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Heart Disease (Coronary Artery Disease & Heart Failure)

Heart disease is the leading cause of death in the United States. Most of it starts with plaque in the heart’s arteries, which can cause chest pain, a heart attack or, over time, heart failure. Treatment, cardiac rehab and everyday habits help many people live full lives — and heart attack signs always mean calling 911.

Signs of a heart attack — call 911 right away: chest pain or discomfort (often in the center or left side of the chest, lasting more than a few minutes, or going away and coming back); pain or discomfort in one or both arms or shoulders, the back, neck or jaw; shortness of breath; breaking out in a cold sweat; nausea or vomiting; and feeling weak, light-headed or faint (CDC, NHLBI, NHLBI).

Women’s symptoms are often different. Women usually have chest pain too, but are more likely to also have pain in the shoulder, back or arm, shortness of breath, unusual tiredness and weakness, an upset stomach, nausea or vomiting, or anxiety — with or without chest pain (NHLBI, CDC). Heart attacks can also be mild or “silent,” especially in older adults and people with diabetes (NHLBI).

Call 911 even if you’re not sure, and don’t drive yourself or let someone else drive you: an ambulance is the safest way to get there, and treatment can start on the way. If you can’t tell whether chest pain is angina or a heart attack, call 911 (NHLBI).

Signs of a stroke — think B.E. F.A.S.T. and call 911: Balance loss or dizziness; Eye (vision) changes; Face drooping on one side; Arm drifting downward; Speech slurred or strange; Time to call 911. Note the time symptoms started, and don’t drive to the hospital (CDC). A guide to stroke is coming soon.

If you have heart failure, call your provider about new or worsening symptoms: weight gain, ankle swelling or increasing shortness of breath can mean fluid is building up. Ask ahead of time how often to weigh yourself, which weight changes to report, and when to get emergency care instead (NHLBI).

Never wait for a chiropractic, acupuncture or massage appointment — or try an herb — for any of these signs.

What is heart disease?

“Heart disease” is a general term for conditions that affect the heart’s structure and how it works (NHLBI). It is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States. In 2023, 919,032 people died from cardiovascular disease — about 1 in every 3 deaths (CDC).

Coronary artery disease and angina

Coronary artery disease (also called coronary heart disease) is the most common type. Fatty deposits called plaque build up inside the arteries that feed the heart muscle, so they can’t deliver enough oxygen-rich blood; in some people, especially women, the problem is in the heart’s tiny blood vessels instead (NHLBI). About 1 in 20 adults age 20 and older have coronary artery disease (CDC).

Angina — chest pain or discomfort — is its most common symptom (CDC). It can feel like pressure, squeezing, tightness or burning, may spread to the shoulders, arms, neck, jaw or back, and often comes with exertion or stress and eases with rest. All chest pain should be checked by a provider (NHLBI). For many people, the first clue is a heart attack (CDC). Plaque in the legs (peripheral artery disease) can mean plaque in arteries to the heart and brain too (NHLBI) — see our circulation guide. For most people, coronary heart disease is preventable with heart-healthy habits and medicines (NHLBI).

Heart attack

A heart attack happens when blood flow to part of the heart muscle is suddenly blocked; if it isn’t restored quickly, the muscle begins to die. It is not the same as cardiac arrest, when the heart suddenly stops beating, though a heart attack can cause one (NHLBI). About 805,000 people in the U.S. have a heart attack each year, and about 1 in 5 is silent (CDC). Many people survive and live active, full lives (NHLBI).

Heart failure

Heart failure means the heart can’t pump enough blood and oxygen for the body’s needs — it does not mean the heart has stopped. Nearly 6.7 million U.S. adults have it. Common symptoms are shortness of breath during daily activities, trouble breathing when lying down, weight gain with swelling in the feet, legs, ankles or stomach, and feeling tired or weak (CDC). It is most often caused by another condition that damages the heart, such as coronary heart disease or high blood pressure (NHLBI). There is no cure, but treatment can help people live longer, more active lives (NHLBI).

