6 things I never do to protect my heart health as a woman and cardiologist

Women’s cardiovascular health has historically been under-diagnosed, under-researched and under-treated. In fact, it wasn’t that long ago that we learned women’s cardiovascular biology differs from that of men, who’ve historically been centered in the health care system.

Heart disease is the leading cause of death for both sexes in the U.S., according to the Centers for Disease Control and Prevention. Cardiovascular disease kills more women than all forms of cancer combined, yet many women are still unaware that cardiovascular disease is their greatest health threat. In fact, almost 45% of women over age 20 are living with some form of cardiovascular disease. For women in particular, certain health patterns that begin as early as childhood can lead to or predict the development of certain heart conditions in the future.

For example, getting your first period at age 10 or earlier increases your risk of cardiac events. Pregnancy complications such as preeclampsia and gestational diabetes can also be warning signs of future heart problems. Having early menopause and being post-menopausal are both considered cardiovascular disease risk factors for women. 

Other health conditions common in women can increase risk of heart disease, including migraine, polycystic ovarian syndrome, lupus, rheumatoid arthritis, psoriasis and inflammatory bowel disease.

Getting screened for cardiovascular disease needs to become as routine as getting a mammogram or pap smear. There are screening tools that exist, including risk calculators and a calcium score test, which can both help predict a woman’s future risk of heart attack or stroke.  

While you may not be able to control certain heart disease risk factors, 80% of cardiovascular disease is preventable by lifestyle choices. You can prioritize heart-healthy habits, such as exercising regularly, eating a balanced diet and not drinking or smoking.

These choices can be tough to stick to — I get it! Looking after your heart can feel like a job in itself, so these six non-negotiables help set me up for success.

I would never explain pain or discomfort away

If you’re experiencing chest pain, you might blame acid reflux, heartburn or stress, but it could be linked to a cardiac issue. There are numerous aspects of the heart that could be responsible for your discomfort, from the arteries to the valves to the lining of the heart, and a cardiologist can explore those things to pinpoint the source of your pain.

Even mild or brief pain can be a warning sign of something more serious. Other possible signs of heart problems may include: jaw pain, shoulder pain, the sensation that your bra is too tight, feeling winded as you walk, fatigue, flu-like symptoms, sweatiness, nausea and sudden limitations when you exercise.

Once you clock that something feels off, timing becomes crucial. Chest pain and other cardiac symptoms can occur weeks before a cardiac event, so early intervention makes all the difference. 

I would never be unaware of my critical numbers

Beginning in your 20s, you’ll want to start keeping track of these four numbers:

• Blood pressure
• Cholesterol
• Blood sugar
• Body mass index

An ideal blood pressure is 120/80 mm Hg, and anything above 130/80 mm Hg is considered high blood pressure.

A cholesterol or lipid panel pulls up four numbers — total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides.

Cardiologists look at all cholesterol values but especially your LDL, or “bad” cholesterol. Elevated LDL levels can cause damage to the delicate lining of your arteries, leading to the buildup of plaque in the artery walls. The plaque in the artery walls can cause chest pain and shortness of breath, and if that plaque ruptures, it can result in a heart attack or stroke. An ideal LDL range is below 100.

If you already have heart disease, your doctor will likely prefer to see LDL levels below 70. And if you’re especially high risk, that level should be below 55. When it comes to LDL, the lower the better.

Cardiologists are also increasingly screening for lipoprotein (a), a genetically determined type of cholesterol that’s associated with heart disease, stroke and aortic valve disease. Cardiologists have recently begun recommending patients get screened for it at least once in their lives.

You should also pay close attention to your A1C, which measures average blood glucose over the past few months. A number in the 5.7-6.4 range is considered prediabetes, according to the American Diabetes Association. A reading of 6.5 or higher is considered diabetes, and anything below 5.7 is considered normal.

BMI isn’t always a perfect marker of health because it doesn’t factor in the weight of muscle. In general, however, a BMI between 18 and 25 is considered normal, between 25 and 30 is considered overweight and above 30 is considered obese. If you find yourself within the overweight or obese ranges, talk to your doctor.

I would never be uninformed about my family history

Everyone should be asking their family members about their cardiovascular health histories. Say your female parent or sister had a cardiac event such as stroke, heart attack, stent or bypass surgery before 65 — that tells the doctor you have a positive family history. And if you have male parent or sibling who’s had the same events occur before 55, that’s considered an early positive family history.

Other conditions that affect the heart can also be genetically determined and passed on. It’s important to ask if you have a family history of heart failure, sudden cardiac death, electrical abnormalities of the heart, aortic aneurysms or elevated lipid levels.  

I would never think I’m immune to heart disease

There’s no picture of what someone with heart disease looks like. While you might be active, eat a healthy diet and not smoke or drink, you’re not necessarily in the clear and could still develop coronary artery disease. In addition, even if your arteries are healthy, you could have a tight or leaky heart valve, aortic aneurysms, heart valve disease, arrhythmias or cardiomyopathies.

Remember, heart disease is the leading cause of death for both men and women, so everyone must consider their risk.

I would never skip stress management or mental health

There’s a link between the mind and the heart, and too much stress can lead to cardiac events, including heart attacks. So, I ask each of my patients about their stress levels and what they’re doing to mitigate that stress.

For people with unavoidable stressors, I recommend taking short breaks to reduce your stress throughout the day to avoid constantly being in fight-or-flight mode. For example, I recommend meditating even for 10 minutes a day and going on short walks. While you might not be able to totally eliminate stress from your life, finding chunks of time when you can dial it back can make all the difference.

I also ask patients about their mental health. Anxiety, depression and other conditions like PTSD can all affect your cardiovascular health. A therapist can be a big help, even if you don’t have a mental health condition, and connecting with your support system of friends and family can be invaluable.

I would never skimp on sleep

Sleep hasn’t gotten enough of a spotlight when it comes to matters of the heart. So many bodily processes happen while you sleep, and not getting enough of it has been linked to poor cardiovascular health. Sleep-disordered breathing conditions, such as sleep apnea, can contribute to high blood pressure and abnormal heart rhythms.

I typically recommend patients aim for seven to eight hours of sleep and prioritizing consistent sleep hygiene before bed — this includes sleeping in a cool, dark room and avoiding screens so that your mind can wind down. If my patients are having trouble falling asleep and staying asleep, I’ll suggest a sleep doctor, who’ll investigate the possibility they have sleep apnea or insomnia.

Heart health is not easy. It’s something you have to make an effort to prioritize, from diet and exercise to keeping up with doctor appointments and monitoring changes in your body. I’m a cardiologist, and I still have days where I struggle to eat a nutritious lunch or get up early enough to hit the treadmill.

It’s hard, but those little choices pay off, like adding to your heart-health savings account bit by bit. It’s essential that every woman prioritize her cardiovascular health and make sure to find a physician who makes her feel seen and heard. Make sure to nurture and love your heart — it’s one of the most precious relationships you will ever have.