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Six steps to taking control of your heart health


Heart disease may be the No. 1 killer of women — but six basic lifestyle choices can help you prevent it, control it, or even reverse your risk for heart attack and stroke. Just as significant, if you have already experienced a heart attack, stroke or other form of heart disease these steps can prevent another life-threatening cardiac event, halt the progression of heart disease and prevent early death.

“Making healthy lifestyle changes can do a lot to help prevent or slow the progression of heart disease,” says Sharonne N. Hayes, M.D., founder of the Women’s Heart Clinic at Mayo Clinic in Rochester, Minnesota. “Depending on your unique needs, you may need strategies to lower blood pressure and LDL cholesterol, a personalized exercise prescription, a healthy-eating plan, advice about how to quit smoking, and stress management techniques.”

Are you skeptical about seeing positive results from a lifestyle upgrade? Check out this quiz to see how six lifesaving tips can help you take control of your health.


How much heart health benefit can older women get from physical activity?

A: For women ages 65 to 97, each 30 additional minutes daily of light physical activity lowers risk of death from heart disease — or any other cause — by 12% compared to folks who aren’t active.

B: If you are out of shape when you turn 65 there’s not much you can do to improve your heart health or extend your longevity.

C: Each addition of 30 minutes of moderate — instead of light — physical activity (brisk walking/bicycling) lowers the risk of cardiovascular disease and of death from all causes by 39%.

A and C are correct: The Objective Physical Activity and Cardiovascular Health Study (OPACH), which includes Women’s Health Initiative participants, measures  the effect of physical activity on cardiovascular health in older women. The study found that both light-intensity and moderate to vigorous physical activity (PA are associated with lower mortality among older women (ages 63 to 97). With each 30 additional minutes of light PA per day, the women had a 12% lower risk of death from any cause. And with every additional 30 minutes of moderate PA (brisk walking/bicycling), their risk was 39% lower.

Six Steps to a Heart-Healthy Lifestyle

1. Upgrade Your Nutrition

You don’t want to be on a diet — you want to adopt a lifelong approach to nutrition that provides you with the healthy fats, vitamins, minerals, proteins and other nutrients you need. Simultaneously, you’ll want to limit foods like added sugars, highly processed carbs, saturated fats, full-fat dairy, and trans fats in fast foods, snacks and baked goods. These foods fuel on-going (chronic) inflammation within blood vessels, a first step to developing cardiovascular disease.

A quick and easy way to do that is to fill at least two-thirds of your plate with fruits, vegetables, beans and whole grains, one-third or less with lean protein — such as skinless poultry, fish or plant proteins, and use low-fat or no-fat dairy.

“There isn’t a food that will save your life … And there isn’t one that’s going to kill you. It’s about balance and variety,” says Dr. Hayes. “I am mostly vegetarian, but eat fish every once in a while. I try to eat whole foods and pay attention to the distance my food travels and amount of processing it goes through before it gets to me. You don’t have to be a vegetarian to be heart healthy, but sticking to a predominantly plant-based diet is best, especially when you also choose healthy fats and limit making animal proteins a central part of your meal. Let the vegetables be the stars of your meal and meats be the supporting characters.”

Color You Smart: One way to introduce heart-healthy variety into your meals is to make sure that every day you eat foods of many colors.

  • Get ready. Red fruits and vegetables such as tomatoes, strawberries and red beans help inhibit formation of cholesterol in the liver.
  • Go green. These fruits and vegetables contain antioxidants that help reduce chronic inflammation, which is damaging to your cardiovascular system. They also deliver heart-protective potassium and vitamin K, which is important for healthy blood clotting. Dark green, leafy vegetables have the highest concentration of heart-friendly antioxidants and fiber.
  • Bountiful blues: Blue and purple fruits and vegetables, like purple grapes, raisins and eggplant (skin), have anti-inflammatory properties, can help reduce cholesterol levels and help you maintain robust blood flow.
  • Orange? Vitamin-C-rich oranges and beta-carotene-loaded carrots provide vitamins and antioxidants that help slow down or prevent a buildup of artery-clogging plaque that can trigger heart attack or stroke.
  • Pale but powerful: White, tan and brown fruits and vegetables like mushrooms, bananas, and onions help maintain heart health (bonus — they also lower the risk of certain cancers).

Making the effort to eat more healthfully has big rewards. A 2020 study found that higher intake of whole grains, vegetables, fruits, beans, peas, lentils and nuts, and lower intakes of red and processed meats and sugar-sweetened beverages reduced the risk of cardiovascular disease by 14% to 21% compared to those eating less healthy foods.

