As you get older, your risk of heart disease and heart attack goes up.

• Women usually get heart disease about 10 years after men typically do. This is because until menopause, the ovaries make the hormone estrogen. Estrogen gives premenopausal women some protection against heart disease. Estrogen may help keep blood vessels relaxed and open and help the body maintain a healthy balance of good and bad cholesterol. Without estrogen, cholesterol may start building up on artery walls.
• When you are younger, your arteries have smooth linings and flexible walls that allow blood to flow freely. As you age, the linings get stiff and the walls thicken, which can make it harder for blood to flow and increases blood pressure. This is most often caused by plaque buildup in your arteries, a process called atherosclerosis (ath-UH-roh-skluh-ROH-sis). Atherosclerosis begins in childhood. The older you are, the more likely your arteries will be narrowed or blocked enough to cause problems.

Menopausal hormone therapy

Many women take menopausal hormone therapy to help relieve menopause symptoms such as hot flashes. Results from a large study called the Women's Health Initiative showed that women taking menopausal hormone therapy with estrogen plus progesterone had a higher risk for stroke, serious blood clots, heart attacks, and other serious health problems. The risks were found to be much higher for women 60 years and older.

If you decide to use menopausal hormone therapy, talk to your doctor. The Food and Drug Administration advises women who want to try menopausal hormone therapy to use the lowest dose that works for the shortest time needed.

Read more about menopausal symptoms and hormone therapy in our Menopause section.

If you don't already drink, don't start drinking for health reasons. Researchers are not sure that even one drink per day for women (or less) is heart healthy. More than three drinks a day can raise blood pressure and triglyceride levels and can damage your heart muscle. In women, there is strong evidence that alcohol increases your risk of breast cancer.

There are many women who should not drink any alcohol, including

• Pregnant women or women trying to get pregnant
• Women younger than 21
• Women taking certain medicines (ask your doctor or nurse)

No amount of alcohol is recommended in the Dietary Guidelines for Americans because the potential risks and harms outweigh any benefit.

Lupus and rheumatoid arthritis are health problems that affect more women than men. Lupus and rheumatoid arthritis are autoimmune disorders. This means that they cause your immune system to attack the tissues and organs in your body, rather than just fighting off infections. Sometimes your heart and blood vessels are the tissues and organs that are attacked.

Treating your lupus or rheumatoid arthritis can lower your risk of heart disease.

Excessive, or extra, blood clotting is when blood clots form too easily or break apart too slowly. Blood clots can narrow arteries and veins or block blood flow completely. This can lead to heart attack, stroke, or damage to the kidneys, lungs, or other parts of the body.

Women of childbearing age (between 15 and 44) are at higher risk of blood clots than men of the same age. Your family health history, pregnancy, and certain medicines can cause excessive blood clotting. Medicines with the hormone estrogen, such as hormonal birth control or menopausal hormone therapy, can raise your risk for blood clots. Healthy everyday habits like healthy eating and getting physical activity can make clots less likely to form. Some people with excessive blood clotting may also need medicine to prevent clots.

High blood pressure, also called hypertension, raises your risk for heart disease. Blood pressure is the force your blood makes against your artery walls when your heart beats. If this force (pressure) is too high, it can damage your heart over time.

Your risk for high blood pressure goes up as you age. Two out of every 3 women 60 and older have high blood pressure.

You are also more likely to have high blood pressure if you have a family history of high blood pressure. Other risk factors for high blood pressure include eating unhealthy food often, not exercising, and being overweight.

In the United States, African-American women are at the highest risk for high blood pressure. This may be because African-American women are more likely to be obese or have diabetes, which can cause high blood pressure. Research has also found a gene common in African-Americans that increases sensitivity to salt. In people who have this gene, just one extra half a teaspoon of salt a day could raise blood pressure. Also, studies show that blood pressure levels are higher among African-Americans in the United States even after controlling for other health factors, and some of the difference is likely due to the effects of discrimination.

Many women — more than men — get "white coat hypertension." This means that your anxiety or stress level goes up when you are at the doctor's office, and this can make your blood pressure go up. If medical visits increase your anxiety level, ask your doctor for a monitor to wear at home to get a more accurate blood pressure reading.

