Heart disease is the leading cause of death in the United States, killing 695,547 people in 2021. We’ve come a long way in understanding what lowers our risk of succumbing to it. However, many misconceptions continue to abound. No two people have the same risk of heart disease. And not all risk can be eliminated. But greater awareness of what you can control and how to take charge of your heart health can help lower your odds of heart disease. Although clarifying myths is one step, nothing beats talking to your physician and getting screened for heart disease. Following are seven common myths about heart disease — and some much-needed clarifications to set the record straight.
Myth #1: All cholesterol is bad.
“Cholesterol is a fatty molecule necessary for the production of vitamin D and many hormones,” says Barbara Roberts, MD, an associate clinical professor of medicine at Brown University in Providence, Rhode Island. Cholesterol is also used to make bile acids. Bile acids promote fat digestion and form an important component of the sheaths around nerves, she adds.
Made in the liver and other organs, cholesterol is carried in the blood by lipoproteins. Several lipoproteins exist, but you mostly hear about low-density lipoprotein (LDL) and high-density lipoprotein (HDL). LDL can be taken up by arteries, particularly when they are damaged, and contribute to the formation of plaque — a hallmark of atherosclerosis. HDL (“good” cholesterol) can remove cholesterol from arteries and carry it to the liver, where it can be eliminated.
Myth #2: Skinny people can’t have high cholesterol (or heart disease).
Activities associated with thinness (healthy diet, regular exercise) can lower your risk of developing high cholesterol. Total cholesterol above 200 mg/dl is considered borderline high. “But high cholesterol can also be genetic, which means it’s likely to be high no matter what you weigh,” says Tiffany Di Pietro DO, a cardiologist based in Fort Lauderdale, Florida. Unfortunately, she says, diet can’t completely fix this. People genetically inclined toward high cholesterol struggle to adequately absorb cholesterol from their bloodstreams.
Myth #3: Only seniors should worry about heart disease.
Older age is associated with greater risk of heart disease, but youth is no exemption. “Autopsy studies of young people killed in automobile accidents have revealed heart disease signs, like fatty streaks in the inner lining of arteries in children as young as 10,” says Roberts. A Nature Reviews Cardiology paper found that in the past two decades, the number of teens and young adults with cardiovascular disease has increased significantly. Researchers blame high intake (over 25 grams) of added sugars (typically sucrose and high-fructose corn syrup) and physical inactivity among young people, since both are linked to obesity, elevated fat in the blood, high blood pressure, and insulin resistance — all contributors to heart disease.
Myth #4: Exercise is always good for your heart.
Physical activity is usually linked with better heart health and associated factors like healthy blood pressure. However, there is such a thing as doing too much. Increased scarring, abnormal heart rhythms, coronary artery hardening, and abnormally thickened heart valves have been found among some endurance athletes. Fortunately, exercise-related cardiac events are rare. But these findings underscore the importance of pacing yourself.
“If you’ve been a couch potato for years and suddenly engage in strenuous, prolonged physical activity, you might trigger a heart attack,” adds Roberts. Your best bet? Ease into new exercise regimens.
Myth #5: I would know if I had high blood pressure.
“You can have high blood pressure for years without knowing because it doesn’t usually cause symptoms until it damages organs,” says Roberts. Her advice? Get your blood pressure checked regularly and know what increases it. Medications like oral contraceptives and decongestants can raise blood pressure. So too can diets high in sugar, salt, and processed foods, as well as being obese and drinking heavily. Eat more fruit, vegetables, and fiber. Limit alcohol consumption to one drink daily if you’re a woman and two if you’re a man.
Myth #6: Heart attack symptoms are the same in men and women.
When the heart muscle dies due to blocked blood flow, “Women are more likely than men to have no chest pain at all — experiencing shortness of breath, unusual fatigue or severe nausea instead,” Roberts says. Because symptoms often go unrecognized, young women are twice as likely as young men to die of heart attacks.
Myth #7: You shouldn’t have sex after a heart attack.
If you’ve undergone surgery following a heart attack, your body needs time to heal before resuming any activity — including sex. “And if you have uncontrolled heart-failure symptoms — increasing shortness of breath when exercising or at rest — or untreated arrhythmia, see your doctor and avoid sex until these symptoms are stabilized,” says Roberts.
That said, “If you have no additional heart disease symptoms, can pass a stress test without experiencing angina, or have undergone procedures to restore blood flow and received medical clearance, your risk of a heart attack during sex is low,” Roberts says.
A version of this article appeared in our partner magazine, The Complete Guide to Heart Health, in 2019.