Myths and Facts: Heart Disease

HEART DISEASE is the leading cause of death for men, women and people of most racial and ethnic groups, killing one person every 34 seconds.¹ Astonishingly, heart disease claims more lives in the U.S. than all forms of cancer and accidental deaths — the number two and three causes of death — combined.² In 2023, 919,032 people died from heart disease, equivalent to one in every three deaths. It is an expensive disease that cost the U.S. about $417.9 billion from 2020 to 2021, including the cost of healthcare services, medicines and lost productivity due to death.¹

Heart disease can be traced back to Egyptian mummies, some 3,500 years old, that had evidence of cardiovascular disease — specifically coronary artery disease (CAD), also known as atherosclerosis (narrowing of the arteries) in different arteries of the body. When exactly civilization first became aware of CAD is difficult to determine; however, it’s known that Leonardo da Vinci (1452-1519) investigated coronary arteries. But, it wasn’t until the 1900s that there was an increased interest, study and understanding of heart disease. Specifically, in 1915, a group of physicians and social workers formed an organization called the Association for the Prevention and Relief of Heart Disease in New York City. Then, in 1924, multiple heart association groups became the American Heart Association Trusted Source, consisting of doctors concerned about the disease because they knew little about it, and patients had little hope for treatment or a fulfilling life. In the late 1940s and early 1950s, researchers began to understand the causes of heart disease and its relationship to diet. In the 1960s and 1970s, the first treatments, including bypass surgery and balloon angioplasty, were used to help treat heart disease. In the 1980s, stents were used to open narrowed arteries. And, in 2014, the Scripps Research Institute developed a new blood test that is able to predict who is at high risk for the occurrence of a heart attack.³

While heart disease was an uncommon cause of death in the U.S. at the beginning of the 20th century, by mid-century, it had become the most common cause of death due to an increase in the prevalence of coronary atherosclerosis with resultant coronary heart disease, as documented by autopsy studies. The number of deaths peaked in the mid-1960s, and has been declining to the present day.4 Yet, it continues to kill more people in the U.S. than any other cause, according to the American Heart Association’s 2025 Heart Disease and Stroke Statistics Update, due to ongoing increases in high blood pressure, obesity and other major risk factors.²

Unfortunately, many people underestimate their risk of contracting heart disease and delay seeking care, mainly due to the many myths and misconceptions circulating, creating a false sense of security. As such, much more needs to be done to spread awareness about heart disease and to separate myth from fact.

Separating Myth from Fact

Myth: Heart disease is an old person’s disease.

Fact: While age is the most important determinant of cardiovascular health, heart disease affects people of all ages. From 2009 to 2018, the respondentreported prevalence of heart disease decreased in adults aged 55 to 64 and 65 to 74, but remained stable in adults aged 18 to 44, 45 to 54 and 75 and over. In 2019, the prevalence of heart disease increased with age, reported by one percent of adults aged 18 to 44, 3.6 percent of adults aged 45 to 54, 9.0 percent of adults aged 55 to 64, 14.3 percent of adults aged 65 to 74 and 24.2 percent of adults aged 75 and over.⁵

The main reason older adults are more susceptible to heart disease is due to age-related changes like artery stiffening, valve wear and tear, and thickening of the heart muscle.⁶ But, as early as childhood and adolescence, plaque can start building up in the arteries and later lead to clogged arteries. In fact, almost one in two U.S. adults (age 20 and older) has heart disease.⁷ The main risk factors other than age for why heart disease can strike before age 50 include smoking; pregnancy issues such as preeclampsia, gestational diabetes and preterm labor; familial hypercholesterolemia (high cholesterol); race; and depression.⁸

“Heart disease starts basically when we are born,” says Tansel Turgut, MD, a Michigan City interventional cardiologist with Franciscan Physician Network. “Aortic disease, atherosclerosis or heart disease doesn’t start when we’re like 40, 50, 60. It starts at ages like 3, 4, 5. Weight, obesity, diabetes, high blood pressure, unhealthy eating habits and smoking directly affect us starting at a very, very young age, contrary to what we have been thinking for many years, that it starts in the elderly. Heart disease doesn’t check our ID.”⁹

Myth: Heart disease is a man’s disease.