2. Exercise Your Right to a Healthy Heart

Physical activity can lower the risk of heart disease and speed your recovery from heart attack or stroke. That’s because not only does it help maintain a healthy weight and avoid weight regain once you have shed excess pounds, it can help improve your control of heart-damaging conditions such as elevated low-density lipoprotein (LDL) cholesterol, diabetes and high blood pressure.

“If you don’t like to exercise there are some ways to increase the chance that you will get some physical activity regularly,” says Warren G. Thompson, M.D., a Mayo Clinic expert in preventive medicine. “If you don’t like running on a treadmill don’t do it. Find something you enjoy — maybe playing tennis, or swimming. Some people are inspired when they make their activity a contest. Get a buddy and compete to see who can do the most steps every day. There doesn’t have to be a contest; other people enjoy the companionship of a good walk with a friend. And if you don’t like exercise at all, then find a hobby like gardening that keeps you moving and active.”

The standard recommendation is to aim for a goal of 150 minutes a week of moderate intensity aerobic exercise, such as walking at a brisk pace, or 75 minutes a week of vigorous aerobic activity. Add to that two or more strength-training sessions weekly. You can increase that as you become stronger. However, if you’ve been sedentary, start slowly. Even shorter bouts of activity offer heart benefits. As little as 10 minutes per day has been shown to lower your risk of death over a 9- to 12-year period! Activities such as gardening, housekeeping, taking the stairs and walking the dog all count toward your total.

“Every little bit helps,” says Amanda R. Bonikowske, Ph.D., program director for Mayo Clinic’s Cardiac Rehabilitation Program.” If you do not exercise regularly, start slow and gradually increase exercise duration and then start increasing intensity.”

HIIT It! High intensity interval training — or HIIT — has been found to be especially helpful for protecting and restoring heart health. “The fun part,” says Dr. Bonikowske, “is that it is infinitely variable — you can choose, and you are in charge of the time spent doing intense effort, moderate activity and resting, so they suit your level of ability.”

The latest studies show HIIT training raises good-for-you high-density lipoprotein (HDL) cholesterol and improves triglyceride levels, It also raises your peak aerobic capacity — your VO2 max — which is a measure of cardiorespiratory fitness. That lowers the risk of premature death.

“One way to incorporate HIIT into your day,” says Dr. Bonikowske, “is with brief bursts of intense activity such as climbing the stairs. Performing 20 second stair climbing bouts 3 times, — for a total of 60 seconds of exercise, plus a minute or two break between each bout — and doing this 3 days per week can improve cardiorespiratory fitness in previously sedentary women. And if that’s too fast for you — doing a slower version is going to be very beneficial too.”

As for HIIT being risky for heart patients — you must always work with your doctor to design an exercise program that is appropriate for your condition, but “adverse events among cardiac rehab patients who do HIIT is low — similar to those doing moderate intensity continuous training and most patients do a combination of the two,” says Dr. Bonikowske.

3. You Can’t Over-Stress the Importance of De-Stressing

Women’s heart health suffers when chronic stress from life, work and family pile on. One recent study found that the combined effect of persistent stress from social interactions and paid work increases a woman’s risk of coronary heart disease (CHD) by 21%. High-stress life events by themselves were linked to a 12% increased risk of developing CHD, compared to men.

Other research shows having difficulty coping with high stress levels can raise your blood pressure and heart rate, increasing the risk for stroke and heart attacks — and that may have an especially negative impact on younger women with a history of heart problems.

You can’t stop life stresses from happening. In fact, manageable episodes of stress can make life exciting and interesting. However, you can improve how you recognize and react to stress. “That’s why it is useful to develop some skills that help you become of aware of stress-inducing conditions and situations and to recognize stress when it hits,” says Dr. Hayes. “That way, before stress gets out of control, you can use short- and medium-range strategies to mitigate the stress that is interfering with your quality of life.”

Some of those smart stress-reducing routines include getting physical activity, sleeping seven to eight hours nightly (see below), eating a noninflammatory diet (see above), meditating or doing breathing exercises once a day, staying in contact with friends and family and acting generously toward others.

4. Sleep Deep

If you don’t regularly get enough sleep you are at an increased risk for heart-damaging obesity, diabetes and depression, as well as heart attack and stroke. Unfortunately, 1 in 4 women has some insomnia symptoms, such as trouble falling asleep, trouble staying asleep or both. And, according to a European Heart Journal study, women who frequently wake up tired (the study calls it nonrestorative sleep) and have to deal with the cumulative symptoms of insomnia, such as fatigue, depression, weight gain and cognitive problems, appear to have a higher relative risk of heart failure than men.

