A red rope tied into a heart shape

Heart disease often starts quietly, progressing from high blood pressure to clogged coronary arteries with few obvious symptoms. But too often it ends with a bang: a heart attack.

Here’s how to understand each stage of heart disease so that you can work with your doctor to slow its progression or, better yet, even reverse it.

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High blood pressure: Your arteries—flexible and elastic in younger years—harden with age, a problem worsened by too much body weight, not being active enough, and smoking, among other things.

In those circumstances, blood pressure starts to rise, straining your heart to push blood through your vessels with increased force.

Over time, that can damage the vessel walls, creating perfect places for cholesterol in your blood to lodge.

Atherosclerosis: A mix of high cholesterol, high blood pressure, and other risk factors can cause cholesterol to build up into plaque deposits, constraining blood flow to the heart. That’s atherosclerosis, or clogged coronary arteries.

Angina: For some people, the narrowing of the coronary arteries causes chest pain when they exert themselves. That pain is known as angina.

Heart attack: People with angina are almost lucky. Angina is the pain that signals something is wrong before a person has a heart attack.

But most patients don’t have any warnings. Heart attacks usually happen when a plaque ruptures, causing a blood clot to form and block an artery feeding the heart. When a clot blocks blood to the brain, that’s a stroke.

Aortic valve disease: Aging, combined with high blood pressure, diabetes, and other risk factors, can also damage the heart’s valves, or the flaps that open and close to synchronize blood flow through the organ.

That can prevent a valve from fully opening or closing, limiting the flow of blood out of the heart or allowing blood to leak back in. Over time, that can cause chest pain or tightness, shortness of breath, fainting or dizziness, or fatigue.

Heart failure: High blood pressure, atherosclerosis, valve disease, and heart attacks—alone or combined with diabetes, thyroid disorders, and other conditions—can eventually weaken your heart, making it harder for it to pump blood through the body.

That’s called heart failure, and it can lead to shortness of breath, fatigue, and swelling in the legs, neck, and abdomen.

Editor’s Note: This article also appeared in the May 2017 issue of Consumer Reports magazine.