Fact: Just like age, heart disease does affect more men than women, but most people (only about half or 56 percent) in the U.S. don’t realize that heart disease is also the leading cause of death among females. More than 60 million women (44 percent) in the U.S. are living with some form of heart disease, and it affects women of all ages. In 2023, 304,970 women — or about one in every five — died from heart disease.¹⁰

Myth: Heart disease affects all races and people of socioeconomic status equally.

Fact: Unfortunately, this is far from true. According to a 2015 literature review on the current science and evidence of population-level differences in risk factors for heart disease among different racial and ethnic populations in the U.S., heart disease disproportionately affects Black/African Americans. More Asian Americans are likely to contract coronary artery disease earlier in life than other races. And, non-White Hispanics have lower cases of cardiovascular disease than Black and Asian Americans, with White Americans having the lowest cases.¹¹

Why are Blacks and Hispanics more susceptible to heart disease? According to Annapoorna Kini, MD, professor of medicine and cardiology at the Icahn School of Medicine at Mount Sinai, “the prevalence of high blood pressure in African-Americans is the highest in the world. Research suggests AfricanAmericans may carry a gene that makes them more salt-sensitive, increasing the risk of high blood pressure and heart disease. African-Americans are disproportionately affected by obesity. Among non-Hispanic Blacks 20 and older, 63 percent of men and 77 percent of women are overweight or obese. AfricanAmericans are [also] more likely to have diabetes than non-Hispanic Whites.”¹² For Hispanic individuals, recent studies have shown high rates of traditional heart disease risk factors such as obesity, hypertension, diabetes, hyperlipidemia and emerging cardiovascular disease risk factors like hypertensive disorders of pregnancy, psychological stress and occupational exposures.¹³

Myth: A “small” heart attack is no big deal.

Fact: Even a mild heart attack is a big deal. According to the Cleveland Clinic, a “mild heart attack” is a term physicians use to describe heart attacks that only partially block blood flow to the heart — unlike the full-blown variety, which happens when a blood vessel is completely blocked. Mild heart attacks are still major medical emergencies that limit the supply of oxygen-rich blood to the heart muscle, causing damage. But they may affect a smaller portion of the heart — or cause less damage — than a “major” heart attack. Nevertheless, having a heart attack of any kind raises the risk for future cardiac events.¹⁴

Myth: There are obvious signs of heart disease

Fact: The signs of heart disease depend on what type of heart disease it is. And for most types of heart disease, there may be no obvious signs. Following are the different types of heart disease (Figure):¹⁵

• Coronary artery disease (CAD) is a common heart condition that affects the major blood vessels that supply the heart muscle. It is usually caused by a buildup of fats, cholesterol and other substances in and on the artery walls. This buildup of what is called plaque in the arteries is called atherosclerosis, which reduces blood flow to the heart and other parts of the body and can lead to a heart attack, chest pain or a stroke. Symptoms typically include chest pain, chest tightness, chest pressure and chest discomfort, called angina; shortness of breath; pain in the neck, jaw, throat, upper belly or back; and pain, numbness, weakness or coldness in the legs or arms if the blood vessels in those body areas are narrowed. However, an individual may never know if he or she has CAD until a heart attack, angina, a stroke or heart failure occurs.
• Heart valve disease can either be called a stenosis if a heart valve is narrowed, or a regurgitation if a heart valve lets blood flow backward. Symptoms depend on which valve isn’t working right, and may include chest pain, fainting or almost fainting, fatigue, irregular heartbeats, shortness of breath and swollen feet or ankles.
• Disease of the heart muscle, called cardiomyopathy, may not cause any symptoms, but as the condition gets worse, symptoms may include dizziness, lightheadedness and fainting; fatigue; feeling short of breath during activity or at rest; feeling short of breath at night when trying to sleep, or waking up short of breath; rapid, pounding or fluttering heartbeats; and swollen legs, ankles or feet.
• Irregular heartbeats, called arrhythmias, can cause the heart to beat too quickly, too slowly or irregularly. Heart arrhythmia symptoms can include chest pain or discomfort, dizziness, fainting or almost fainting, fluttering in the chest, lightheadedness, racing heartbeat, shortness of breath and slow heartbeat.
• Congenital heart defects, heart conditions a person is born with, are typically noticed soon after birth. Congenital heart defect symptoms in children could include blue or gray skin (depending on skin color, these changes may be easier or harder to see); swelling in the legs, belly area or areas around the eyes; and shortness of breath during feedings, leading to poor weight gain. However, some congenital heart defects may not be found until later in childhood or during adulthood, with symptoms including getting very short of breath during exercise or activity, easily tiring during exercise or activity, and swelling of the hands, ankles or feet.

