Updated on Feb. 07, 2025
"Heart disease takes years to decades to develop, and the process starts in the younger years," one heart doctor told us. Here, cardiologists share their best-kept secrets to set up your ticker for a long run.
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Time is a scarce resource at the doctor’s office, with the average visit lasting nearly 19 minutes, according to 2023 research published in Journal of the American Medical Association Health Forum. But it’s not that your doc doesn’t want to spend more time with you. The report points to a recent estimate showing that physicians would need at least 27 hours per day to provide the level of care they want to deliver across their typical patient load.
That’s why heart doctors are eager to share everything they know about potentially life-saving heart health secrets you can use to keep your cardiovascular system strong—and what’s important for you to bring up during the limited time you have at the doctor’s office.
“When people are massively overweight, it’s an obvious issue [for their heart disease risk factor],” says Stuart Connolly, MD, the former director of the division of cardiology at McMaster University in Hamilton, Ontario. “When they’re only moderately overweight, it’s more difficult [to bring it up] because we accept people being a little overweight.”
What you should know: Certain aspects of being overweight are associated with a higher risk of heart disease—particularly central adiposity or an accumulation of weight around the belly and waist.
Additionally, “the recent SELECT trial showed that people with heart disease and [those who are overweight or obese] may obtain cardiovascular benefits from semaglutide,” says Ashish Sarraju, MD, a cardiologist at the Cleveland Clinic. This trial shows that being overweight or obese is “actionable” and is a modifiable risk factor for heart disease outcome improvement.
Body mass index (BMI) is a numerical value derived from an individual’s weight and height, explains Madhavi Kadiyala, MD, a cardiologist and the Director of Cardiac MRI & CT at Tufts Medical Center. “However, by itself, BMI is a weak indicator of cardiovascular health.” This is because it cannot distinguish between muscle mass and fat mass.
What you should know: People who have a BMI in the obesity range (greater than 30) have higher all-cause mortality, Dr. Sarraju says. But there are situations where it needs to be taken with a grain of salt, adds Joy Gelbman, MD, a cardiologist at NewYork-Presbyterian and Weill Cornell Medicine. “BMI may overestimate the degree of adiposity in very muscular individuals—and it also might underestimate it in older individuals due to age-related loss of muscle mass.”
“Patients are often surprised when they have heart attacks, despite being thin,” Dr. Kadiyala says. Research published in the Journal of the American College of Cardiology in 2021 found that excess fat around the heart—called pericardial fat—can occur no matter how much you weigh.
What you should know: Even if you’re lean, you’re still at risk of building up fat around your heart. Your waist-to-hip ratio (WHR) is a good indicator of the level of internal fat deposits around the heart and other organs, Dr. Kadiyala explains. “A waist-hip ratio of 0.9 or less in men and 0.85 or less in women is considered healthy.”
Regular exercising, eating a nutrient-rich diet, and avoiding too much sugar and processed foods can help reduce the amount of fat that surrounds your organs.
“TV personality John Oliver hit it on the nail when he said that women are not ‘men with pesky hormones’,” Dr. Kadiyala says. Women go through distinctive life changes from birth, she explains, with various hormonal changes that influence heart health. But this is an active area of research that’s still not well understood.
“Making things more challenging is that women often have atypical symptoms of heart disease,” Dr. Gelbman says. “[Women] may not have the classic sensation of chest pressure—’like an elephant sitting on my chest’—but may instead feel malaise, nausea, sweatiness, or simply ‘not right’.” Dr. Kadiyala adds symptoms like indigestion, back pain, arm and jaw pain, or extreme fatigue as potential symptoms.
“These are often misdiagnosed as unrelated to the heart,” she says—and that women’s heart disease often only gets the appropriate medical care when it shows up like men’s heart disease, a phenomenon called Yentl’s syndrome.
What you should know: Women need to take any new symptoms seriously and press their medical providers to consider the possibility of a cardiac cause, Dr. Gelbman emphasizes. This is especially true if new symptoms occur during physical exertion or emotional stress, adds Dr. Kadiyala.
Womens’ heart disease risk spikes post-menopause, Dr. Kadiyala says. “Declining estrogen during menopause leads to an increase in LDL—or bad—cholesterol, which increases cardiovascular risk.”
Autoimmune conditions such as Rheumatoid arthritis, lupus, scleroderma, and psoriasis lead to systemic inflammation, which can accelerate atherosclerosis (the thickening or hardening of arteries), Dr. Kadiyala says. “There is a higher prevalence of autoimmune conditions in women, and it is important to recognize that they may be at higher than expected risk for heart disease.”
But women can have other sex-specific risk factors. In particular, “pregnancy is a condition that allows us to glimpse into future cardiovascular risk and can be considered a stress test for women,” Dr. Kadiyala says. Certain pregnancy issues can indicate blood vessel problems that can spell heart trouble later in life.
