whether exercise triggers symptoms. For people who can’t exercise, medication can mimic the heart’s response to physical activity.
More advanced imaging includes cardiac CT scans, which create detailed cross-sectional images of the heart and coronary arteries, and cardiac MRI, which provides high-resolution images using magnetic fields. Cardiac catheterization involves threading a thin tube through a blood vessel to the heart and can directly identify blockages in the coronary arteries.
Prevention and Lifestyle Management
Because atherosclerosis develops over decades, prevention works best when it starts early and stays consistent. The American Heart Association recommends at least 150 minutes per week of moderate physical activity (like brisk walking) or 75 minutes of vigorous activity, plus muscle-strengthening exercises at least twice a week. This level of activity improves blood pressure, cholesterol levels, blood sugar control, and weight management simultaneously.
Diet recommendations center on whole, minimally processed foods: a wide variety of vegetables and fruits, whole grains rather than refined grains, and healthy protein sources with an emphasis on shifting from meat toward beans, lentils, nuts, fish, and seafood. When you do eat meat, lean and skinless cuts are preferable, and processed meats should be limited. Unsaturated fats from liquid plant oils should replace saturated fats from sources like butter, coconut oil, and fatty meats. Sodium and added sugars, especially from beverages, should be kept low. If you don’t drink alcohol, there’s no cardiovascular reason to start.
For people already diagnosed with cardiovascular disease or at high risk, medications to lower blood pressure and cholesterol are often necessary alongside lifestyle changes. The treatment goal for blood pressure is typically below 130/80 mmHg. For cholesterol, the aim in high-risk individuals is to cut LDL levels by at least 50% and bring them below 70 mg/dL, with even lower targets for those at very high risk. These numbers guide treatment decisions, but the practical takeaway is that both blood pressure and cholesterol respond meaningfully to the combination of medication and sustained lifestyle changes.