Myth: Heart disease symptoms are identical for men and women.

Fact: This is perhaps the biggest misconception of all. In fact, heart disease can develop and present in dramatically different ways across the sexes due to a variety of reasons:¹⁶

1. Much like men and women display differences in their anatomy and physiology, they also have differences in their cardiovascular systems. Compared to men, women have smaller hearts and narrower blood vessels.
2. While a heart attack occurs when cholesterol plaque builds up inside the walls of arteries and causes damage in the major blood vessels, men typically develop this plaque buildup in the largest arteries that supply blood to the heart, whereas women are more likely to develop this buildup in the heart’s smallest blood vessels, known as the microvasculature.
3. Men and women experience different symptoms during a heart attack, with men and women typically presenting with chest pain, but women also more likely than men to experience nausea, sweating, vomiting and pain in the neck, jaw, throat, abdomen or back.
4. Women are more likely than men to suffer from diseases that mimic a heart attack such as a coronary spasm that occurs when a blood vessel clamps down and mimics a heart attack, a coronary dissection that occurs when the wall of a blood vessel tears, or broken heart syndrome, which is a chemical heart attack where enzymes in the blood and changes in the heart muscles resemble a heart attack, but there are no blocked arteries like you see in CAD.
5. Men and women may have different risk factors for heart disease. Risk factors for heart disease in women include reproductive history and certain pregnancy conditions, such as preeclampsia and gestational diabetes, which may be powerful predictors of future risk of heart disease.

Research also shows an increase in cardiac events among women approximately 10 years after menopause. Although the exact reasons remain unclear, decreased estrogen can affect cholesterol balance and artery health, increasing the risk of heart disease.¹⁷

Myth: If you have heart disease, it’s best to take it easy.

Fact: Actually, the opposite is true. According to cardiologist Richard T. Lee, MD, co-editor in chief of the Harvard Heart Letter, physical activity helps strengthen the heart muscle, improves blood flow to the brain and internal organs, and improves overall health and well-being. “For the vast majority of people with heart disease, being sedentary is a bad idea. It can lead to blood clots in the legs and a decline in overall physical condition,” says Dr. Lee.¹⁸

When performed regularly, moderateand vigorous-intensity aerobic activity can lower the risk for coronary heart disease. But for those who already have been diagnosed with heart disease, the heart works better with regular aerobic activity. What’s more, physical activity can reduce the risk of a second heart attack in people who already have had heart attacks. But, vigorous aerobic activity may not be safe for people who have heart disease.¹⁹

Studies have shown heart attack survivors who are regularly physically active and make other heart-healthy changes live longer than those who don’t. “We want activity after a heart attack. Very soon, we want them out of bed, we want them walking,” says Dr. Turgut. “We want them as active as possible, and we send them to cardiac rehab. That’s another thing, cardiac rehab decreases deaths actually 25 to 30 percent in the hospitalizations, but only 20 to 30 percent of our patients go to cardiac rehab.”⁹

Myth: Diabetes and high blood pressure won’t cause heart disease if you take medication.

Fact: According to the American Heart Association, “Treating diabetes can help reduce your risk for or delay cardiovascular diseases. But even when blood sugar levels are under control, you’re still at increased risk for heart disease and stroke. That’s because the risk factors that contribute to diabetes onset also make you more likely to develop cardiovascular disease. These overlapping risk factors include high blood pressure, overweight and obesity, physical inactivity and smoking.⁷

Myth: You can lower your risk of heart disease with vitamins and supplements.