What you should know: Early menopause, infertility, polycystic ovary syndrome, and pregnancy complications like gestational hypertension, preeclampsia, or diabetes are all heart disease risk factors specific to women, Dr. Gelbman says. This is important information to share with your physician, as “most doctors won’t ask a 50-year-old woman about her pregnancy health from 25 years ago,” says Malissa J. Wood, MD, co-director of the Women’s Heart Health Program at Massachusetts General Hospital.
It’s all about the types of fat you consume, the experts emphasize. “Saturated and trans fats are the predominant culprits in raising LDL (bad cholesterol), [which] causes plaque to form inside the blood vessel,” Dr. Kadiyala says. “Think of plaques as tiny pimples inside your blood vessels.” Conversely, incorporating healthy fats rich in omega-3 fatty acids is highly recommended for heart health.
What you should know: Saturated fat is present in red meat and full-fat dairy products, while trans fats are found in processed foods, baked goods, and margarine, says Dr. Kadiyala.
“Excessive sugar and refined carbohydrates are linked to obesity, insulin resistance, and diabetes—all of which increase the risk of heart disease,” Dr. Kadiyala says.
But that doesn’t mean you need to stop eating fruit or other foods that naturally contain sugar. A 2023 study in BMC Medicine specifies that “free sugar” intake, or sugars added to processed food, is what causes inflammation in the body and stresses the heart and blood vessels.
What you should know: Refined sugar added to processed foods has effects on the body that contribute to heart disease (and other chronic diseases, like diabetes). This is why reading labels is so important, too. “Low-fat” or “low-calorie” products may have been processed to remove dangerous fats—but often add sugar to enhance lost flavor. But sugar in whole, intact foods is generally a healthy part of a balanced diet.
Diet regimens such as paleo, keto, Atkins, interval, zone, and Whole 30 claim dramatic short-term results—however, they have not met the American Heart Association’s science-based criteria for heart-healthy diet, says Dr. Kadiyala.
“The main approach I recommend is to follow a proven, healthy pattern rather than spending a lot of time on specific macronutrients or supplements, adds Dr. Sarraju.
These include well-researched approaches like The Mediterranean diet pattern, the DASH diet pattern, or a whole food plant-based diet pattern, he says.
What you should know: The most important dietary consideration is consistency. A blended diet focused on heart-healthy foods you enjoy—and can sustain—is better than following a strict regimen you can only keep up with for a short time, Dr. Gelbman says.
People will come in and say, “My grandma died of a heart attack when she was 80, so heart disease runs in my family,” explains Sarah Samaan, MD, FACC, FACP, FASE, a retired cardiologist, Master Certified Physician Development Coach, and author of Best Practices for a Healthy Heart. But that’s not necessarily true—everyone has to die of something.
That said, there are genetic conditions that present increased cardiac risk, says Dr. Sarraju. One heritable condition is having elevated levels of lipoprotein (a). Lipoproteins carry cholesterol through your bloodstream to your cells, and elevated levels can indicate a higher risk of heart disease, even if your cholesterol levels are in a healthy range.
In addition, “the heritability factor is estimated to affect 40-60% of patients with coronary artery disease,” Dr. Kadiyala says. This is due to another genetic condition called familial hypercholesterolemia, inherited high cholesterol that increases the risk of premature coronary artery disease.
What you should know: The genetic link for heart disease is more strictly defined than you might think. Talk to your doctor about preventative heart disease measures if:
Hypertension (high blood pressure) is a major risk factor for heart disease—and it’s another condition that can have genetic ties. That said, 2023 research in the International Journal of Hypertension suggests that while some people may be predisposed to hypertension, lifestyle factors can play a major role in this genetic expression (meaning your family history does not doom you).
For instance, “a sedentary lifestyle, excess alcohol, and stress all put you at a higher risk for hypertension,” says George L. Bakris, MD, an internationally recognized expert in hypertension and kidney disease. And the scary thing about high blood pressure is that it can persist for years—causing body-wide damage—without any noticeable symptoms.
What you should know: A healthy lifestyle is key to hypertension prevention, Dr. Bakris says.
If you have a high risk of hypertension (or are already managing the condition), home blood pressure readings can actually be more accurate than at the doctor’s office. “I see a lot of white-coat hypertension,” explains Dr. Samaan, which refers to the anxiety people experience being around doctors, which makes their blood pressure rise.
What you should know: Here’s how to get the most accurate blood pressure reading, according to Dr. Bakris: “Sit with your legs uncrossed and your back fully supported and rest for five minutes. Then roll up your sleeve and rest your arm on a table or armrest. The room should be silent and you should not be talking, listening to music, or watching TV.”
