Do you have high blood pressure (hypertension)?

There are two numbers involved in measuring blood pressure: systolic and diastolic. Systolic blood pressure measures the amount of force your blood exerts on the walls of your arteries while your heart is contracting (pumping blood). Diastolic pressure — which is always lower — is the same measurement, but it’s for your heart at rest, in between beats.

What counts as high blood pressure, or hypertension? According to the American Heart Association, a person has hypertension if:

  • Their systolic blood pressure is over 130.
  • Their diastolic blood pressure is over 80.

According to cardiologist Ashish Sarraju, MD, hypertension strains the heart and increases wear and tear on blood vessels, making blockages more likely.

It’s worth noting that, while it’s rarer, people with chronic low blood pressure (hypotension) are also at risk for heart disease. It’s a Goldilocks thing — you want your blood pressure to be in the “just right” range. Not too high or too low.

What’s your biological sex?

Men and people assigned male at birth (AMAB) have a higher risk of CHD than women and people assigned female at birth (AFAB) do. But the risk of CHD goes up during and after menopause, more or less evening out the risk.

How old are you?

The older you get, the more likely you are to develop CHD. According to the National Institute on Aging, your risk goes up significantly at age 65. That’s because, Dr. Sarraju says, the longer you live, the more likely you are to develop (or exacerbate) other risk factors.

Does your biological family have a history of heart disease?

The genetic (inherited) make-up of some individuals increases their chances of developing CHD.

When you look at your biological family tree, Dr. Sarraju recommends you do more than just take note of the branches that include heart disease. You should also think about how closely you’re related to those individuals — and how old they were when they developed CHD.

It’s especially important to let your providers know if you have relatives who developed heart disease before the age of 50 or had high cholesterol at a young age. It could be a sign of an inherited condition called familial hypercholesterolemia (FH). While an FH diagnosis is nobody’s idea of a good time, Dr. Sarraju explains that an early diagnosis can be life-changing — in a good way. Preventive treatment for FH may significantly reduce your risk of heart disease.

Do you have high cholesterol?

High cholesterol (hyperlipidemia) can contribute to the build-up of plaques in your bloodstream. Those plaques can clog the blood vessels leading to your heart, narrowing them and potentially blocking blood flow. Cholesterol can be high for many reasons, some of which (like your diet) are in your power to change. But Dr. Sarraju is quick to note that high cholesterol can also be hereditary.

Total cholesterol greater than 200 mg/dL is considered borderline high, and above 240 mg/dL is high. You also want your LDL cholesterol (the “bad” cholesterol) to be less than 100, and your HDL cholesterol (the “good” cholesterol) to be 60 or higher.

Do you smoke?

At this point, it’s common knowledge that smoking is bad for your health. It’s normal to think first about conditions like chronic obstructive pulmonary disease (COPD) and lung cancer, but smoking also does a number on your heart. In fact, it’s the most important of the known, changeable risk factors for CHD.

Nicotine speeds up the heart and narrows the arteries, making it harder for enough blood to get through. And prolonged use of nicotine patches and nicotine lozenges also raises your risk for heart disease. That’s why Dr. Sarraju says it’s important for nicotine replacement therapy to be short-term. It definitely shouldn’t be your whole smoking cessation plan.

How physically active are you?

You’ve probably heard it before: Experts recommend 30 minutes of moderate-intensity exercise five times a week. If that time commitment or level of physical activity feels unattainable, don’t despair: When it comes to your cardiovascular health, every little bit helps. Do what you can, as often as you can, and slowly build to a five-day-a-week routine.

As the name suggests, regular cardio workouts are a particularly great way to improve your heart health and reduce your risk of developing CHD. In addition to improving your circulation and increasing the amount of oxygen in your blood, over time, cardio can also reduce both your blood pressure and your heart rate. It may even help raise your “good” HDL cholesterol and reduce the “bad” LDL cholesterol.

If you have a disability that limits your ability to engage in physical activity, have a conversation with your provider about it. Together, you can determine what kind and amount of exercise is appropriate for you. Remember: Any activity is good activity, from chair yoga to pool walking, from breathing exercises to physical therapy. Your provider may even be able to point you in the direction of accessible exercise facilities.

What do your meals look like?

According to Dr. Sarraju, it’s best to limit your consumption of the following types of food:

  • Red meat and organ meat.
  • Refined grains (as opposed to whole grains).
  • Added sugars and excessive salt.
  • Highly processed and fast foods.
  • Tropical oils (as opposed to liquid plant oils like olive oil).
  • High-fat dairy products.
  • Alcohol.

When it comes to heart health, the gold-standard eating plan is the Mediterranean diet. In fact, studies have shown it’s significantly more effective for reducing heart disease risk than a reduced-fat approach. And unlike crash or fad diets, the Mediterranean diet is sustainable in the long term, which is key to keeping your heart healthy as you get older.

Have you been diagnosed with diabetes?

According to the U.S. Centers for Disease Control and Prevention (CDC), people living with diabetes — be it Type 1 or Type 2 — are two times more likely to develop heart disease than people who don’t have diabetes. Those are scary statistics, but here’s the thing: The lifestyle changes that doctors recommend for managing diabetes also have a positive impact on your heart health.

How stressed are you — and how well do you cope with stress?

“Chronic stress can damage our heart both directly and indirectly,” Dr. Sarraju states. Let’s start by reviewing the direct impact.

When we’re under stress for prolonged periods of time, our cortisol levels go up. Cortisol is a stress hormone that impacts every part of our body, including the systems that regulate our blood pressure. It also causes chronic inflammation.

Cortisol is actually supposed to suppress inflammation. But when you’re in a constant state of fight or flight, your body basically gets used to all that cortisol, making it ineffective. Chronic inflammation is linked to cardiovascular disease, as well as weight gain and blood sugar issues