Heart disease is the leading cause of death in the United States and according to the Centers for Disease Control and Prevention, “One person dies every 34 seconds in the United States from cardiovascular disease. About 697,000 people in the United States died from heart disease in 2020—that’s 1 in every 5 deaths. Heart disease cost the United States about $229 billion each year from 2017 to 2018.3 This includes the cost of healthcare services, medicines, and lost productivity due to death.”

In addition, every 40 seconds someone in the U.S. has a heart attack, the CDC states. Those numbers are alarming, but heart disease is actually really avoidable by practicing healthy lifestyle choices. Cleveland Center says, “Ninety percent of the nearly 18 million heart disease cases worldwide could be prevented by people adopting a healthier diet, doing regular exercise, and not smoking.”

While prevention is a life-saver, so is knowing the signs. Most people recognize the common symptoms of heart disease such as chest pain, chest tightness and shortness of breath, but there’s sneaky signs to be aware of.  Eat This, Not That! Health spoke with experts who share what to know about America’s leading killer and hidden symptoms to be aware of. Read on—and to ensure your health and the health of others, don’t miss these Sure Signs You’ve Already Had COVID.

Dr. Majid Basit, cardiologist, Memorial Hermann in Houston, Texas explains, “Heart disease starts early in life as a small fatty deposit which grows over many years. A diet rich in cholesterol and saturated fat feeds not only deposits in the heart but also in other blood vessels throughout our bodies. Some other factors like diabetes, smoking and kidney disease will accelerate the growth of these deposits. Eventually, the deposits lead to blockages limiting the flow of blood to the heart and other vital organs.  This causes symptoms like chest pain and shortness of breath. Sometimes, the blockages will rupture leading to fat and cholesterol erupting into the bloodstream. 

Think of it like a volcano, slowly growing due to small eruptions. One day, the volcano erupts much more forcefully leading to death and destruction. A large rupture causes our bodies to want to seal the newly created tear which leads to a blood clot being formed. If the blood clot is large enough, the blood vessel can become completely blocked. This is how heart attacks and strokes happen.”

Dr. Basit says, “Think about our diet and activity levels. I like to use the example of a goat herder in Africa. Heart disease is very rare in this population. They eat very little fatty foods like meats and desserts and they are active all day long. Fortunately, heart disease is preventable if we start when we are young with regular exercise and limiting our consumption of excess calories, saturated fat and simple sugars. It is our poor diet and sedentary lifestyle that has helped heart disease become the number one killer.”

Bernadette Boden-Albala, MPH, DrPH, Director and Founding Dean, University of California, Irvine Program in Public Health says, “In some cases, heart disease may be “silent” and not diagnosed until major symptoms or emergencies like heart attack, arrhythmia and heart failure occur. If people are not participating in annual physicals they may not realize they have high blood pressure, cholesterol and triglycerides that are signs of heart disease.”

Dana Ellis Hunnes PhD, MPH, RD is a senior dietitian at UCLA medical center, assistant professor at UCLA Fielding school of public health, and author of RECIPE FOR SURVIVAL adds, “Heart disease is preventable, but it’s also a condition that often takes decades to develop. Most people don’t know that the many years of eating highly processed foods and animal-based foods and the inflammation these all cause in the body is sight-unseen. Also, we need to eat, it’s a fact of life; often what we WANT to eat takes priority over what is good for our health.”

According to Dr. Basit, “Heart disease does not always cause typical chest pain and shortness of breath. You may also have fatigue, dizziness, and sweating. Some patients report upper back, arm or jaw pain. Women, diabetics, and the elderly are more likely to present with somewhat atypical symptoms of heart disease. It is important to seek medical help right away. Even a few minutes can make a difference. A heart attack causes heart muscle death and can lead to heart failure.”

Joyce Oen-Hsiao, MD, a Yale Medicine Cardiologist adds, “Subtle signs of heart disease include headaches, shortness of breath, swelling of the legs. These should not be ignored because if we can treat and catch the issues early, usually we can prevent damage to the heart.” 

Dr. Basit says, “Women have a higher level of estrogen than men. Estrogen tends to decrease the risk of heart disease, at least until menopause. Estrogen helps to make the blood vessels more flexible and decreases their ability to absorb cholesterol and fat. Estrogen also reduces the level of bad cholesterol (LDL).   Once menopause occurs, estrogen levels decrease and heart disease risk increases. Women may have different symptoms of heart attack including fatigue and dizziness. It is important for health care providers to pay particular attention to these symptoms so that a heart attack is not missed.”

Dr. Boden-Albala explains, “Heart disease is the leading cause of death for women in the United States where 1 in every 5 females die from heart disease. Women tend to develop heart disease later in life than men because the difference has been attributed to the loss of estrogen during the menopausal transition. Although some women have no symptoms, others may have angina (dull and heavy or sharp chest pain or discomfort), pain in the neck, jaw, or throat, and pain in the upper abdomen or back.”6254a4d1642c605c54bf1cab17d50f1e

Dr. Basit shares, “They say knowledge is power. It is important to know your health numbers including your blood pressure, blood sugar and cholesterol levels. Most adults should get yearly blood tests and discuss treatment options with their doctor if the numbers are not at goal. It may be as simple as a healthy diet and a vigorous exercise program.  Goals should include smoking cessation, limiting foods rich in saturated fat and cholesterol, and exercising vigorously for 30-45 minutes every day. It is important to create good habits and reward yourself once short-term goals are reached.” 

Dr. Oen-Hsiao emphasizes, “Exercise!  The American Heart Association recommends 150 minutes of moderate intensity exercise every week! If you are a diabetic, get those sugars under control!  The elevated sugars can cause the cholesterol plaque to stick to the heart arteries earlier and faster, leading to increased risk of heart attack. If you smoke, try to quit!  Smoking raises your blood pressure levels at least 10 points for about two hours after each cigarette. In addition, it also increases the plaque that sticks onto the heart arteries.”