The relationship between Covid-19 and cardiovascular disease is an active area of research, explains Dr. Kadiyala. “There appears to be an increased risk of myocarditis (inflammation of the heart), arrhythmias (irregular heartbeat), and thromboembolism (blood clots) with Covid-19,” she says. However, any long-term cardiovascular effects of Covid are still being studied.
What you should know: “It is pertinent for patients to discuss recent Covid illness with their physicians,” Dr. Kadiyala says.
“Misconceptions exist around exercise,” Dr. Gelbman says. “Some patients think this has to mean joining a gym and doing a formal regimen—which can be intimidating.”
What you should know: When it comes to heart health, Dr. Gelbman wants people to know that even brisk walking, gardening, or cleaning the house can be a form of exercise. “Anything that gets the heart rate up for at least 30 minutes most days of the week should be the goal.”
“If patients want to do one thing for their health, it would be to stop smoking,” Dr. Connolly says. “Even quitting in your 70s improves survival.” Smoking causes inflammation, increases blood pressure, and accelerates atherosclerosis—but it is considered a major modifiable risk factor.
What you should know: “Quitting smoking significantly reduces the risk of heart disease so much that former smokers can reduce their cardiac risk to that of non-smokers after long-term abstinence,” Dr. Gelbman says.
Not getting enough sleep is strongly associated with heart disease risk. Dr. Kadiyala says the American Heart Association recommends seven to nine hours of high-quality sleep for adults.
But if you’re getting “enough” sleep and still feel tired in the morning—or your partner complains about your snoring—these could be signs of sleep apnea, “A condition that can lead to increased cardiac risk, hypertension, elevation pulmonary pressures, and arrhythmia,” says Dr. Gelbman.
What you should know: Getting enough sleep is important for heart health. But “poor sleep can be a sign of obstructive sleep apnea, which requires specific treatments, so making that diagnosis is important,” Dr. Sarraju says.
It’s true that studies suggest certain components of red wine known as polyphenols may have cardioprotective effects, Dr. Kadiyala explains. But there’s wide variability among individuals—and some people may be more susceptible to the negative effects of alcohol than others.
The same wisdom goes for dark chocolate. It is good for you—it lowers blood pressure and has antioxidants—but most people are not eating just the recommended one ounce per day.
What you should know: In general, “if you don’t drink red wine currently, I would not recommend starting just for perceived benefits,” Dr. Sarraju says. “If you enjoy a drink every now and then, red wine is probably better than cocktails or beers that have lots of empty calories.”
If your gums bleed when you brush or floss, this is a common sign of gum disease—inflammation of your gums. “If you have lots of inflammation in your mouth, it’s a sign your whole body is experiencing an inflammatory response,” says Stephen Sinatra, MD, FACC, FACN, a former cardiologist, bioenergetic psychotherapist, and author of numerous books about heart health.
What you should know: Dr. Sinatra says patients with gum disease tend to have a higher risk of heart disease. If you’re unsure, ask your doctor to check your mouth.
Stress activates parts of your body that release hormones like adrenaline and cortisol. “[These hormones] increase the heart rate, blood pressure, and cardiac output,” Dr. Kadiyala says. When facing a sudden, stressful situation—like encountering a bear in the woods—this response enables our fight-or-flight response, which is necessary for survival.
“Chronic stress, however, leads to a low-grade, long-term hyperadrenergic state, resulting in high blood pressure, arrhythmias, inflammation—all of which contribute to heart disease.” Ongoing stress also makes it difficult to follow healthy lifestyle patterns, adds Dr. Sarraju.
What you should know: To protect your heart health, it’s important to find ways to relieve stress in your life, Dr. Gelbman advises. “These might include things like taking a walk, being outdoors, stretching, breath work, listening to music, or meditation.”
“Depression, anxiety, post-traumatic stress disorders are conditions long known to be associated with higher cardiovascular risk,” Dr. Gelbman says. In particular, anxiety can increase your heart rate and blood pressure, causing symptoms that overlap with heart disease, Dr. Sarraju explains.
What you should know: Treating mental health is an important part of overall heart disease care. Unfortunately, it’s easier for doctors to prescribe medication for mental health conditions than addressing the root cause, Dr. Sinatra explains. If you’re struggling, ask your doctor for a referral to a behavioral health specialist.
Doctors who strongly recommend certain supplements are often the ones selling them in their office, says Dr. Samaan. One of the latest trends is the use of adaptogens, herbs, roots, and other plant substances that may promote heart health.
“There’s no clinical evidence to support the use of adaptogens, especially focusing on cardiovascular health,” Dr. Kadiyala says. “However, there is limited data on adaptogens—such as ginseng-like herbs—which help with hormonal balance and stress, which in turn can offer some cardiovascular benefits.”
