One in every five women dies from heart disease in the United States, per the Centers for Disease Control and Prevention (CDC). The risk increases with age, but there are ways of treating your heart right in your younger years.
“Heart health choices that you make when you are young will affect your life in later years,” says Joyce Oen-Hsiao, MD, cardiologist at Yale Medicine in Connecticut. “If you start following a healthy, active lifestyle when young, you will be more likely to maintain that healthy and active lifestyle as you get older.”
Prevention is key, says Christine Jellis, MD, cardiologist at Cleveland Clinic in Ohio. “When we think about prevention, it’s all about setting ourselves up for success in the future.” Consider this: 80 percent of heart disease is preventable, according to the American Heart Association (AHA). What can you do to beat the nation’s No. 1 killer? Follow this decade-by-decade guide to keep your heart healthy.
Your 20s and 30s: Lay the Foundation for Good Health
What’s Happening Now
During your prime years, you’re less likely to have artery-clogging cholesterol buildup, thanks to plentiful amounts of estrogen. This powerful hormone helps keep arteries flexible and blood cholesterol levels low, according to the AHA.
Still, if during pregnancy you develop high blood pressure, preeclampsia (pregnancy-induced high blood pressure), or gestational diabetes (pregnancy-related diabetes), or if you give birth preterm (before 37 weeks), then you’re at increased risk for cardiovascular disease, later in life, according to Cleveland Clinic. “Having preeclampsia shows that there is twice the risk of developing heart attack, stroke, or blood clots within 5 to 15 years after pregnancy,” Dr. Oen-Hsiao says.
If you had gestational diabetes, according to the CDC, you have a 50 percent chance of later developing type 2 diabetes, which can also increase the risk of heart attack.
While preeclampsia or other pregnancy complications don’t guarantee heart problems later in life, Dr. Jellis says it’s good to know if you are part of a group that should be more proactive about your heart health.
What to Do Now
See a primary care physician. If you developed high blood pressure, preeclampsia, or gestational diabetes, or gave birth preterm, see a primary care physician after your baby is born (not just an ob-gyn). You may even want to see a cardiologist.
Even if you have never been pregnant, says Jellis, “everyone should have a primary care physician or provider: somone who they check in with on a regular basis, so that they are updated with the latest data and evidence as to what [they] should be doing.”
Eat to beat heart disease. Jellis suggests eating a Mediterranean-style diet, which is loaded with fruits, vegetables, whole grains, lean protein such as fish, and healthy unsaturated fats like olive oil. Since you’ve got time on your side, developing healthy lifelong eating habits in your twenties and thirties can help keep your arteries clear.
Fit in fitness. Try putting in at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise each week, the AHA recommends. They also suggest adding weight training to your fitness routine. “We don’t have to take up powerlifting,” says Jellis, “but there is good data to show that resistence or strength training is important and is something that a woman can integrate early in her life.”
Give up harmful habits. Picking up habits that can do considerable harm to the body, as well as the heart, like cigarette smoking and drinking too much alcohol isn’t worth it. Before it becomes a lifelong habit, quit smoking and keep drinking to a minimum — to no more than one drink a day, the AHA says.
Your 40s: Keep Track of Your Health Metrics
What’s Happening Now
Unless you enter menopause in your forties, your risk of heart disease generally remains low throughout this decade. Still, if you’ve got a family, maybe even parents to look after, and a busy work schedule, it’s easy to let your health slide. It may also be a good idea to ask your family members about their health history. If your family has a history of heart disease, your chances of developing the same are higher, according to the CDC.
Women in their forties must often juggle a lot of responsibilities, says Jellis, but even though you are premenopausal and at a lower risk of cardiovascular disease, you still need to optimize your health and avoid as many risk factors as possible.
What to Do Now
Keep close tabs on your numbers. Get yearly checkups so you can track important numbers, such as blood pressure, fasting blood glucose, body mass index (BMI), and cholesterol. If your LDL “bad” cholesterol, blood pressure, or other risk factors aren’t where they should be, work with your physician to take steps to improve them. For example, change your diet, exercise more, or take medication to lower your blood pressure or cholesterol if your doctor recommends it.
According to StatPearls and the AHA, here’s an overview of the numbers you need to know and the goals to shoot for.
