Heart disease is the world’s deadliest killer, and one of the most preventable

Cardiovascular disease causes a third of all deaths

Ischaemic heart disease (caused by narrowed arteries) is the world’s biggest killer, at about 16% of all deaths. Counting strokes and other blood vessel diseases, cardiovascular disease killed about 19.8 million people in 2022.

In the U.S., heart disease has caused about 1 in 5 deaths for decades, more than any other cause in men, women, and most racial and ethnic groups.

Fewer women know heart disease is their top killer

In American Heart Association surveys, the share of U.S. women who knew this fell from 65% in 2009 to 44% in 2019, most steeply among younger women and women of color.

Chest pain is the most common heart attack symptom. Women more often also have shortness of breath, nausea, back or jaw pain, or unusual tiredness, which get dismissed as stress or indigestion.

Plaque builds in your arteries for decades

Most heart attacks and many strokes come from atherosclerosis, plaque buildup inside artery walls.

1. Cholesterol particles that carry a protein called ApoB, mainly LDL, get stuck in the artery wall.
2. Immune cells swallow the trapped cholesterol. Over years, this inflammation forms plaque.
3. High blood pressure, smoking, and high blood sugar damage the artery lining and let more particles in.
4. A plaque cracks, often an inflamed one rather than the biggest. A clot forms and blocks the artery: a heart attack in the heart, a stroke in the brain.

A large U.S. autopsy study found early fatty deposits in the aorta (the main artery) even in 15- to 19-year-olds who died in accidents. A heart attack usually ends a decades-long process.

The European Atherosclerosis Society concluded that LDL directly causes this disease. Risk rises with both how high your LDL is and how many years it stays high.

For most people, habits matter more than genes

The INTERHEART study compared about 15,000 first heart attack patients in 52 countries with similar people without one. In every region, age group, and ethnicity studied, nine changeable risk factors accounted for over 90% of the risk in men and 94% in women:

• Abnormal blood cholesterol
• Smoking
• High blood pressure
• Diabetes
• Abdominal obesity
• Stress and depression
• Eating few fruits and vegetables
• Physical inactivity
• Alcohol use (in this study, regular drinking was linked to slightly lower risk; that isn’t a reason to start drinking)

Six numbers predict your risk

• Blood pressure, which usually rises without symptoms. In a meta-analysis of 1 million adults, each 20 mmHg higher systolic pressure (the top number), starting from 115/75, was linked to about double the risk of heart disease death.
• LDL cholesterol or ApoB, the main drivers of plaque. ApoB counts these particles directly and is increasingly recommended.
• Lipoprotein(a), or Lp(a), a mostly genetic cholesterol particle that diet barely changes. About 1 in 5 people have levels high enough to raise heart attack and stroke risk. The European Atherosclerosis Society recommends testing it at least once in adulthood.
• Blood sugar (HbA1c or fasting glucose). Insulin resistance and diabetes damage blood vessels years before diagnosis.
• Waist size. Belly fat tracks with heart risk more closely than weight does.
• Family history. A parent or sibling with a heart attack or stroke before 55 (men) or 65 (women) raises your risk and may mean screening earlier.

If your risk is unclear, your clinician may suggest a coronary artery calcium (CAC) scan, a quick low-dose CT showing hardened plaque.

Psoriasis and other inflammatory diseases raise heart risk

Inflammation drives plaque. In one large study, 30-year-olds with severe psoriasis had about three times the heart attack risk of peers without it, after accounting for other risk factors. The extra risk shrank with age but remained.

Dermatology guidelines recommend heart and metabolic screening for people with psoriasis. With psoriasis, eczema, lupus, rheumatoid arthritis, or inflammatory bowel disease, ask your clinician to check your heart numbers regularly.

Eight habits lower your risk

The American Heart Association’s “Life’s Essential 8”:

1. Don’t smoke or vape. Heart attack risk drops sharply within 1 to 2 years of quitting.
2. Exercise: 150 minutes a week of moderate activity, plus strength training.
3. Eat mostly vegetables, fruit, legumes, whole grains, nuts, fish, and olive oil. Limit processed meat, salt, and sugary drinks. Soluble fiber from oats, beans, and lentils helps lower LDL.
4. Sleep 7 to 9 hours a night. Short sleep and untreated sleep apnea raise blood pressure.
5. Keep a healthy weight and waist size.
6. Manage cholesterol: food first, then medication if your risk calls for it. Statins and similar drugs have strong evidence for preventing heart attacks in higher-risk people.
7. Manage blood sugar.
8. Manage blood pressure with less salt, more movement, limited alcohol, and medication if needed.

Stress and loneliness are also linked to heart disease.

Heart attack and stroke warning signs

Heart attack:

• Chest pain, pressure, squeezing, or fullness lasting more than a few minutes, or that comes and goes
• Pain or discomfort in one or both arms, the back, neck, jaw, or stomach
• Shortness of breath
• Cold sweat, nausea, or lightheadedness

Stroke (BE FAST): Balance loss, Eyes (vision changes), Face drooping, Arm weakness, Speech difficulty, Time to call 911.

Call 911 right away. Don’t drive yourself or wait to see if it passes.

Start this week

1. Check your blood pressure on two different days, seated and rested.
2. Ask for a lipid panel (cholesterol blood test), and whether ApoB and a one-time Lp(a) test make sense for you.
3. Ask your family about early heart attacks or strokes.
4. Walk 10 minutes after your biggest meal.
5. Swap one salty, processed food for a whole food.

What to track

Track blood pressure, movement minutes, sleep hours, stress (0 to 10), and lab results. Trends tell you more than single readings. A daily check-in keeps these visible.