When it comes to supplements, most doctors agree that you should be getting the nutrients you need from food (unless you have dietary restrictions or malabsorption conditions). But this may not always be realistic. “For primary prevention, if you’re not eating fish two to three times a week, then fish oil is probably a good idea,” Dr. Samaan says. “I also recommend vitamin D because 80% of U.S. adults are deficient. Those are the only two I take.”
What you should know: Supplements won’t “protect” your heart. But speak to your doctor if you think you could benefit from adding heart-healthy supplements to your diet.
Heart palpitations or arrhythmia can be a feeling that people variably describe as “skipped beats,” “hard beats,” fluttering, or pounding—which can all seem a bit scary.
Yet they are “one of the most common complaints cardiologists see,” explains Todd Hurst, MD, FACC, FASE, a board-certified cardiologist and founder of HealthspanMD. They’re often harmless, linked to causes like caffeine and stress.
What you should know: If you’re experiencing heart palpitations that last more than five minutes, cause lightheadedness, or if you have a history of heart disease, you should see your doctor, Dr. Hurst says. Also note that some heart palpitations or murmurs are not detectable without a professional’s help—so stay on top of preventative checkups. In some cases, such a condition can be life-threatening.
“Erectile dysfunction is also a marker of blood vessel disease,” says Dr. Wood. “My own father found out that he had a blockage in his neck when he went in for a prescription for [ED].”
In addition, many people think they’re slowing down because of “old age,” but it could be a sign of developing heart disease, says Monali Desai, MD, NBE, CBNC, ABIM, a quadruple-board-certified cardiologist with UnityPoint Health in Iowa. “I ask patients to keep track of how long it takes them to walk one mile—from year to year, there should not be dramatic changes in how long it takes.”
What you should know: If you experience sudden changes to your health or ability to carry out your normal lifestyle, make sure to check in with your doctor.
People used to start getting stress tests at age 50 and then get them yearly, Dr. Samaan says. “But a stress test will only pick up blockages of 70% or greater—a normal test doesn’t mean you don’t have blockages.”
What you should know: Dr. Samaan says that there’s no medical reason to have a stress test unless you have symptoms like chest pain, shortness of breath, or an abnormal EKG. “It’s become a patient security blanket, and many insurance companies no longer cover them [for preventive reasons].”
Multiple studies conducted by the National Institutes of Health have found that stents and surgery are no better than medication and lifestyle changes at reducing cardiac events. “And once you do a stent, then you need to do another, and the problem can proliferate,” Dr. Wood adds. “In the absence of a severe blockage, treating with medication is just as good.”
The one caveat? Stents may provide a higher quality of life for those with chest pain.
What you should know: Studies now show that medication and lifestyle changes provide comparable, less invasive treatment for blocked arteries (for most people).
There’s been a huge roll-out of generic drugs over the last few years, and this is key for anyone who wants to lower their drug costs, Dr. Samaan says.
What you should know: “Ask me about [discounted medications],” Dr. Samaan urges.
“‘What do you think I could be doing better?’ is such a simple question, but it encompasses everything about risk reduction,” Dr. Sarraju says. “I love it when patients ask me this directly.” Similarly, he says that he appreciates when patients are transparent about their lifestyle, diet, and exercise. “Don’t be apologetic or shy about enjoying some pizza on your birthday—just tell me about it,” he says.
What you should know: Ask your doctor any questions you have, and don’t be shy about providing information, even if you’re embarrassed or not sure if it’s important. “My job is never to judge, only to inform, and I can do that best if I know everything well,” he adds.
“Heart disease takes years to decades to develop, and the process starts in the younger years,” says Dr. Sarraju. You are born with the best-shaped, most efficient heart you will ever have, adds Christopher Hanifin, EdD, PA-C, a physician assistant, Department Chair, and Assistant Professor at Seton Hall University. If you do things that stress your heart, it can cause your heart to change its shape a little in response—which makes it work less efficiently, causing more stress. “The next thing you know, a person can find themselves on a fast downward spiral.”
But there’s a silver lining, says Dr. Sarraju: “Healthy habits and regular healthcare in your younger years can have a positive compounding effect over time.”
What you should know: Nobody is too young to start preventive measures for heart disease, says Dr. Sarraju.
One of the most important—and challenging—things to do in cardiology is to determine an individual patient’s risk for future heart problems like heart attack, heart failure, and even death, says Dr. Hurst. “The amount of risk is the most important factor in deciding the best treatment,” he says. “All treatments have potential side effects—so if a patient is at low risk, it makes sense to be conservative in choosing treatment options. However, if a patient is at high risk, it may make sense to recommend more aggressive treatment options.”
What you should know: People should take an active role in understanding their own cardiovascular risk, Dr. Kadiyala says. This can help you understand your doctor’s recommendations—and ask for the right tests (such as risk markers like lipoprotein Lp (a), Apo B, inflammatory markers, or imaging with calcium scoring of heart arteries) that can refine risk and guide management strategies.
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