Although many providers still use BMI as a measurement for obesity, it doesn’t always give the full picture, according to the National Institutes of Health, and a waist circumference greater than 35 inches in women can also point to an increased risk of heart disease. If your numbers are out of the normal range, your provider can work with you to take action.
Continue (or start) exercising. “Women whose lives were ‘too busy’ to exercise consistently in their thirties should try to start back to a good exercise regimen to try to reduce their risk of plaque formation,” says Oen-Hsiao. As women age, she adds, the arteries and heart can stiffen, which can add to increased blood pressure, but consistent exercise can keep your arteries more flexible and lower this important number.
Your 50s: Kick Your Health Plan Into High Gear
What’s Happening Now
After menopause, the risk of heart disease rises. A study published in 2022 in The Journal of the North American Menopause Society suggests severe menopausal symptoms may provide clues to your future cardiovascular health. In the study, the more severe the menopausal symptoms, the more likely subjects were to develop heart problems later on.
With the loss of estrogen, blood pressure tends to go up, as do LDL cholesterol and triglyceride levels, while HDL cholesterol tends to decline, setting the stage for artery-clogging atherosclerosis. But, says Oen-Hsiao, “keeping risk factors, like cholesterol, blood pressure, and blood sugars down will help to prevent coronary artery disease.”
What to Do Now
Consider hormone therapy. Where providers used to make generalized recommendations on hormone therapy, says Jellis, “this has evoled over time and now we really advise women to seek guidance from their provider or from an endocrinologist, because it is based on an individualized approach.” In general, menopause replacement therapy is based on your personal risk factors and level, Jellis explains.
Assess your heart disease risk. Even if you feel fine, you can still have heart disease that’s not yet causing symptoms. Plugging in your age, cholesterol, blood pressure, and other details into the AHA’s online risk calculator will estimate your 10-year risk of heart disease.
Depending on your results, the AHA provides recommendations you can discuss with your physician. They may recommend preventive treatment, such as aspirin or statin medication. A statin helps shrink arterial plaque, according to the American College of Cardiology, preventing or delaying cardiovascular symptoms or events.
Ask about a low-dose noncontrast CT scan of your heart. This test measures calcified plaque deposits in your arteries and gives you a calcium score. From this score, “you can calculate the percentile rank of a person based on their gender, ethnicity, and age that will give you a ranking of your cardiovascular risk,” says Jellis. These results can be helpful, because it can highlight patients who are at higher risk than first thought, she notes. It can also encourage people to follow their treatments more closely, or to take additional treatment if needed.
Your 60s and Older: Keep Up the Good Work
What’s Happening Now
The risk of heart attack is higher now. Between the ages of 60 to 79, about 78 percent of women have heart disease, according to a study review published in 2019 in the Journal of Cardiovascular Development and Disease. The good news is that you still have the power to reduce your risk of heart attack and stroke.
What to Do Now
Keep your provider in the loop. At this point in life, Jellis recommends regular checkups with your health provider. “Your provider can look at the cumulative effect of the risk scores and be proactive about treatment,” she says. “If your calcium score is high, your provider may be more inclined to put you on more therapies and be aggresive about that risk factor targeting.” The more your provider knows about the state of your heart health, the more they can do to help.
Watch your risk factors. The numbers you started tracking in your forties — cholesterol, blood pressure, fasting blood glucose, weight, and BMI — can mean even more now since the probability of a cardiac event like a heart attack or stroke is greater, according to the 2019 article in The Journal of Cardiovascular Development and Disease. Do what you can to stay in the ideal ranges. Keep working with your doctor to develop a personal treatment or prevention plan to manage your risk factors. Follow up as often as recommended to make sure any medical interventions, such blood pressure medication or a statin, are working.
Don’t ignore sneaky symptoms. If you have symptoms of heart disease, such as angina (tightness, pressure, or discomfort in your chest when you’re exercising or stressed), see your doctor. Seeking prompt medical treatment can help head off a heart attack. The AHA reports heart attack symptoms in women can be different from men. While chest pain is still common, many women often report other symptoms like nausea, vomiting, back pain, or jaw pain when experiencing a heart attack. If you feel concerned at all about any symptom, seek medical help right away.
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