Valve disease, cardiomyopathy and arrhythmias

  • Valve disease: a heart valve leaks, is too narrow or doesn’t open properly. Extreme tiredness is often the first symptom; most valve conditions can be treated with medicine or a procedure to repair or replace the valve (NHLBI).
  • Cardiomyopathy makes the heart muscle thicker, stiffer or larger, which weakens it. It can be inherited or caused by other conditions, and can affect anyone, including young athletes and women around pregnancy (NHLBI).
  • Arrhythmias are problems with the rate or rhythm of the heartbeat. They are treatable, but untreated ones can lead to stroke, heart failure or cardiac arrest (NHLBI). A Rapid Heartbeat guide is coming soon; fainting can also be a heart sign — see our fainting guide.

Risk factors

High blood pressure, high blood cholesterol and smoking are the key risk factors (CDC); the more you have, the higher your risk (NHLBI).

  • Blood pressure and cholesterol can be lowered with habits and, when needed, medicine — see our blood pressure and cholesterol guides.
  • Diabetes doubles the risk for heart disease (CDC) — see our diabetes guide.
  • Smoking raises the risk of heart disease and heart attack, and secondhand smoke raises it even for nonsmokers. Inactivity, an unhealthy diet, obesity and heavy drinking add to it (CDC). Smoking and Weight Control guides are coming soon.
  • Age and family history: risk rises for men from around 45 and for women from around 55, and a father or brother with heart disease before 55, or a mother or sister before 65, raises yours (NHLBI).
  • Other factors include poor sleep and sleep apnea, stress, depression and anxiety, kidney disease and air pollution (NHLBI). A Sleep Apnea guide is coming soon. For women, high blood pressure in pregnancy doubles later heart disease risk (CDC).

How it’s diagnosed

Risk screening starts around age 20: your provider checks blood pressure and weight, orders blood tests for cholesterol and diabetes, and may use a risk calculator (NHLBI). If you have symptoms, tests may include an electrocardiogram (ECG) of the heart’s electrical rhythm; a stress test on a treadmill or bike, or with medicine; an echocardiogram, which uses sound waves to show how the heart pumps and how the valves work; and coronary angiography, which uses dye and X-rays to find blockages (NHLBI, NHLBI). In the emergency room, a troponin blood test looks for a protein that leaks from damaged heart muscle (NHLBI).

When to see a doctor: get any chest pain checked (NHLBI). If you have heart disease, call your provider about new or worsening symptoms (NHLBI). Never stop a heart medicine without first talking to your doctor, nurse or pharmacist (CDC).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Heart-healthy habits for everyone; medicines such as statins, beta-blockers, ACE inhibitors or ARBs, antiplatelets, nitrates and, for heart failure, SGLT2 inhibitors and diuretics; stents, bypass surgery or devices when needed; cardiac rehab after a heart event. Medicare Part B covers cardiac rehab for eligible conditions (20% of the Medicare-approved amount after the deductible). Other costs: being researched. Treatment can relieve symptoms, prevent heart attacks and help people with heart failure live longer, more active lives. Most people take medicines long term; never stop one without your doctor.
Chiropractic No role in treating heart disease. May help back or neck pain once a doctor has ruled out the heart. Cost estimate being researched. Chest, arm, jaw or upper-back pain should never be assumed to be a muscle or joint problem. Neck manipulation carries a rare, debated stroke risk.
Acupuncture Needle treatments added to standard angina medicines in some trials. Cost estimate being researched. A 2019 trial and a 2025 review found fewer angina attacks when acupuncture was added to standard treatment; larger trials are still needed. Never a substitute for emergency care. Blood thinners raise bleeding risk.
Herbal medicine Mostly a question of safety: many herbs interact with heart medicines. Prescription omega-3 (icosapent ethyl) is a medicine, not a supplement; hawthorn and CoQ10 have mixed evidence. Cost estimate being researched. No supplement replaces heart medicines. St. John’s wort, ginkgo, garlic, licorice and red yeast rice can be risky with heart medicines. Show every product to your doctor or pharmacist.
Massage therapy Gentle, relaxing massage for comfort and stress, for people whose heart condition is stable. Cost estimate being researched. Studies after heart surgery found less pain, anxiety and tension. Not a treatment for heart disease. Check with your cardiologist first if you take a blood thinner or had a recent procedure.
MBHA Wellness Coach Life’s Essential 8: heart-healthy eating (DASH or Mediterranean), activity, quitting tobacco, sleep, weight, cholesterol, blood sugar and blood pressure — plus stress, mood, taking medicines and, for heart failure, salt and daily weights. Cost estimate being researched. Supports — never replaces — medical care and cardiac rehab. Small, steady changes add up.

