cardiovascular disease#Prevention

File:Inflammatory heart diseases world map - DALY - WHO2004.svg for inflammatory heart diseases per 100,000 inhabitants in 2004{{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 }}{{Div col|small=yes|colwidth=10em}}

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There are many cardiovascular diseases involving the blood vessels. They are known as vascular diseases.{{Cite web |title=Vascular Diseases: MedlinePlus |url=https://www.nlm.nih.gov/medlineplus/vasculardiseases.html |access-date=2015-06-23 |website=www.nlm.nih.gov}}

• 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 valves.
• 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 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.

There are many risk factors for heart diseases: age, sex, tobacco use, physical inactivity, non-alcoholic fatty liver disease, excessive 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.{{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 }}{{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 }}{{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 }}{{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 }} 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.{{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 }} 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).{{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 }} People with obesity are at increased risk of atherosclerosis of the coronary arteries.{{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 }}

Cardiovascular disease in a person's parents increases their risk by ~3 fold,{{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}} 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.{{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}} There are more than 40 inherited cardiovascular disease that can be traced to a single disease-causing DNA variant, although these conditions are rare. 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.{{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}}{{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}}

File:Calcified Heart.jpg

Age is the most important risk factor in developing cardiovascular or heart diseases, with approximately a tripling of risk with each decade of life.{{cite journal |vauthors=Finegold JA, Asaria P, Francis DP |title=Mortality from ischaemic heart disease by country, region, and age: statistics from World Health Organisation and 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 }} Coronary fatty streaks can begin to form in adolescence.{{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 |pages=912047 |date=2015 |pmid=25663838 |pmc=4309297 |doi=10.1155/2015/912047 |doi-access=free }} It is estimated that 82 percent of people who die of coronary heart disease are 65 and older."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 Simultaneously, the risk of stroke doubles every decade after age 55.{{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}}

Multiple explanations are proposed to explain why age increases the risk of cardiovascular/heart diseases. One of them relates to serum cholesterol level.{{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 }} 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.

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.{{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 }}

{{see also|Cardiovascular disease in women}}

Men are at greater risk of heart disease than pre-menopausal women.{{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 }} Once past menopause, it has been argued that a woman's risk is similar to a man's although more recent data from the WHO and UN disputes this. If a female has diabetes, she is more likely to develop heart disease than a male with diabetes.{{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}} 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.{{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 }}{{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 }}

Coronary heart diseases are 2 to 5 times more common among middle-aged men than women. 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.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. Another study reports similar results finding that sex differences explains nearly half the risk associated with cardiovascular diseases One of the proposed explanations for sex differences in cardiovascular diseases is hormonal difference. 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. The production of estrogen decreases after menopause, and this may change the female lipid metabolism toward a more atherogenic form by decreasing the HDL cholesterol level while increasing LDL and total cholesterol levels.

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

Cigarettes are the major form of smoked tobacco. Risks to health from tobacco use result not only from direct consumption of tobacco, but also from exposure to second-hand smoke. Approximately 10% of cardiovascular disease is attributed to smoking; however, people who quit smoking by age 30 have almost as low a risk of death as never smokers.{{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 | pages = 1519 | date = June 2004 | pmid = 15213107 | pmc = 437139 | doi = 10.1136/bmj.38142.554479.AE }}

{{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. In 2008, 31.3% of adults aged 15 or older (28.2% men and 34.4% women) were insufficiently physically active.

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).{{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}} 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.

