Age and heredity

Increasing age and heredity (including race) are two major risk factors for heart disease and stroke that women can't control. As women age, their chance of developing heart disease increases. Approximately four of five people who die of heart disease are 65 or older.

If your family has a history of heart disease, you're more likely to develop heart disease. Risk is higher for African-American women, whose death rate is 69 percent higher than the rate for white women. Women who have had a previous heart attack, stroke, or transient ischemic attack (TIA) sometimes known as a temporary "mini-stroke", also face a greater risk.

Type 2 diabetes

Because women withType 2 diabetes have high levels of insulin in their bloodstreams, they're more prone to blood clots. This may explain why 75 percent of people with Type 2 diabetes die of heart attacks or strokes. Women with diabetes are three times more likely to die of heart disease than women without diabetes. Type 2 diabetes doubles the risk for a second heart attack in women, but not in men.

Although there is no cure for Type 2 diabetes, women can help control this medical condition by maintaining a healthy weight and exercising regularly. A recent study published in the Journal of the American Medical Association (JAMA) found that women with Type 2 diabetes could reduce their risk for heart attack or stroke by exercising regularly. Based on findings from this long-term CVD risk study of 3,000 people, researchers believe that regular exercise may improve a person's ability to dissolve blood clots and possibly lower the risk for CVD. Exercise makes the body more receptive to the effects of insulin.

Menopause

During menopause, women stop producing the sex hormone estrogen, which offers some protection against heart disease. In recent years, doctors used hormone replacement therapy (HRT) to restore estrogen to pre-menopausal levels and to reduce a woman's risk for cardiovascular disease (CVD). But because of recent clinical trials, the American Heart Association recommends that HRT should NOT be used to prevent a second heart attack to reduce a woman's risk for CVD.

Smoking

If you smoke, you're two to six times more likely than a nonsmoker to have a heart attack. Consider these facts:

• Studies show that the more cigarettes you smoke regularly, the greater your  risk for heart disease.
• There's a direct link between smoking and atherosclerosis.
• Smokers who take birth control pills are at the greatest risk for a heart attack  and stroke.
• Constant exposure to secondhand smoke increases a woman's risk for heart  disease.
• Smoking also boosts the risk for stroke.

Homocysteine

Women with high levels of the chemical homocysteine in their blood may have an increased risk for developing heart disease, stroke, and poor circulation in their hands and feet. Researchers are not sure how high levels of homocysteine affect the heart, but they believe that it damages the arteries, which makes the blood more likely to clot and the blood vessels less flexible. Sometimes high levels of homocysteine run in families; other women may develop the problem after menopause.

If you have a high homocysteine level, ask your doctor for additional information.

A good way to keep your homocysteine levels in check is to eat plenty of foods rich in folic acid (citrus fruits, tomatoes, lentils, beans, and fortified cereals and grains), vitamin B6 (meat, poultry, fish, fruits, vegetables, and grain products), and vitamin B12 (meat, poultry, fish, and dairy products).

High blood pressure

Women with high blood pressure face a greater risk for stroke, heart attack, or heart failure. Although high blood pressure is more common in men, postmenopausal women also have a high risk for developing the condition. In many cases, women can help control their blood pressure by maintaining a healthy weight, limiting alcohol intake to one drink per day, exercising regularly, following a heart-healthy diet, and reducing stress. However, some people may require medications to lower their blood pressure.

Chronic stress

Chronic stress can possibly contribute to heart disease by prompting the body to produce "fight-or-flight" hormones, like adrenaline, that constrict coronary arteries and promote blood clots. The good news is you can help control the stress in your life by eating nutritious foods, getting enough sleep, and exercising on a regular basis. Many women have found relief by taking stress-management courses, as well.

Obesity

Obesity not only doubles your risk for heart disease and stroke, but it also increases your likelihood for developing diabetes, hypertension and high cholesterol, which all contribute to heart disease. If you're overweight, talk to your doctor about sensible ways to lose weight and eat healthfully.

Body Mass Index

Body mass index, or BMI, is a measure of weight for height. It is used to gauge weight status in adults. Weight status categories include: underweight, normal, overweight and obese.

Calculate your BMI.

While the BMI calculator can give you a good indication of your body mass index, it's important to note that BMI varies with age, gender, race and physical build.

High triglyceride/cholesterol levels

Women can reduce their risk for heart disease by controlling their triglyceride levels (levels of the most common type of fat in our bodies). About 25 percent of American women have high cholesterol levels (240 mg/dL or above), and more than half of women over age 55 in the United States need to lower their blood cholesterol. This waxy substance can cause hardening of the arteries (atherosclerosis), the major cause of heart attacks.

Although excess weight tends to increase your blood cholesterol level, heredity and diet also contribute to the condition. High cholesterol can run in families, and a diet high in saturated fat and cholesterol can cause high blood cholesterol levels. The good news is that you can lower your blood cholesterol levels and, in turn, slow, stop, or even reverse buildup in the arteries by adopting a healthy lifestyle. (For more information, see the section on Cholesterol Management.)

The deadly quartet

Obesity, diabetes, high blood pressure, and high triglyceride levels are sometimes called "the deadly quartet." According to a recent study, women are more likely to die if they have only one of the four risk factors, but women with all four have 5 times the risk for death as men with the "deadly quartet." Additionally, women with this combination are up to 12 times more likely to die than men during the first 10 years following coronary bypass graft surgery.

Physical exercise

Because the heart is a muscle, its performance improves with exercise. Regular exercise helps prevent heart attack and stroke by lowering blood pressure and low-density lipoprotein cholesterol (LDL, the bad kind). Exercise also makes blood vessel walls more flexible and, in turn, helps prevent hardening of the arteries and may help raise HDL cholesterol (the good kind.)