High blood pressure does not usually have symptoms. The only way to know you have it is to get your blood pressure measured. Measure your blood pressure to find out your numbers:

• Systolic (the first or top number) is the pressure as your heart beats or pumps blood into your arteries.
• Diastolic (the second or bottom number) is the pressure when your heart is at rest.

To lower your risk for heart disease, try to lower your blood pressure levels to less than 120 systolic/80 diastolic. To lower your blood pressure:

1. Lose weight if you have overweight. Learn more in our Healthy Weight section.
2. Get at least 30 minutes of physical activity most days. Learn more in our Getting Active section.
3. Don't smoke. Find resources to help you quit at women.smokefree.gov.
4. Eat healthy.
5. Lower sodium in your diet. Learn more in our Healthy Eating section.
6. Don't drink alcohol, or drink only in moderation.
7. Take blood pressure medicine if your doctor prescribes it.

Cholesterol is a waxy, fat-like substance that is found in all cells of your body. Your body makes all the cholesterol you need. You also get cholesterol and saturated fat from food such as meat and dairy products. Fruits and vegetables do not have any cholesterol or saturated fat.

The extra fat from the foods you eat can clog your arteries. A blood test can measure your levels of:

• Low-density lipoprotein (LDL) or "bad" cholesterol. High LDL levels lead to cholesterol buildup in arteries.
• High-density lipoprotein (HDL) or "good" cholesterol. High HDL levels are actually good. HDL cholesterol helps lower the total cholesterol level in your body.
• Total cholesterol. This is the total amount of cholesterol in your blood, including LDL cholesterol and HDL cholesterol.
• Triglycerides. Triglycerides are another type of fat in your blood. High triglycerides may raise women's heart disease risk more than men's heart disease risk.

In women, high triglycerides combined with low HDL cholesterol can mean a very high risk of heart disease. There are no symptoms of high cholesterol or triglycerides. The only way to know whether you have high LDL or "bad" cholesterol or triglyceride levels is to see your doctor for a blood test. Your doctor can prescribe medicines and talk with you about changing your eating habits and getting more physical activity to help lower your cholesterol level.

Depression affects twice as many women as men. Also, research found that women 55 and younger who are depressed are twice as likely to have a heart attack or to die of heart disease as women who are not depressed. Depression also increases your risk for another heart attack if you've had one already. Depression can hurt your heart's ability to beat correctly. It also can speed up the buildup of plaque in your arteries.

Most people with depression get better with treatment, which may include therapy and medicine. Treating your depression can help lower your risk for heart disease.

Diabetes seriously raises your risk for heart disease and makes you less likely to survive a heart attack. This is true for women and men. But the number of men with diabetes who develop heart disease has gone down. The number of women with diabetes who develop heart disease has not gone down in recent years. Experts think this may be because of the link between heart disease, diabetes, and obesity, especially extra body fat that is carried around the waist. This link may be stronger for women, especially postmenopausal women, than for men.

Uncontrolled diabetes can damage your arteries and make you more likely to get high blood pressure and form blood clots that can cause a heart attack. About 28% of Americans with diabetes don't know that they have it. The only way to know for sure whether you have diabetes is to get a blood test.

What you eat is a big part of preventing heart disease and other chronic (long-term) diseases like type 2 diabetes. Eating healthy can also prevent other health problems that lead to heart disease, like high blood pressure or obesity.

There is no special vitamin or ingredient that can prevent disease. Healthy eating to prevent chronic diseases means eating a healthy combination of foods from all of the food groups. Use the MyPlate Plan Tool at ChooseMyPlate.gov to find a personalized healthy eating plan.

Eating healthy also means you do not eat a lot of food with saturated fat or trans fat, sodium (salt), or added sugar.

Your family history can raise your risk for heart disease:

• If your father or brother had heart disease before 55, you are at higher risk of getting heart disease yourself.
• If your mother or sister had heart disease before 65, you are also at higher risk.

A family history of heart disease does not always mean that you will have it too. This is especially true if your family member who had heart disease smoked or had other heart disease risk factors, such as high blood pressure or high cholesterol, that were not under control.