{{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. Frequent consumption of high-energy foods, such as processed foods that are high in fats and sugars, promotes obesity and may increase cardiovascular risk. The amount of dietary salt consumed may also be an important determinant of blood pressure levels and overall cardiovascular risk. There is moderate quality evidence that reducing saturated fat intake for at least two years reduces the risk of cardiovascular disease.{{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 | pages = CD011737 | date = August 2020 | issue = 8 | pmid = 32827219 | pmc = 8092457 | doi = 10.1002/14651858.CD011737.pub3}} High trans-fat intake has adverse effects on blood lipids and circulating inflammatory markers,{{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 }} and elimination of trans-fat from diets has been widely advocated.{{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 }}{{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}} In 2018 the World Health Organization estimated that trans fats were the cause of more than half a million deaths per year. There is evidence that higher consumption of sugar is associated with higher blood pressure and unfavorable blood lipids,{{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 }} and sugar intake also increases the risk of diabetes mellitus.{{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}} High consumption of processed meats is associated with an increased risk of cardiovascular disease, possibly in part due to increased dietary salt intake.{{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 }}

{{further|Alcohol and cardiovascular disease}}

The relationship between alcohol consumption and cardiovascular disease is complex, and may depend on the amount of alcohol consumed.{{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 }} There is a direct relationship between high levels of drinking alcohol and cardiovascular disease. Drinking at low levels without episodes of heavy drinking may be associated with a reduced risk of cardiovascular disease,{{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 }} but there is evidence that associations between moderate alcohol consumption and protection from stroke are non-causal.{{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 }} 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.{{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}} 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.{{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}}

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.

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.{{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 }}{{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 }}

Sleep disorders such as sleep-disordered breathing and insomnia, are also associated with a higher cardiometabolic risk.{{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 }}

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.{{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 }}

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.{{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}}

Cardiovascular disease has a greater impact on low- and middle-income countries compared to those with higher income.{{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 }} Although data on the social patterns of cardiovascular disease in low- and middle-income countries is limited, reports from high-income countries consistently demonstrate that low educational status or income are associated with a greater risk of cardiovascular disease.{{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}} Policies that have resulted in increased socio-economic inequalities have been associated with greater subsequent socio-economic differences in cardiovascular disease 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.{{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 }} 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.{{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}}

Particulate matter has been studied for its short- and long-term exposure effects on cardiovascular disease. Currently, airborne particles under 2.5 micrometers in diameter (PM_2.5) 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/m³ of PM_2.5 resulted in a 48% increase of CVD mortality risk. 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/m³ of PM_2.5.{{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 }} Other research has implicated PM_2.5 in irregular heart rhythm, reduced heart rate variability (decreased vagal tone), and most notably heart failure.{{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 }} PM_2.5 is also linked to carotid artery thickening and increased risk of acute myocardial infarction.

Existing cardiovascular disease or a previous cardiovascular event, such as a heart attack or stroke, is the strongest predictor of a future cardiovascular event.{{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 }} 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.{{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}} These measures, and sometimes others, may be combined into composite risk scores to estimate an individual's future risk of cardiovascular disease. Numerous risk scores exist although their respective merits are debated.{{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 | pages = e106455 | year = 2014 | pmid = 25271417 | pmc = 4182667 | doi = 10.1371/journal.pone.0106455 | bibcode = 2014PLoSO...9j6455V | doi-access = free }} {{open access}} 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.{{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 }}{{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 | pages = 115 | date = August 2014 | pmid = 25154373 | pmc = 4283079 | doi = 10.1186/1741-7015-12-115 | doi-access = free }} {{open access}} High blood phosphorus is also linked to an increased risk.{{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 }}

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.{{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 }} Moreover, posttraumatic stress disorder is independently associated with increased risk for incident coronary heart disease, even after adjusting for depression and other covariates.{{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 }}

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%.{{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}}

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.{{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}}

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.

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.{{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}}

{{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.{{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}}

A 2015 SBU-report looking at non-chemical factors found an association for those:

• with mentally stressful work with a lack of control over their working situation — with an effort-reward imbalance
• who experience low social support at work; who experience injustice or experience insufficient opportunities for personal development; or those who experience job insecurity
• those who work night schedules; or have long working weeks
• those who are exposed to noise

Specifically the risk of stroke was also increased by exposure to ionizing radiation. Hypertension develops more often in those who experience job strain and who have shift-work. Differences between women and men in risk are small, however men risk having and dying of heart attacks or stroke twice as often as women during working life.{{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}}

A 2017 SBU report found evidence that workplace exposure to silica dust, engine exhaust or welding fumes is associated with heart disease.{{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|url-status=dead|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}} Associations also exist for exposure to arsenic, benzopyrenes, lead, dynamite, carbon disulphide, carbon monoxide, metalworking fluids and occupational exposure to tobacco smoke. Working with the electrolytic production of aluminium or the production of paper when the sulphate pulping process is used is associated with heart disease. An association was also found between heart disease and exposure to compounds which are no longer permitted in certain work environments, such as phenoxy acids containing TCDD(dioxin) or asbestos.

