Smoking is a greater risk factor for heart disease in women than it is in men.

Wells urges her patients who smoke to quit. But she acknowledges that smoking “is the most difficult habit to beat, because it’s psychologically addictive. If you fail [to quit] one time, that’s not permanent. Keep trying.”

Losing weight reduces the heart’s workload and decreases your chance of developing diabetes.

“If most overweight is carried in the belly, compared to the thighs, there’s a higher risk of insulin resistance,” says Wells. “Women with waists of thirty-five inches or more and men with waists of forty inches or more are at risk [of insulin resistance],” she explains.

The Nurses’ Health Study followed a large cohort of nurses for many years to observe the long-term effects of their lifestyle habits on their health. The research has led to many insights including information on cardiovascular disease. The study demonstrated that women who exercise, walking briskly 30 minutes for five out of seven days a week, reduce their risk of a heart attack by 50%.

Wells makes sure her patients know how much exercise can help them protect their health. “I tell them it’s more effective than all but a few medicines I can prescribe,” she says.

While there are other biomarkers that can be considered in assessing heart disease, Wells wants her patients to keep track of their blood glucose, cholesterol and blood pressure measurements.

• Blood glucose should be less than 100.
• LDL cholesterol (the bad kind) should be less than 100, ideally less than 70.
• HDL cholesterol (the good kind) should be greater than 50. If it’s less than 50, there’s a problem.
• If blood pressure is higher than 130/85, you need to talk to a doctor.

Get tested for diabetes if you are experiencing excessive thirst and frequent urination. If you already have the disease, closely monitor your blood glucose level and stick to your doctor’s treatment plan.

Women who have diabetes are more likely to develop heart disease than men with the condition. Also, because diabetes can change the way you feel pain, you’re at greater risk of having a silent heart attack — without symptoms — says Mayo Clinic.

Your doctor can suggest lifestyle changes you can make to lower blood pressure. Wells recommends the DASH (Dietary Approaches to Stop Hypertension) diet to lower blood pressure and develop healthy eating habits.

The diet promotes a variety of foods rich in nutrients that help lower blood pressure, such as potassium, calcium and magnesium. It also recommends reducing your sodium intake.

Talk to your doctor about whether you should be taking an aspirin regularly (or any other medications for that matter). Aspirin helps some patients avoid heart attacks by keeping their blood thinner, but is not recommended for everyone.

“Recent metanalyses of earlier studies indicate aspirin may not be beneficial for primary prevention,” says Wells. “That should be decided on an individual basis by the patient and physician,” she adds.

Wells reminds her patients that the Type-A personality (people who are highly competitive, risk-takers and impatient) has been strongly associated with heart attacks in men; studies have not yet been definitive for women. She says the quick-to-anger trait goes with the personality and is not a response to working in a demanding job.

Exercise, meditation, journaling and keeping a gratitude list have all been shown to reduce stress. “We’re learning more about optimism and positivity in women,” says Wells. “The Women’s Health Initiative [study] has shown that higher optimism is associated with higher outcomes of good health,” she adds.

Wells’ mother suggested this action to learn more about your family’s medical history. Heart disease runs in families. Wells says you should find out exactly what type(s) of heart disease your family members had, or have, and discuss it with your doctor.

And if you have any concerns about your heart health, don’t wait. Wells says you should schedule an appointment with your physician as soon as possible.