If heart disease runs in your family, it may be because your family carries genes that raise your risk. An example would be a gene that makes your blood more likely to clot. Talk to your doctor about your family health history.

C-reactive protein (CRP) is made by the body and released into the blood in response to swelling. Swelling (or inflammation) is how your body reacts to heal infections or cuts. Swelling can also happen over time in response to high stress levels or poor eating habits. Swelling for infections or cuts will raise your CRP levels for a short time, but swelling that continues for a long time may mean your arteries are damaged, which puts you at risk for heart disease.

If you are at borderline risk for heart disease, your doctor might test your blood for your CRP levels to use as a "tiebreaker." Your doctor may have to do this test several times to monitor your CRP levels. High CRP levels over several tests means that your risk of heart attack to about two to three times higher than people with low CRP levels. Women usually have higher CRP levels than men. Also, Hispanic and African-American women often have the highest CRP levels.

Your CRP level can help your doctor decide whether you need to take steps to lower your CRP level to prevent heart disease. This may include changing your eating habits, getting more physical activity, or taking medicine to treat high blood pressure or high cholesterol.

Metabolic (met-uh-BOL-ihk) syndrome is the name for a group of risk factors that happen together and are related to your metabolism. Metabolism is the process your body uses to convert food into energy. Having metabolic syndrome doubles your risk of heart disease. Metabolic syndrome is more common in women than men. You have metabolic syndrome if you have any three of these five risk factors:

• Waist measurement of more than 35 inches
• Triglyceride level greater than 150 mg/dL (milligrams per deciliter)
• HDL cholesterol less than 50 mg/dL
• Blood pressure of 130/85 mmHg (millimeters of mercury) or higher
• Blood glucose greater than 110 mg/dL after fasting for at least eight hours

If you have metabolic syndrome, you can take steps to control your risk factors. Your doctor will do cholesterol, blood pressure, and blood glucose tests regularly to find out your risk for metabolic syndrome.

The more overweight you are, the higher your risk of heart disease is. This is true even if you have no other risk factors.

Three out of every four women in the United States are overweight or obese. Women of all races and ethnicities are more likely to be obese than men of the same age, but women in some racial groups are more likely to be obese than others.

Extra weight increases your heart disease risk in two main ways:

• The extra pounds hurt your heart. Extra weight makes your body larger. The heart has to work harder to move blood around the body. Like an overworked pump, the hearts of overweight and obese people wear out more quickly.
• Excess weight makes you more likely to develop other risk factors for heart disease, such as high blood pressure and diabetes.

To lower your risk for heart disease, your body mass index (BMI) should be between 18.5 and 24.9. A BMI between 25 and 29.9 is considered overweight. A BMI of 30 or higher is considered obese. Find your BMI using this BMI calculator from the Centers for Disease Control and Prevention.

Where you carry extra weight also affects your heart disease risk. Women who carry body fat around their waists (apple-shaped body) are at higher risk for heart disease than those who carry weight around their hips and thighs (pear-shaped body). Women with waist measurements more than 35 inches, regardless of their height, have a higher risk of heart disease.

Less than one in every five American women gets enough physical activity to help prevent heart disease. Being inactive is a major risk for heart disease.

The heart is like any other muscle: the more you work it, the stronger it gets. Physical activity also helps keep your blood vessels flexible and open so the blood can reach all of your organs. It can help prevent the buildup of plaque in the arteries. Being active also can prevent other risk factors for heart disease. These include high blood pressure, diabetes, and obesity.

You need to get at least 30 minutes of physical activity five times a week to stay healthy.

• Gestational high blood pressure (sometimes called gestational hypertension or pregnancy-induced hypertension). High blood pressure during pregnancy can happen in some women who do not normally have high blood pressure. Gestational high blood pressure goes away after birth but raises your risk for high blood pressure and heart disease later in life, after pregnancy is over. Gestational high blood pressure can also develop into preeclampsia.
• Preeclampsia. Preeclampsia is a health problem that can happen during pregnancy. It is unexpected high blood pressure and problems with your kidneys (called "protein in the urine"). Women who have had preeclampsia are more likely to develop high blood pressure and heart disease later in life, after pregnancy is over.
• Gestational diabetes. Having gestational diabetes (diabetes that happens only during pregnancy) puts you at higher risk for type 2 diabetes later in life, after pregnancy is over. Diabetes is a risk factor for heart disease.