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.

As of 2017, evidence suggests that certain leukemia-associated mutations in blood cells 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.{{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 }}

Radiation treatments (RT) for cancer can increase the risk of heart disease and death, as observed in breast cancer therapy.{{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 }} Therapeutic radiation increases the risk of a subsequent heart attack or stroke by 1.5 to 4 times;{{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 }} the increase depends on the dose strength, volume, and location. Use of concomitant chemotherapy, e.g. anthracyclines, is an aggravating risk factor. The occurrence rate of RT induced cardiovascular disease is estimated between 10% and 30%.{{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}}

Side-effects from radiation therapy for cardiovascular diseases have been termed radiation-induced heart disease or radiation-induced cardiovascular disease.{{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 }}{{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 |pages=e021686 |date=September 2021 |pmid=34482706 |pmc=8649542 |doi=10.1161/JAHA.121.021686 |url=}} 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 cell damage and oxidative stress can lead to these and other late side-effect symptoms.

File:Cardiovascular calcification - Sergio Bertazzo.tif

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.{{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 }}

Obesity and diabetes mellitus are linked to cardiovascular disease,{{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 }} as are a history of chronic kidney disease and hypercholesterolaemia.{{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 |url-status=dead |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 }} 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.{{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 }}{{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 }}{{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 }}

Screening ECGs (either at rest or with exercise) are not recommended in those without symptoms who are at low risk.{{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 }} This includes those who are young without risk factors.{{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 }} In those at higher risk the evidence for screening with ECGs is inconclusive.{{cite journal | 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 }} Additionally echocardiography, myocardial perfusion imaging, and cardiac stress testing is not recommended in those at low risk who do not have symptoms.{{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 }} Some biomarkers may add to conventional cardiovascular risk factors in predicting the risk of future cardiovascular disease; however, the value of some biomarkers is questionable.{{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 }}{{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 }} 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.{{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 }}

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.{{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 }} It is hoped that early testing will improve lifestyle factors in those at risk such as diet and exercise.{{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 }}

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).{{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}} 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.{{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 | pages = i2416 | date = May 2016 | pmid = 27184143 | pmc = 4868251 | doi = 10.1136/bmj.i2416|author6-link= Ioanna Tzoulaki }} 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. 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.

Up to 90% of cardiovascular disease may be preventable if established risk factors are avoided.{{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 }} Currently practised measures to prevent cardiovascular disease include:

• Maintaining a healthy diet, such as the Mediterranean diet, a vegetarian, vegan or another plant-based diet.{{cite web|date=28 November 2019|title=Heart Attack—Prevention|url=https://www.nhs.uk/conditions/heart-attack/prevention/|publisher=NHS Direct}}{{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|pages=756810|doi=10.3389/fcvm.2021.756810|issn=2297-055X|pmc=8604150|pmid=34805312|doi-access=free}}{{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|pages=3952|doi=10.3390/nu13113952|issn=2072-6643|pmc=8624676|pmid=34836208|doi-access=free}}{{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|pages=e0209086|bibcode=2018PLoSO..1309086B|doi=10.1371/journal.pone.0209086|issn=1932-6203|pmc=6301673|pmid=30571724|doi-access=free}}
• 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.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

