Heart Health & Disease Prevention

People with early heart disease often do not have symptoms, or the symptoms may be barely noticeable. This is one of the reasons why having regular checkups with your doctor is very important. If symptoms do occur because of a more advanced disease, they can vary widely in type and severity for each patient. Some of the more common symptoms are listed below:

• Chest pain or pressure (angina): While classic angina occurs during physical activity and gets better when you rest, other patterns can occur and severe chest pain at rest could represent early signs of a heart attack
• Shortness of breath when active, at rest or while lying flat
• Pain, numbness and/or tingling in the shoulders, arms, neck, jaw or back
• Cold sweats
• Nausea/vomiting
• Palpitations or fluttering in the chest
• Lightheadedness or dizziness
• Confusion
• Tiredness or fatigue
• Swelling in the ankles, feet, legs, stomach and/or neck
• Problems doing your normal activities with reduced ability to exercise or be physically active

While chest pain (pressure or discomfort) is the hallmark of most heart diseases, other symptoms can be more prominent in many patients. In addition, as the underlying disease progresses, chest pain may become less common or less intense. Therefore, you should stay aware of significant changes in how you feel and contact your doctor right away if you experience symptoms that might suggest heart problems.

Heart disease is often caused by atherosclerosis, a condition characterized by the hardening of artery walls and the accumulation of fatty deposits, or plaques, within them. This process typically develops over many years. When it affects the arteries that supply blood to the heart muscle, it is known as coronary atherosclerosis.

The coronary arteries surround the outside of the heart, delivering oxygen and nutrients to the heart muscle. Plaque buildup inside these arteries reduces the space available for normal blood flow, limiting the oxygen supply to the heart. When the heart muscle does not receive enough oxygen and nutrients, it can weaken or even die, leading to a heart attack. If the plaque buildup only partially reduces blood flow, it may cause angina (chest pain or discomfort), signaling worsening blood flow issues. In some cases, for reasons not fully understood, a stable plaque that remained unchanged for years can suddenly rupture, triggering the formation of blood clots at the site. This can result in a sudden and complete blockage of blood flow, which is the most common cause of life-threatening heart attacks.

If a significant portion of the heart muscle is damaged or dies due to inadequate blood flow, the heart’s ability to pump blood to the rest of the body can be greatly reduced. This is one of the leading causes of congestive heart failure.

Heart disease is a major cause of death and disability, limiting activity and eroding the quality of life for millions of people. 

Aging

Individuals aged 65 and older are more likely than younger people to suffer a heart attack, stroke or develop coronary heart disease and heart failure.

Aging can lead to changes in the heart and blood vessels, such as the hardening of the arteries throughout the body, including those supplying the heart. Over time, fatty deposits, or plaque, can build up in the arterial walls. When these issues occur in the heart’s arteries, they can narrow and restrict blood flow, potentially leading to heart attacks. Atherosclerosis can affect all arteries throughout the body, increasing the risk of high blood pressure and stroke. Additionally, if atherosclerosis severely narrows arteries, it can damage vital organs that rely on normal blood flow.

As you age, your heart may not be able to beat as quickly during physical activity or times of stress as it did when you were younger, which could make it harder to tolerate the same level or intensity of physical activity.

High blood pressure

It is also important to have your blood pressure (BP) checked regularly as you age, even if you feel healthy. Aging can change your arteries and lead to hypertension, which often shows no symptoms unless your BP is extremely high. Most people feel fine, but if untreated high blood pressure can result in stroke, and other conditions affecting the heart, eyes, brain and kidneys. Managing high blood pressure can be aided by exercise, dietary changes and reducing salt intake. As you age, medication often becomes necessary, and it’s common to require more than one medication to effectively control your blood pressure.

Other heart conditions

Age can cause other changes to the heart. For example:

• Age-related changes in the heart’s electrical system can lead to arrhythmias - rapid, slowed, or irregular heartbeat - which may necessitate a pacemaker.
• The heart’s valves, which act as one-way doors controlling blood flow between the heart’s chambers, may thicken and stiffen over time. Stiff valves can limit blood flow out of the heart cause or valve leakage. Severe and progressive valve disease can cause significant dysfunction and impair the heart’s ability to maintain normal blood flow.
• The heart chambers may enlarge, and the heart wall may thicken and stiffen with age. In severe cases, this can reduce the amount of blood that a chamber can hold, and the heart may fill more slowly. Long-standing hypertension is the primary cause of heart wall thickening, which can lead to a form of congestive heart failure and increase the risk of a common electrical rhythm disturbance called atrial fibrillation.
• With age, people become more sensitive to salt, potentially raising blood pressure. Additionally, because older veins may not function as efficiently, ankle or foot swelling (edema) can occur.
• Other factors, such as thyroid disease or chemotherapy, more prevalent in the elderly, may also weaken the heart muscle.

