Senior Medical Advisor · Last reviewed January 2025
Cardiovascular disease — encompassing coronary artery disease (CAD), heart failure, stroke, and peripheral arterial disease — remains the leading cause of death in the United States. According to the AHA's 2023 Heart Disease and Stroke Statistics, approximately 128 million Americans have some form of cardiovascular disease. The mortality toll is enormous: cardiovascular disease causes approximately one in every three deaths in the US.
Coronary Artery Disease
CAD results from the accumulation of atherosclerotic plaques in the coronary arteries, reducing blood flow to the myocardium. Clinical presentations range from stable angina (chest pain with exertion) to acute coronary syndrome (unstable angina and myocardial infarction). CAD is driven by modifiable risk factors — hypertension, hyperlipidemia, diabetes, smoking, obesity, and physical inactivity — alongside non-modifiable factors including age, sex, and family history.
Risk Factor Management
Primary prevention targets modifiable cardiovascular risk factors: statin therapy is recommended for most adults aged 40–75 with elevated 10-year ASCVD risk; blood pressure control to below 130/80 mmHg; smoking cessation (the single most effective cardiovascular risk reduction intervention); diabetes management; weight management; and physical activity (150 minutes/week of moderate-intensity aerobic activity). Aspirin for primary prevention is now generally not recommended for most individuals due to bleeding risks outweighing benefits in the absence of established CVD.
Heart Failure
Heart failure affects approximately 6.2 million Americans and is one of the leading causes of hospitalization. The cornerstone pharmacotherapy for heart failure with reduced ejection fraction (HFrEF) has evolved substantially — current guideline-directed medical therapy includes ACE inhibitors or ARBs (or ARNI with sacubitril-valsartan), beta-blockers, mineralocorticoid receptor antagonists, and SGLT-2 inhibitors, which together reduce mortality by approximately 50–60% compared to no treatment.
Depression and Heart Disease
Depression affects approximately 20–30% of individuals with coronary artery disease and is an independent risk factor for adverse cardiovascular outcomes — myocardial infarction, rehospitalization, and mortality. The mechanisms are both behavioral (reduced adherence to medications and lifestyle recommendations, physical inactivity) and physiological (HPA axis activation, platelet hyperreactivity, endothelial dysfunction, inflammatory cytokines). Screening for and treating depression in cardiac patients is an important component of comprehensive cardiac care.
Cardiac Rehabilitation
Cardiac rehabilitation — supervised exercise training, cardiovascular risk factor education, and psychosocial support — is one of the most evidence-based interventions in cardiology, associated with 20–30% reductions in cardiovascular mortality. Despite this evidence, it remains significantly underutilized, with only 20–30% of eligible patients completing a program.
Related: Hypertension · Diabetes · Preventive Care