Fact: Researchers at Johns Hopkins Medicine say vitamins and supplements don’t protect people from heart disease. After reviewing randomized clinical trials involving hundreds of thousands of subjects, in which some were given vitamins and others a placebo, they found “no evidence of benefits to cardiovascular disease,” says Johns Hopkins physician Edgar R. Miller III, MD, PhD, whose research review on the topic has been published in the Annals of Internal Medicine. “Supplements were ineffective and unnecessary. The bottom line is, we don’t recommend supplements to treat or to prevent cardiovascular disease. The good news is, you don’t have to spend any money on supplements.”

However, they do say that one possible exception is omega-3 or fish oil capsules, which is a type of fatty acid found in fish and marine algae that helps the heart. But patients should be cautioned that consuming too much of certain vitamins can be harmful. For example, too much calcium and vitamin D are associated with an increased risk of cardiovascular disease, Dr. Miller says.

Another concern is that what is on a supplement label isn’t always what is in it. Investigations have shown that too often pills said to contain medicinal herbs are actually full of fillers like powdered rice or even dangerous substances. Some don’t even contain any of the herbs on the labels. “Supplement production is not regulated by the FDA, nor does the industry need to prove health benefits, so they can use vague language like ‘good for heart health’ — but they can’t say ‘will lower blood pressure,’” Dr. Miller adds.²⁰

Myth: If you have smoked for years, you can’t reduce your risk of heart disease by quitting smoking

Fact: Only good comes from quitting smoking. In fact, the benefits of quitting smoking start the minute a person quits, no matter their age, how long they have smoked or how many cigarettes a day they smoked. Heart attack risk drops by 50 percent only one year after quitting. And in 10 years, it will be the same as if that person had never smoked.¹⁸

Myth: People with a family history of heart problems have no way of preventing them.

Fact: There is no question that genetics play a role in the risk for heart disease depending on the number and age of affected first-degree relatives. Many cardiac disorders can be inherited, including arrhythmias, congenital heart disease, cardiomyopathy and high blood cholesterol. Just one genetic variation (mutation) in a single gene can affect the likelihood of developing heart disease. A study that examined 2,302 male and female offspring participants with a parental history of premature cardiovascular disease (fathers younger than 55 years and mothers younger than 65 years) who were analyzed for cardiovascular disease risk found that after eight years of follow-up, cardiovascular disease risk increased 75 percent with a paternal and about 60 percent with a maternal history of premature cardiovascular disease. It also found that cardiovascular disease risk increased about 40 percent in those whose siblings had cardiovascular disease.

Yet, the study authors pointed out that while “unlucky genes can double or triple the risk of heart disease … genes do not act alone — lifestyle, diet and exercise modify the risk of [cardiovascular disease]. These factors are more important than simply having a genetic makeup that predisposes one to heart disease.”²¹

Myth: There are no tests to detect heart disease.

Fact: Multiple tests can detect heart disease:²²

• A routine annual physical can reveal critical risk factors such as high blood pressure, high cholesterol, type 2 diabetes, smoking and family history. If heart disease runs in the family, a person may be asked to undergo a radiologic test that detects calcium in the arteries surrounding the heart.
• Blood tests can be conducted to check for certain heart proteins that slowly leak into the blood after heart damage from a heart attack. For example, a highsensitivity C-reactive protein test checks for a protein linked to inflammation of the arteries. Other blood tests check cholesterol and blood sugar levels.
• A chest X-ray will show the condition of the lungs and if the heart is enlarged.
• An electrocardiogram (ECG or EKG), a test that records the electrical signals in the heart, can tell if the heart is beating too fast or too slow.
• A Holter monitor, a portable ECG device that’s worn for a day or more to record the heart’s activity during daily activities, can detect irregular heartbeats that aren’t found during a regular ECG exam.
• An echocardiogram, which uses sound waves to create detailed images of the heart in motion to show how blood moves through the heart and heart valves, can help determine if a valve is narrowed or leaking.
• Exercise tests or stress tests, which often involve walking on a treadmill or riding a stationary bike while the heart is checked, help reveal how the heart responds to physical activity and whether heart disease symptoms occur during exercise.
• A cardiac catheterization test, which uses a long, thin flexible tube called a catheter that is inserted in a blood vessel (usually in the groin or wrist) and guided to the heart assisted by a dye that helps the arteries show up more clearly on X-ray images, can show blockages in the heart arteries.
• A heart CT scan, also called a cardiac CT scan, and a heart magnetic resonance imaging scan, can collect images of the heart and chest.

