Abstract Body (Do not enter title and authors here): Background
Heart disease (HD) remains the leading cause of death in the U.S. and globally, with growing prevalence and cost. Complementary health approaches (CHAs) have risen in use over the past two decades. However, limited data exist on CHA use, expectations, and experiences among individuals with HD.

Purpose
To examine associations between HD and CHA usage, expectations of benefit, and experiences of past use.

Methods
We conducted a secondary analysis of a national cross-sectional survey of 3,022 U.S. adults (225 with HD), quota-matched to census demographics. Associations between HD and CHA variables were assessed using Pearson’s Chi-square tests and logistic regression with adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Models controlled for age, sex, race, education, region, insurance, community size, employment, poverty, and BMI.

Results
Approximately 95% of respondents reported using at least one CHA in the past year. HD respondents had similar overall use but significantly higher odds of using several modalities: chiropractic care (aOR=1.74, CI: 1.19–2.54), osteopathic manipulation (aOR=2.57, CI: 1.37–4.83), light/magnetic/electrical stimulation (aOR=2.22, CI: 1.41–3.50), non-conventional devices (aOR=3.17, CI: 1.95–5.15), tai chi (aOR=2.44, CI: 1.44–4.14), naturopathy (aOR=2.63, CI: 1.54–4.49), and herbalist visits (aOR=2.26, CI: 1.37–3.75). HD respondents had lower expectations of CHA benefit overall (aOR=0.70, CI: 0.51–0.96) and across nutritional (p=0.005), physical (p=0.001), combined (p<0.001), and system-based modalities (p=0.001). Both groups reported similar overall favorable experiences, with HD respondents reporting more favorable experiences with herbalists (p=0.03) and less favorable experiences with psychological modalities (aOR=0.55, CI: 0.32–0.95.

Conclusion
People with HD use several specific CHAs more frequently than those without HD and report overall similar positive experiences of CHAs they have used. People with HD report lower overall expectations for untried CHAs. Findings support evidence-informed patient-provider discussions and educational strategies for safe CHA integration in cardiovascular care.

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