Approach 1 of 6

Conventional medicine (AMA)

Treatment depends on how serious your symptoms are and what other conditions you have, and may combine lifestyle changes, medicines and procedures (NHLBI).

1. Lifestyle first — and always

The American Heart Association measures heart health with Life’s Essential 8: diet, physical activity, nicotine exposure, sleep health (added in 2022), body mass index, blood lipids (cholesterol), blood sugar and blood pressure (AHA presidential advisory, 2022). NHLBI recommends these lifelong changes for people with coronary heart disease too (NHLBI). See the MBHA Wellness Coach section.

2. Medicines

Your provider chooses medicines for your condition; we don’t list doses.

Aspirin only when your clinician advises it. After a heart attack or stroke, your provider may prescribe it to help prevent another (NHLBI). For people without heart disease, the U.S. Preventive Services Task Force (2022) recommends against starting aspirin for prevention at age 60 or older, and calls it an individual decision for some higher-risk adults 40 to 59, because aspirin raises the risk of bleeding in the stomach and brain (USPSTF, 2022).

Take medicines as prescribed and tell your provider about every over-the-counter product and supplement (NHLBI); some medicines and combinations can make heart failure worse (AHA scientific statement, 2016).

3. Procedures and devices

  • Angioplasty and stents (PCI): a balloon opens a narrowed artery and a small mesh tube (stent) is often left to keep it open; in a heart attack it is often done right away (NHLBI). A guide to stents is coming soon.
  • Bypass surgery (CABG) uses healthy blood vessels from elsewhere in the body to route blood around blocked arteries (NHLBI).
  • Devices: an implantable cardioverter defibrillator (ICD) shocks a dangerous rhythm back to normal and can lower the risk of sudden death (NHLBI); a biventricular pacemaker (cardiac resynchronization therapy, CRT) helps both sides of a weak heart pump together (NHLBI).

4. Cardiac rehabilitation

One of the best-supported treatments after a heart event — see Cardiac rehabilitation below, including Medicare coverage.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care has no role in treating heart disease. A 2021 review found no clear benefit of spinal manipulation for conditions outside the muscles and joints, such as high blood pressure (NCCIH).

Check the heart first. Heart pain can spread to the shoulders, arms, neck, jaw or back (NHLBI), and women’s heart attacks often bring shoulder, back or arm pain (NHLBI). Never assume this kind of pain is a muscle or joint problem — have it checked medically first, and call 911 for warning signs.

Safety: neck manipulation has been linked to rare tears in the neck arteries that can cause a stroke, though experts disagree about whether manipulation causes them (NCCIH). As a precaution, MBHA suggests telling your chiropractor about your heart condition and any blood thinner you take.

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture has been studied mainly as an add-on to standard medicines for stable angina.

  • 2019 trial: 404 people in China with chronic stable angina, all on standard angina medicines, had 12 sessions of acupuncture on traditional heart-related points, acupuncture on other points, sham acupuncture, or no acupuncture. At 16 weeks the first group had fewer angina attacks than each of the others (Zhao et al., 2019).
  • 2025 review of 46 trials (3,976 people), all adding acupuncture to angina medicines, ranked acupuncture-based treatments ahead of medicines alone for fewer angina attacks; the authors said larger trials are needed (Kong et al., 2025).

So there is early evidence that acupuncture may reduce angina attacks when added to standard care. It does not open arteries, replace heart medicines or substitute for emergency care.

Safety: relatively few complications have been reported, mostly from non-sterile needles or poor technique (NCCIH). In a Taiwanese study of more than 13 million sessions, anticoagulants such as warfarin raised the risk of bleeding after acupuncture (Hsieh et al., 2023). Tell your acupuncturist about every blood thinner you take.

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

For heart disease, the main issue with herbs and supplements is safety: many interact with heart medicines, and none has been shown to replace them.

Products that can interact or harm

  • St. John’s wort can weaken heart medicines such as digoxin and ivabradine, and the blood thinner warfarin (NCCIH).
  • Ginkgo may raise bleeding risk with anticoagulants such as warfarin, and research suggests it doesn’t help prevent heart disease (NCCIH).
  • Garlic supplements may raise bleeding risk, which matters if you take an anticoagulant or aspirin (NCCIH). Warfarin can also interact with coenzyme Q10, echinacea, ginseng and goldenseal (MedlinePlus).
  • Licorice root can cause an irregular heartbeat and cardiac arrest, and even small amounts have been linked to severe effects in people with high blood pressure or heart conditions (NCCIH).
  • Red yeast rice can contain monacolin K, identical to the statin lovastatin, with the same side effects and drug interactions; some products contain citrinin, which can damage the kidneys (NCCIH). MBHA advises never combining it with a statin unless your prescriber says so.