African-American and American Indian and Alaska Native women are more likely to have heart disease than white, Hispanic, and Asian-American women. But heart disease is still the number one killer of white and African-American women.

African-American women:

• Are more likely than other groups to have heart disease risk factors like high blood pressure, obesity, and diabetes
• May be less likely than others to receive preventive treatment including medicines to lower blood pressure and advice from doctors or nurses about weight control and quitting smoking
• May be more likely than others to have heart surgery at less-experienced hospitals

American Indian and Alaska Native women:

• Are more likely to have high rates of diabetes, overweight and obesity, and high blood pressure, which raise the risk of heart disease
• Are more likely to smoke and not get enough physical activity, which raises the risk of heart disease.
• Are more likely than other groups to die from heart disease at younger ages

Loud snoring is often a sign of sleep apnea (AP-nee-uh). Sleep apnea is a common sleep disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.

Sleep apnea is linked to atrial fibrillation (irregular heartbeat). Sleep apnea also may affect more than half of people with heart disease.

With obstructive sleep apnea, the most common type, the tissue in the back of the throat relaxes. This blocks airflow to your lungs and lowers the oxygen level in your blood. Your heart must work harder to pump blood through your body. This raises your risk for high blood pressure, heart attack, and stroke.

Women with sleep apnea may have different symptoms than men. The most common symptom of sleep apnea in men is loud snoring. While women may also have snoring, they may have insomnia, morning headaches, or sleepiness instead. These symptoms can be mistaken for other health problems.

If you think you might have sleep apnea, talk to your doctor. Treating sleep apnea with continuous positive airway pressure (CPAP) can lower high blood pressure in people with sleep apnea.

Smoking causes heart disease and can be even more dangerous for women than men. Women over 35 who smoke have a slightly higher risk of dying from heart disease compared to male smokers over 35. Smokers are up to four times more likely to have heart disease than nonsmokers. Even smoking in your 20s speeds up the process of developing heart disease.

Smoking raises your risk for heart disease in many ways, including:

• Smoking can cause your blood to thicken and be more likely to clot.
• The nicotine in cigarettes can raise your blood pressure.
• Smoking causes atherosclerosis, which damages your blood vessel walls.

The longer you smoke, the more your risk of heart disease and heart attack goes up.

But within one year of quitting smoking, your heart disease risk is cut in half compared to what it was while you smoked. Within 15 years, your heart disease risk is the same as a woman who never smoked.

If you smoke, do not use hormonal birth control. Many studies have found that women who smoke and take combination birth control pills (birth control pills with both estrogen and progesterone) are at even higher risk of heart disease and stroke, especially women older than 35. Like smoking, birth control pills, and possibly other forms of combination hormonal birth control like the vaginal ring or skin patch, can raise your risk for blood clots and high blood pressure. Blood clots and high blood pressure can cause a heart attack or stroke.

Secondhand smoke also can harm the heart and blood vessels of people who don't smoke in the same way that smoking harms people who smoke. There are two types of secondhand smoke. One type is the smoke that comes from the burning end of a cigarette, cigar, or pipe. The other type is smoke that is breathed out by someone who is smoking. Both types are harmful when inhaled.

E-cigarettes and your heart health

Electronic or e-cigarettes, also called vaporizer cigarettes, release water vapor. Most e-cigarettes contain nicotine, the addictive chemical found in regular cigarettes. The Food and Drug Administration regulates e-cigarettes and all other tobacco products. Researchers do not yet know the potential long-term health effects of e-cigarettes or how much nicotine or other harmful chemicals are inhaled.

Researchers also do not yet know what effect e-cigarettes have on heart health. Talk to your doctor about the dangers of e-cigarettes to your health.

Stress is your body's response to a change or a challenge. Long-term stress raises your risk of heart disease. If you have heart disease, long-term stress also makes you more likely to have a heart attack.

An emotionally upsetting event, especially one involving anger, can be a trigger for heart attack. Stress also may indirectly raise your risk of heart disease if it makes you more likely to smoke, eat unhealthy foods, or less likely to exercise.