Other tests may include a transesophageal echocardiography to assess the function of heart valves, follow heart valve disease and look for blood clots inside the heart; a pharmacologic stress test to determine the cause of chest pain, shortness of breath and weakness;²³ a coronary artery calcium score test to measure the amount of calcium buildup in the coronary arteries;²⁴ among others.

Myth: Diagnosing and treating heart disease are the same for men and women

Fact: Actually, men and women require different diagnostic heart care. For instance, if a heart attack is suspected, both men and women receive a cardiac troponin (cTn) test that measures circulating levels of troponin, a protein released in the blood when a heart attack has damaged heart muscle. If there are higher levels of troponin, there is more heart damage. But the clinical threshold that signals a heart attack may differ across the sexes. “Some women may be having a heart attack but are falling below the level of detection. Providers are only starting to apply sex-specific thresholds for certain diagnostic tests,” says Michelle O’Donoghue, MD, a Mass General Brigham cardiologist.

Another diagnostic test, cardiac catheterization, long considered the gold standard for diagnosing a heart attack, looks for blockages in large arteries. But, since women are more likely than men to experience more plaque buildup in the smallest arteries, this test may not be the most appropriate to diagnose heart disease in women. Instead, a cardiac MRI to look for inflammation of the heart, or intracoronary imaging to look at the inside of blood vessel walls within the heart, may be more appropriate.

The same is true for treatment. Medical providers treat the typical cholesterol plaque buildup in the largest blood vessels of the heart, whereas there is not a great understanding of how to treat plaque in the microvasculature, or inflammation of the heart. As such, more clinicians are approaching treatment decisions with the knowledge that women may benefit from treatments that are different from those used in men, from subtle calibrations in pacemakers to variations on angioplasty.¹⁶

Myth: Angioplasty and stenting, or bypass surgery, can fix a person’s heart.

Fact: While angioplasty and bypass surgery can relieve chest pain (angina) and improve quality of life, they don’t stop the underlying disease, which is atherosclerosis.¹⁸

In fact, National Institutes of Healthfunded studies have found that invasive procedures such as bypass surgery and stenting are no better at reducing the risk for heart attack and death in patients with stable ischemic heart disease than medication and lifestyle changes alone. The studies, the official outcomes of the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA), the largest and one of the most consequential studies of its kind, were designed to settle a decades-old controversy in cardiology.

The ISCHEMIA trial followed more than 5,000 patients with stable heart disease and moderate to severe heart disease for a median of 3.2 years. It compared an initial conservative treatment strategy to an invasive treatment strategy. The conservative treatment strategy involved medications to control blood pressure, cholesterol and angina (chest discomfort caused by inadequate blood to the heart), along with counseling about diet and exercise. The invasive treatment strategy involved medications and counseling, as well as coronary procedures performed soon after patients recorded an abnormal stress test. The trial allowed tests that assess coronary blood flow restriction, called ischemia, to determine who could participate in the study.

“Previous studies have reached similar conclusions as ISCHEMIA, but they were criticized for not including patients who had severe enough disease to benefit from the procedures. ISCHEMIA studied only patients with the most abnormal stress tests,” said Yves Rosenberg, MD, study co-author and chief of the National Heart, Lung, and Blood Institute’s Atherothrombosis and Coronary Artery Disease Branch. “These findings should be applied in the context of careful attention to lifestyle behaviors and guideline-based adherence to medical therapy, and will likely change clinical guidelines and influence clinical practice.”²⁵

Dispelling the Myths Now

Heart disease remains the leading cause of disease globally. But extensive research is ongoing to advance innovative therapeutics and novel diagnostics for prevention and treatment. And, while heart disease is a serious challenge, knowledge about the disease and encouraging healthy habits allow for early intervention, which can prevent serious health events such as heart attack and stroke.