Fish oil: prescription vs. supplements

Some evidence suggests people with heart disease or high triglycerides may benefit from omega-3s, but prescription omega-3 products differ from supplements in makeup, testing and regulation (NCCIH). In the REDUCE-IT trial, prescription icosapent ethyl lowered heart attacks, strokes and other heart events in people on a statin with high triglycerides, though more were hospitalized for atrial fibrillation (Bhatt et al., 2019). In contrast, the VITAL trial found an ordinary omega-3 supplement did not lower major heart events in about 25,900 older U.S. adults from the general population (Manson et al., 2019).

Hawthorn and CoQ10 for heart failure

  • Hawthorn: a 2008 Cochrane review found better exercise tolerance and fewer symptoms when hawthorn was added to standard treatment, but no useful data on heart attacks or deaths (Cochrane review, 2008). NCCIH calls the evidence conflicting: one study suggested it may have raised the early risk of heart failure worsening, and the FDA has warned that some “tejocote root” products contained toxic yellow oleander (NCCIH).
  • CoQ10: research for heart failure is inconclusive, and it may interact with warfarin (NCCIH). A 2021 Cochrane review found it probably lowers deaths and hospital stays, but the studies had risk of bias and the authors found no convincing evidence to support or refute its use (Cochrane review, 2021).

Never stop or cut back a heart medicine to take a supplement. “Natural” doesn’t always mean safe, and supplements can interact with medicines (NCCIH). Show every product to your doctor or pharmacist. We don’t list doses here.

Approach 5 of 6

Massage therapy

Massage won’t treat heart disease, but it can be relaxing and may ease pain and tension during recovery. In a randomized study of 113 patients after heart surgery, massage reduced pain, anxiety and tension compared with quiet rest (Bauer et al., 2010), and a 2023 analysis of 42 trials found massage may relieve pain after heart surgery (Liu et al., 2023).

Safety: the risk of harm appears low, but rare blood clots, nerve injuries and broken bones have been reported, sometimes with vigorous deep-tissue massage or in older adults (NCCIH). As a precaution, MBHA suggests gentle massage only when your heart condition is stable; telling the therapist about any blood thinner and recent procedure; avoiding pressure on incisions, catheter sites or implanted devices; and checking with your cardiologist first.

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you build heart-healthy habits one at a time — alongside, never instead of, your medical care and cardiac rehab.

Life’s Essential 8

The American Heart Association scores heart health in eight areas: diet, physical activity, nicotine exposure, sleep, body weight, cholesterol, blood sugar and blood pressure (AHA presidential advisory, 2022). A coach can help you pick one to start.

Heart-healthy eating

Eat vegetables, fruits, whole grains, low-fat dairy, fish, lean meats, beans and vegetable oils, and limit sodium, saturated fat, added sugars and alcohol. Your provider may suggest the DASH eating plan, proven to lower blood pressure and LDL cholesterol (NHLBI, NHLBI). In a large Spanish trial of people at high heart risk, a Mediterranean diet with extra-virgin olive oil or nuts led to fewer heart attacks, strokes and heart deaths than a low-fat diet (Estruch et al., 2018). The AHA stresses overall eating patterns, with minimally processed foods and little added sugar or salt (AHA scientific statement, 2021).

Move more

Adults need 150 minutes of moderate-intensity activity a week, plus at least 2 days of muscle-strengthening activity (CDC). With heart disease, ask your provider what level is right for you first (NHLBI).

Quit tobacco

Quitting lowers your risk for heart disease (CDC). Free, confidential coaching is available at 1-800-QUIT-NOW, and counseling plus medicine gives the best chance of quitting for good (CDC). Smoking is also the main risk factor for COPD (NHLBI) — see our emphysema guide.

Sleep and stress

Adults need 7 to 9 hours of sleep; too little raises heart disease risk (NHLBI, NHLBI). Stress can contribute to high blood pressure, and an upsetting event can trigger angina or a heart attack in some people; ask your provider which stress-relief activities are safe for you (NHLBI).