The good news is there are things you can do to delay or reduce your risk of developing heart disease as you age. While aging, like genetics and family history, is a “non-controllable” risk factor for heart disease, many other risk factors can be managed or modified at any age. Addressing these factors effectively can offer protection as you get older. 

Your doctor will check your blood pressure and perform basic laboratory blood tests to evaluate your risk of heart disease. These tests typically include assessments of kidney function, blood counts, sugar levels to screen for diabetes and a cholesterol profile. Cholesterol is a type of fatty substance that is the main contributor to developing plaques in your arteries. Your doctor may also measure levels of proteins that indicate inflammation or heart failure.

In addition to blood tests, you will likely have an electrocardiogram (ECG or EKG) to examine the electrical activity in your heart. A chest x-ray, which is easy to perform, can reveal if your heart is enlarged, or if there’s fluid in your lungs—both potential signs of heart failure.  

If a more detailed evaluation of your heart is needed, your cardiologist may order additional tests. The most common is an echocardiogram, a painless test that uses sound waves to visualize your heart in motion, assessing its pumping function and checking for valve or other structural abnormalities. Other tests, such as nuclear stress testing, CT or MRI, can be used to examine all the major structures of your heart and evaluate blood flow in the coronary arteries.  

If one or more of your tests suggest there may be a serious problem, you may need to undergo an invasive procedure such as cardiac catheterization. This involves passing a small catheter from an artery in your arm or leg to your heart, injecting contrast dye, and using X-rays to image the arteries and other major portions of the heart. The pressures within the heart’s chambers can be measured as well. Depending on the findings, treatment with specialized catheters and other equipment may be performed in the same procedure. In some cases, surgery may be the best option to address your heart condition.  

After a thorough evaluation, your cardiologist will recommend the most appropriate testing and treatment strategy for you.  

There are many steps you can take to keep your heart healthy:

• Try to be more physically active. Talk with your doctor about the type of activities that would be best for you. If possible, aim to get at least 150 minutes of physical activity each week. Every day is best. It does not have to be done all at once.
• If you smoke, quit. Smoking is the leading cause of preventable death. Smoking adds to the damage to artery walls and increases the risk of sudden injury to the artery and plaque which can lead to a heart attack. It’s never too late to get some benefit from quitting smoking. Quitting, even in later life, can lower your risk of heart disease, stroke and cancer over time.
• Follow a heart-healthy diet. Stay reasonable with your overall consumption of food and calories. Choose foods and drinks that are low in saturated fats, added sugars and salt. Eat plenty of fruits, vegetables and foods high in fiber, like those made from whole grains. Get more information on healthy eating from NIA. You also can find information on the Dietary Approaches to Stop Hypertension (DASH) eating plan and the U.S. Department of Agriculture’s Food Patterns.
• Keep a healthy weight. Balancing the calories you eat and drink with the calories burned by being physically active helps to maintain a healthy weight. Some ways you can maintain a healthy weight include limiting portion size and being physically active. Learn more about how to maintain a healthy weight from NIA.
• Keep your diabetes, high blood pressure and/or high cholesterol under control. Follow your doctor’s advice to manage these conditions, and take medications as directed. These disorders are 3 of the most important risk factors for developing coronary heart disease.
• Don’t drink a lot of alcohol. Men should not have more than two drinks a day and women only one. One drink is equal to:
  • One 12-ounce can or bottle of regular beer, ale, or wine cooler
  • One 8- or 9-ounce can or bottle of malt liquor
  • One 5-ounce glass of red or white wine
  • One 1.5-ounce shot glass of distilled spirits like gin, rum, tequila, vodka or whiskey
• Manage stress. Learn how to manage stress, relax and cope with problems to improve physical and emotional health. Consider activities such as a stress management program, meditation, physical activity and talking things out with friends or family. To learn more about stress management techniques, visit the National Center for Complementary and Integrative Health.