• Decrease body fat if overweight or obese.{{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}} The effect of weight loss is often difficult to distinguish from dietary change, and evidence on weight reducing diets is limited.{{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|pages=CD008274|doi=10.1002/14651858.CD008274.pub4|pmc=8093137|pmid=33555049}} In observational studies of people with severe obesity, weight loss following bariatric surgery is associated with a 46% reduction in cardiovascular risk.{{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}}
• Limit alcohol consumption to the recommended daily limits. People who moderately consume alcoholic drinks have a 25–30% lower risk of cardiovascular disease.{{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}}{{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}} However, people who are genetically predisposed to consume less alcohol have lower rates of cardiovascular disease{{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|pages=g4164|doi=10.1136/bmj.g4164|pmc=4091648|pmid=25011450}} suggesting that alcohol itself may not be protective. Excessive alcohol intake increases the risk of cardiovascular disease{{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}} and consumption of alcohol is associated with increased risk of a cardiovascular event in the day following consumption.
• Decrease non-HDL cholesterol.{{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}}{{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}} Statin treatment reduces cardiovascular mortality by about 31%.{{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}}
• Stopping smoking and avoidance of second-hand smoke. Stopping smoking reduces risk by about 35%.{{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 | pages = 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}}
• At least 150 minutes (2 hours and 30 minutes) of moderate exercise per week.{{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}}{{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}}
• Lower blood pressure, if elevated. A 10 mmHg reduction in blood pressure reduces risk by about 20%.{{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 }} Lowering blood pressure appears to be effective even at normal blood pressure ranges.{{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}}{{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}}{{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 }} 50px Available under [https://creativecommons.org/licenses/by/4.0/ CC BY 4.0].
• 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.U.S. National Library of Medicine. (2021, March 24). Heart Disease Prevention. MedlinePlus. https://medlineplus.gov/howtopreventheartdisease.html.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.

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.{{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 | pages = 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 }}

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.{{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 | pages = CD006887 | date = March 2017 | issue = 6 | pmid = 28290160 | pmc = 6464686 | doi = 10.1002/14651858.CD006887.pub4 }} 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.{{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 |pages=CD009197 |doi=10.1002/14651858.CD009197.pub5 |issn=1469-493X |pmc=9531722 |pmid=36194420}} 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.{{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 |pages=106595 |doi=10.1016/j.envint.2021.106595 |issn=0160-4120|doi-access=free |pmid=34011457 |pmc=8204267 |bibcode=2021EnInt.15406595P }}

Decrease psychosocial stress.{{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}} This measure may be complicated by imprecise definitions of what constitute psychosocial interventions.{{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}} Mental stress–induced myocardial ischemia is associated with an increased risk of heart problems in those with previous heart disease.{{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}} Severe emotional and physical stress leads to a form of heart dysfunction known as Takotsubo syndrome in some people.{{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}} Specific relaxation therapies are of unclear benefit.{{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}}{{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}} 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.{{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}} Psychosocial intervention programs have been shown to improve risk of developing cardiovascular disease in the high-risk population.{{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 }}

{{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.{{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|pages=g4490|doi=10.1136/bmj.g4490|pmc=4115152|pmid=25073782}}

A 2021 review found that plant-based diets 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. 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". A 2018 meta-analysis of observational studies concluded that "In most countries, a vegan diet is associated with a more favourable cardio-metabolic profile compared to an omnivorous diet."

Evidence suggests that the Mediterranean diet may improve cardiovascular outcomes.{{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}} 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).{{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|url-status=live|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}}

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,{{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 }} lower total and low density lipoprotein cholesterol{{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 }} and improve metabolic syndrome;{{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 }} but the long-term benefits have been questioned.{{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 }} A high-fiber diet is associated with lower risks of cardiovascular disease.{{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 }}