Sleep apnea is increasingly a problem for women, points out Dr. Hayes. It causes snoring, stopping breathing during sleep and gasping for air, and frequent daytime fatigue. All that puts women at a higher risk for heart attack, stroke, atrial fibrillation and uncontrolled hypertension. The most common form is obstructive sleep apnea (OSA). As a person with OSA moves into a deep phase of sleep, the airway at the back of the throat collapses, disturbing normal breathing. This rouses the body out of deep sleep and into lighter sleep, where normal breathing resumes. This reduction of deep sleep cuts short some of the important restorative processes to tissues and the immune system that occur during deep sleep. Additionally, when people stop breathing during sleep, their blood oxygen levels drop. Over time that puts a stress on their heart and lungs. 

If your bedmate says that you snore and snort or stop breathing while you’re asleep, or if you feel exhausted every morning, ask your doctor for a referral to a sleep disorder center for evaluation. OSA, when diagnosed correctly, can be controlled with weight loss, abstaining from alcohol, use of a continuous positive airway pressure device or other appliance, like the adaptive servo-ventilation system, and medications.

Whatever the cause of your sleep disturbances, you will benefit from establishing a sleep routine you stick to even on weekends; making sure you turn off all digital devices an hour before bedtime; having your bedroom cool, dark and quiet; and checking with your doctor to see if any medications you are taking could be negatively affecting your sleep. If you try these techniques and your sleep problems persist, talk to your health care provider about having a sleep study — which can often be done at home — or going to a sleep clinic to get a diagnosis of your sleep troubles and personalized sleep-improvement plan.

5. No Smoking (Anything)

Smoking can double or quadruple your risk of heart disease and stroke — and for women it is particularly risky. Women who smoke have a 25% higher risk of developing heart disease compared to men who smoke.

Although these statistics are about tobacco smoke, emerging research on the cardiovascular effects of smoking marijuana indicate that it is harmful too. Cannabinoids (the psychoactive part of marijuana) pump up your resting heart rate, dilate blood vessels and make the heart pump harder, increasing the risk of having a heart attack in the hour after smoking marijuana. This is particularly risky for people with diagnosed cardiovascular and heart disease.

To get help quitting smoking, click here.

6. Health Screenings Are the Movie of Your Life

“I never had any idea I was walking around with high blood pressure,” says Dina Piersawl, an ex-athlete, stroke survivor and WomenHeart Champion. “If I had known, I would have done something about it. Now, I am a 13-year stroke survivor. My BP is maintained with medication and I monitor my BP often. I tell my best friends, people in grocery stores, in bookstores, everyone wherever I go, ‘Know your numbers.’ “

The numbers you want to keep track of are your blood pressure, lipids (total cholesterol, LDL and HDL cholesterol and triglycerides) and blood glucose. Your targets are:

Blood pressure: Less than 120/80 mmHg 

Fasting Glucose Level: Less than 100 milligrams per deciliter (mg/dL)  


HDL: Above 60 mg/dLin women; above 50 mg/dL for men 

LDL cholesterol: Below 100mg/dL; (if you have coronary artery disease (CAD): below 70 mg/dL

Triglycerides: Below 150 mg/dL

If your numbers are creeping up, or they are high, you want to act immediately to protect your heart and other organ systems. Following the recommendations in this article for nutrition, exercise, stress management and sleep will help you get your numbers in the heart-healthy range. But also connect with your health care team, because lifestyle steps to improve heart health — while extremely beneficial — are sometimes are not enough.

To protect or improve your heart health — and help other women who are working to do the same — you can join the voices at Mayo Clinic Connect and at WomenHeart. Share your story, ask questions, explore the latest medical insights into heart disease and get the support you deserve — and need — in your journey.

Sharonne N. Hayes, M.D.

Dr. Hayes is a cardiologist and Professor of Cardiovascular Medicine at Mayo Clinic. She has over 25 years of experience in treating complex heart and blood vessel conditions, especially those that uniquely or disproportionately affect women. She founded and practices in the Women’s Heart Clinic and has diverse research interests that include sex and gender-based cardiology, spontaneous coronary artery dissection (SCAD), health equity, and the utility and optimal role of social media in clinical practice, medical research and health education.

Amanda R. Bonikowske, Ph.D.

Dr. Bonikowske is an exercise physiologist with certification as a Clinical Exercise Physiologist through the American College of Sports Medicine. Dr. Bonikowske is currently the Program Director of the Cardiac Rehabilitation Program at Mayo Clinic in Rochester, Minn.

Warren G. Thompson, M.D.

Dr. Thompson is an Associate Professor of Medicine who works at the Mayo Clinic Healthy Living Program and practices in the Executive Health Program.  His research interests include the effects of exercise on weight and diabetes.

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