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Even though heart disease kills more women than breast, lung, and ovarian cancers combined, only 1 in 10 women see themselves at risk. Before you say, "But I don't have to worry about that until I'm 50," consider this: Studies show that heart trouble -- including clogged arteries and high cholesterol -- can start as early as childhood. The positive news: you have some control over your risk, since more than 80 percent of all heart disease in women is avoidable. In fact, taking protective measures in your 20s, 30s, or 40s can help lower your odds of developing heart problems by as much as 60 percent. Here are the preventive steps you should take in each decade, starting now.Start Early
Believe it or not, heart trouble can start surprisingly early. Several studies have found that a large number of young people have early buildup of cholesterol in their arteries. Researchers recommend making healthy lifestyle choices, such as not smoking, drinking within moderate limits, exercising daily, and eating a healthy diet. The earlier you start to alter your habits, the easier it will be to maintain a healthy heart throughout your life.Know Your Numbers
Make an appointment with your doctor for a complete physical with lab work by age 20 (see chart below). "The important thing at this time is becoming aware of your personal risks," says Sharonne N. Hayes, MD, director of the Women's Heart Clinic at the Mayo Clinic in Rochester, Minnesota. If you have any risk factors, talk to your doctor about ways to lower them through diet, exercise, and medication if needed. Here's a quick rundown of the crucial basic screenings:
Test: Blood Pressure
Should be: Below 120/80 mm Hg
Should be: 18.5?24.9 kg/m2
Should be: Total, less than 200 mg/dL; LDL (bad), less than 100 mg/dL
Should be: Less than 150 mg/dL
Test: Fasting Blood Sugar
Should be: Below 100 mg/dL
"Lighting up more than doubles a woman's odds for developing coronary heart disease," says Nieca Goldberg, MD, chief of women's cardiac care at Lenox Hill hospital in New York City and author of The Women's Healthy Heart Program: Lifesaving Strategies for Preventing and Healing Heart Disease (Ballantine Books, 2006). Within one year of quitting, your risk of coronary heart disease decreases by a whopping 50 percent.Know Your Family Medical History
A first-degree female relative (a mother or a sister) who has a heart attack at age 65 or younger increases your risk of heart disease, says Barbara Roberts, MD, director of the Women's Cardiac Center at the Miriam Hospital in Providence and author of How to Keep from Breaking Your Heart: What Every Woman Needs to Know About Cardiovascular Disease (Jones and Bartlett, 2004). The same holds true if a male relative has suffered a heart attack at age 55 or younger, she says. But don't panic if you have a strong family history of heart disease -- making lifestyle changes in your 20s can significantly lower your risk.Eat the Right Foods
Replace pepperoni pizza with a veggie slice; trade sugary cereals for oatmeal or other whole grains, which add fiber, helping to shuttle cholesterol out of your bloodstream. Other heart-friendly foods include blueberries, kale, strawberries, spinach, brussels sprouts, plums, broccoli, beets, oranges, and red grapes. All contain high levels of antioxidants, which help prevent hardening of the arteries. Omega-3 fatty acids, found in fatty fish, walnuts, and flaxseed, protect against inflammation, another heart disease risk factor. "They may also help lower LDL cholesterol levels and can prevent blood clots," says Suzanne Steinbaum, DO, a cardiologist and director of the Center for Cardiac Health at Beth Israel Medical Center in New York City.Move!
This is the decade to make exercise a habit. A study in the New England Journal of Medicine reports that both walking and vigorous exercise can reduce cardiovascular events such as heart attack and stroke in women, regardless of their age, BMI, or race. Aim for 30 minutes of moderate-intensity exercise on most, if not all, days. If you don't have time for 30 minutes straight, break it up: Take a 15-minute walk at lunch and then another one after dinner.