Worldwide, dietary guidelines recommend a reduction in saturated fat,{{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 | pages = e8707 | date = February 2013 | pmid = 23386268 | pmc = 4688426 | doi = 10.1136/bmj.e8707 }} 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.{{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 = }} Total fat intake has not been found to be associated with cardiovascular risk.{{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}}{{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 }} A 2020 systematic review found moderate quality evidence that reducing saturated fat intake for at least 2 years caused a reduction in cardiovascular events.{{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 |pages=CD011737 |doi=10.1002/14651858.CD011737.pub3 |doi-access=free|pmid=32827219 |pmc=8092457 |issn=1469-493X}} A 2015 meta-analysis of observational studies however did not find a convincing association between saturated fat intake and cardiovascular disease.{{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 | issue = h3978 | pages = h3978 | date = August 2015 | pmid = 26268692 | pmc = 4532752 | doi = 10.1136/bmj.h3978 }} Variation in what is used as a substitute for saturated fat may explain some differences in findings. The benefit from replacement with polyunsaturated fats appears greatest,{{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 }} while replacement of saturated fats with carbohydrates does not appear to have a beneficial effect. A diet high in trans fatty acids is associated with higher rates of cardiovascular disease,{{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 }} 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'.{{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 }} There is conflicting evidence concerning whether dietary supplements of omega-3 fatty acids (a type of polyunsaturated essential fatty acid) added to diet improve cardiovascular risk.{{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 | pages = CD003177 | date = February 2020 | pmid = 32114706 | pmc = 7049091 | doi = 10.1002/14651858.CD003177.pub5 }}{{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 }}

The benefits of recommending a low-salt diet in people with high or normal blood pressure are not clear.{{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 | pages = CD009217 | date = December 2014 | volume = 2014 | pmid = 25519688 | pmc = 6483405 | doi = 10.1002/14651858.CD009217.pub3 }} In those with heart failure, after one study was left out, the rest of the trials show a trend to benefit.{{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 | url-status = dead | archive-date = 2013-12-20 | access-date = 2013-08-23 }}{{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}} 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.{{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}}{{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 }} 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.

Overall, the current body of scientific evidence is uncertain on whether intermittent fasting could prevent cardiovascular disease.{{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 | pages = CD013496 | date = January 2021 | pmid = 33512717 | pmc = 8092432 | doi = 10.1002/14651858.CD013496.pub2 | collaboration = Cochrane Heart Group }} Intermittent fasting may help people lose more weight than regular eating patterns, but was not different from energy restriction diets.

Blood pressure medication reduces cardiovascular disease in people at risk, irrespective of age,{{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 }} the baseline level of cardiovascular risk,{{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 }} or baseline blood pressure.{{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 }} 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.{{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 }} Larger reductions in blood pressure produce larger reductions in risk, and most people with high blood pressure require more than one drug to achieve adequate reduction in blood pressure.{{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 }} 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.{{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 |pages=CD011851 |doi=10.1002/14651858.CD011851.pub3 |issn=1469-493X |pmc=10966941 |pmid=38533994}}

Statins are effective in preventing further cardiovascular disease in people with a history of cardiovascular disease.{{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 }} As the event rate is higher in men than in women, the decrease in events is more easily seen in men than women. 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.{{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 | pages = 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 }} The benefit, however, is small.{{cite journal |title=Statins in primary cardiovascular prevention? |journal=Prescrire International |date=July–August 2018 |volume=27 |issue=195 |pages=183 |url=http://english.prescrire.org/en/81/168/55118/0/NewsDetails.aspx |access-date=4 August 2018}} A United States guideline recommends statins in those who have a 12% or greater risk of cardiovascular disease over the next ten years.{{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 }} 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.{{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 | pages = g4379 | date = July 2014 | pmid = 25038074 | pmc = 4103514 | doi = 10.1136/bmj.g4379 }} Fibrates lower the risk of cardiovascular and coronary events, but there is no evidence to suggest that they reduce all-cause mortality.{{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 | pages = CD009753 | date = November 2016 | issue = 3 | pmid = 27849333 | pmc = 6464497 | doi = 10.1002/14651858.CD009753.pub2 | collaboration = Cochrane Heart Group }}

Anti-diabetic medication may reduce cardiovascular risk in people with Type 2 diabetes, although evidence is not conclusive.{{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 }} 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.{{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 }}

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.{{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 }} In those at very low risk, including those over the age of 70, it is not recommended.{{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}}{{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 }} 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.{{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 }}

The use of vasoactive agents for people with pulmonary hypertension with left heart disease or hypoxemic lung diseases may cause harm and unnecessary expense.{{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}}