Mood after a heart attack

Depression is common in people with coronary heart disease and is linked to more heart problems. The American Heart Association recommends screening heart patients for depression (AHA science advisory, 2008) and calls it a risk factor for poorer outcomes after a heart attack (AHA scientific statement, 2014). Talk with your care team; counseling or a support group can help (NHLBI). See our depression and anxiety guides.

Medicines and heart failure routines

Never stop a medicine without first talking to your doctor, nurse or pharmacist (CDC); a coach can help with pill organizers and reminders. With heart failure, you may be asked to cut sodium, which can worsen fluid buildup (NHLBI), to drink less liquid and to track symptoms every day (CDC). Ask your provider how often to weigh yourself and which changes to report (NHLBI); a coach can help you keep the log.

Another approach

Heart attack: know the signs

Not every heart attack starts with sudden, crushing chest pain. Symptoms can start slowly, be mild, or come and go over several hours, and a second heart attack may feel different from the first (NHLBI).

  • In women: chest pain is somewhat less likely, and dizziness, extreme tiredness, nausea, stomach pain, or chest pressure or tightness more likely (NHLBI). Women often don’t recognize these signs and delay getting help, which raises their risk of serious problems afterward (NHLBI).
  • Angina or heart attack? Stable angina usually eases within a few minutes of rest or medicine; heart attack pain doesn’t. If you don’t know which it is, call 911 (NHLBI).
  • Every minute matters: never delay calling 911 to take aspirin or try anything else (NHLBI). If someone collapses, bystanders trained in CPR or in using a defibrillator can help until help arrives (CDC).
  • After a heart attack your risk of another is higher (NHLBI); about 200,000 of the yearly U.S. heart attacks happen to people who have had one before (CDC).

What it costs

Cost estimate being researched.

Another approach

Living with heart failure

Heart failure usually means lifelong treatment and often gets worse over time, but following your plan can ease symptoms and lower the chance of a hospital stay (NHLBI).

  • Shortness of breath after routine activities, such as climbing stairs, is often an early sign; older adults may feel tired and confused instead (NHLBI).
  • Take medicines as prescribed and report side effects. Tell your provider and pharmacist about every medicine, since some can worsen heart failure (NHLBI).
  • Follow your salt and fluid limits, and get care for conditions that worsen heart failure, such as diabetes, high blood pressure and sleep apnea (NHLBI).
  • Stay as active as your provider advises; limit alcohol and quit smoking (NHLBI).
  • Keep phone numbers, directions and your medicine list handy. Heart failure can bring fear, anxiety and depression — counseling and support groups help, and palliative or hospice care can make life more comfortable when it is very serious (NHLBI).

What it costs

Medicare covers cardiac rehab for stable chronic heart failure (see below). Other costs: cost estimate being researched.

Another approach

Cardiac rehabilitation

Cardiac rehab is a medically supervised program of exercise training, education about heart-healthy living and counseling to reduce stress, for people recovering from heart problems (NHLBI). The team also helps you manage risk factors such as high blood pressure, high cholesterol, depression and diabetes (MedlinePlus).

Why it matters

  • A 2021 Cochrane review of 85 trials (23,430 people) found exercise-based cardiac rehab reduces heart attacks and hospital stays, likely gives a small reduction in deaths, and over the longer term may reduce deaths from heart disease (Dibben et al., 2021).
  • People who attend 36 sessions have a 47% lower risk of death and a 31% lower risk of heart attack than those who attend only one (Million Hearts).
  • Women, minorities and older people are referred less often, and the strength of the doctor’s recommendation is the biggest predictor of joining (Million Hearts). Ask for a referral before you leave the hospital.

What Medicare covers

Medicare Part B covers regular and intensive cardiac rehab if you have had a heart attack in the last 12 months, bypass surgery, stable angina, a heart valve repair or replacement, angioplasty or a stent, a heart or heart-lung transplant, or stable chronic heart failure (Medicare.gov). A standard program is 36 supervised sessions over 12 weeks, and most insurance plans cover it (NHLBI).

What it costs

  • Medicare: in a doctor’s office, you pay 20% of the Medicare-approved amount after the Part B deductible; in a hospital outpatient setting, you also pay the hospital a copayment (Medicare.gov).
  • Without Medicare: cost estimate being researched.

Member stories

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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