Life's a lot more complicated now than it was in your 20s. Most likely, your career has gained momentum and you may be starting a family. The U.S. Department of Labor Statistics reports that in 2004, 57 percent of married women with children under the age of 6 worked and 66 percent of women in the workforce had children of all ages. Balancing work and family might be upping your stress levels, which raises your risk for heart disease, says Dr. Goldberg. Cortisol and adrenaline -- two major stress hormones -- can constrict blood vessels, raising blood pressure and leaving vessels vulnerable to blockages. You're more prone to weight gain now (which can strain your heart), since your metabolism has started to slow down, and it may be challenging to fit exercise into your schedule. Higher stress levels may also be cutting into your sleep, another risk factor.Decompress
You may not be able to change your stressors, but you can change how you react to them. "The more you learn to relax, the more adept your body will be at regulating stress hormone levels," says Dr. Goldberg. Find your own relief zone, whether it's yoga, aerobic exercise, tai chi, or a weekly massage or manicure and pedicure appointment. If you're very busy with young children, try a calming hobby that you can do at home, such as knitting or keeping a journal. A study of medical students under a high degree of pressure at the University of Mumbai in India found that residents turned to hobbies as the most common stress reliever.Muscle Up
If you haven't already started a weight-training routine, doing so now will help maintain and boost your percentage of lean body mass, which keeps your metabolism stoked and prevents the pounds from creeping up. Not familiar with the weight room? Hire a personal trainer to show you the ropes, start attending a resistance-training class at your local gym, or opt for a home video. Aim for twice weekly sessions of an hour each.Play with Your Kids
Every little bit of activity counts. A Harvard study found that people who gained as little as 11 pounds significantly increased their risk of coronary heart disease. Use daily physical activities to keep your weight steady. Take your baby on long walks -- believe it or not, pushing a stroller counts as light resistance training, which helps build muscle. Choose a parking spot that's not right in front of the grocery store and carry the bags out to the car yourself. (More weight training!) Take the dog on daily walks and join your kids for freeze tag in the park.Get Enough Sleep
Sleeping fewer than five hours per night can increase your risk of heart disease by about 39 percent. Make sure you get more than that (about six to eight hours), and go to bed and wake up at the same time every day, even on weekends. The National Sleep Foundation also recommends establishing a relaxing bedtime routine, like a hot bath, light reading, or listening to soothing music to help you fall asleep faster. If young children are interrupting your nighttime sleep cycle, try to nap when they do. Skip alcohol, since it conks you out initially but then wakes you up in the middle of your sleep cycle.Cut Back on the 3 White Devils
You don't need to avoid sugar, salt, and refined flours entirely, but limiting your intake can go a long way toward keeping your arteries healthy. "Foods high in sugar and low in fiber, such as cakes and cookies, can contribute to weight gain, and raise your cholesterol and triglyceride levels," says Steinbaum. Additionally, the more salt you have in your diet, the higher your blood pressure. The American Heart Association recommends that you limit daily sodium intake to under 2,300 milligrams.Rethink Your Birth Control
If you have high blood pressure, high cholesterol, or a strong family history of heart disease, reconsider using hormonal contraceptives such as the pill and the patch, cautions Dr. Goldberg. "These don't increase heart disease risk by themselves, but they could exacerbate risk factors you already have," she explains. "If you smoke, for example, they may not be a good choice." Talk with your gynecologist about whether a nonhormonal birth-control method like a diaphragm, cervical cap, sponge, or IUD is a better option.
Your lifestyle has probably stabilized, but your role as caretaker may be more taxing as you are sandwiched between children and aging parents. Declining estrogen levels can raise your risk of heart disease, because this hormone helps maintain the elasticity of arteries and guards against hardening. As you age, you're also more likely to develop visceral fat around your abdomen, which has been linked to low HDL, high blood sugar, and elevated triglycerides, all of which increase your chances of having a heart attack. You're also more at risk for developing type 2 diabetes, which has been linked to heart and blood vessel diseases.Build Your Social Circle
"A strong social network can ward off heart disease, since it helps relieve stress," says Dr. Goldberg. An American Heart Association study shows that those who go to church, volunteer, join social clubs, and have many friends have significantly lower blood pressure and other heart disease risk factors than those who don't. Plus this makes room for "you" time -- take a break from caring for everyone else!Have More Sex
Sex isn't just fun; it may actually decrease the risk of stroke, reports a study in the Journal of Epidemiology and Community Health. That's because sex gives your heart a mini workout. And you're probably way more comfortable in your own skin this decade, leading to greater satisfaction between the sheets, in the shower or...well, you get the picture.Take It Easy on the Coffee
Researchers haven't found a definitive link between caffeine and heart disease, but this stimulant can flood the body with increased stress hormones like cortisol and adrenaline, which in turn can boost your stress level and unnecessarily tax your ticker. If your coffee consumption has crept up this decade, try switching one cup of java for green tea. A Japanese study showed that it contains nutrients that have significant antioxidant and anti-inflammatory properties, which may reduce cardiovascular disease risk factors.
The following screenings may benefit women who have a strong family history of the disease but none of the clearer-cut risk factors, such as elevated blood pressure and cholesterol. Ask your doctor if your history warrants taking any of these tests.
C-Reactive Protein (CRP)
Marks levels of inflammation, which experts now say may be the most important predictor of heart trouble.
Excess levels of this amino acid may indicate scarring or thickening of arterial lining.
Too much of this blood protein, which is essential for clotting, can increase your chances of having a stroke.
This blood lipid disrupts the body's ability to dissolve clots.
"Heart attacks aren't usually the clutch-and-fall Hollywood drama; often they're extremely subtle," says Sharonne N. Hayes, MD. In fact, only half of all patients suffering from a heart attack experience chest symptoms. Fatigue, abdominal upset, nausea, or jaw pain in any combination are more common. "Any new chest, neck, or back discomfort associated with shortness of breath or sweating is a warning sign to take action immediately," says Dr. Hayes.
Originally published in Fitness magazine, February 2006.