Antibiotics for secondary prevention of coronary heart disease

Antibiotics may help patients with coronary disease to reduce the risk of heart attacks and strokes.{{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 | pages = CD003610 | date = February 2021 | pmid = 33704780 | pmc = 8094925 | doi = 10.1002/14651858.CD003610.pub4 | collaboration = Cochrane Heart Group }} However, evidence in 2021 suggests that antibiotics for secondary prevention of coronary heart disease are harmful, with increased mortality and occurrence of stroke; the use of antibiotics is not supported for preventing secondary coronary heart disease.

Exercise-based cardiac rehabilitation following a heart attack reduces the risk of death from cardiovascular disease and leads to less hospitalizations.{{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 |pages=CD001800 |doi=10.1002/14651858.CD001800.pub4 |doi-access=free|pmid=34741536 |pmc=8571912 |issn=1469-493X}} 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.{{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 | pages = CD009387 | date = August 2014 | volume = 2014 | pmid = 25120097 | doi = 10.1002/14651858.CD009387.pub2 | pmc = 6669260 }}

A systematic review estimated that inactivity is responsible for 6% of the burden of disease from coronary heart disease worldwide.{{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 }} 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.{{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 | pages = 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 }} Tentative evidence suggests that home-based exercise programs may be more efficient at improving exercise adherence.{{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 | pages = CD004017 | date = January 2005 | volume = 2005 | pmid = 15674925 | pmc = 6464851 | doi = 10.1002/14651858.cd004017.pub2 }}

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.{{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 | pages = CD011114 | date = March 2017 | issue = 3 | pmid = 28301692 | pmc = 6464316 | doi = 10.1002/14651858.CD011114.pub2 }}{{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 }}{{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 }}{{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 | pages = e004224 | date = July 2018 | pmid = 29991644 | doi = 10.1161/CIRCOUTCOMES.117.004224 | s2cid = 51615818 | doi-access = free }} Mineral supplements have also not been found to be useful.{{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 }} 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.{{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 }}{{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 }} Magnesium supplementation lowers high blood pressure in a dose-dependent manner.{{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 }} Magnesium therapy is recommended for people with ventricular arrhythmia associated with torsades de pointes who present with long QT syndrome, and for the treatment of people with digoxin intoxication-induced arrhythmias.{{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 }} There is no evidence that omega-3 fatty acid supplementation is beneficial.{{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 }} A 2022 review found that some dietary supplements, including micronutrients, may reduce risk factors for cardiovascular disease.{{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 }}

Cardiovascular disease is treatable with initial treatment primarily focused on diet and lifestyle interventions. 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.{{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 | pages = CD005050 | date = May 2015 | volume = 2015 | pmid = 25940444 | doi = 10.1002/14651858.CD005050.pub3 | pmc = 8511741 }}

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. 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. Aspirin, ACE inhibitors, beta-blockers, and statins used together for secondary CVD prevention in the same regions showed single QALY costs of $350.{{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}}

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 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.{{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}}

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.{{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 |pages=CD010315 |doi=10.1002/14651858.CD010315.pub5 |issn=1469-493X |pmc=9673465 |pmid=36398903}}

File:Cardiovascular diseases world map-Deaths per million persons-WHO2012.svg

[[File:Cardiovascular diseases world map - DALY - WHO2004.svg|thumb|upright=1.3|Disability-adjusted life year for cardiovascular diseases per 100,000 inhabitants in 2004{{Div col|small=yes|colwidth=10em}}

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Cardiovascular diseases are the leading cause of death worldwide and in all regions except Africa. 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.{{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 }}

{{See also|Heart-on-a-chip|Vessel-on-a-chip}}

There is evidence that cardiovascular disease existed in pre-history,{{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 }} and research into cardiovascular disease dates from at least the 18th century.{{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}} 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{{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 }} the potential for novel therapeutic interventions,{{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 }} and the genetics of coronary heart disease.{{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 }}

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{{Reflist}}

• [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