Butt out: "Cigarette smoking more than doubles a woman's odds for developing coronary heart disease," says Nieca Goldberg, M.D., medical director of the Joan H. Tisch Center for Women's Health in New York City. Within one year of quitting, your risk decreases by 50 percent.
Move more: The American Heart Association recommends at least 30 minutes of moderate-intensity aerobic activity -- that's brisk walking, biking, or dancing -- at least five days a week. If you can't spare that half-hour all at once, 10 to 15 minutes at a time works, too. Also aim for 20 minutes of strength training twice a week. This helps you build muscle and keep your metabolism revved.
Keep track of your pregnancy: Gestational diabetes or preeclampsia (high blood pressure during pregnancy) raises the risk of diabetes or heart disease later in life. Make sure your regular doctor makes note of these conditions in your medical history. A related concern: Polycystic ovarian syndrome also raises your risk for developing heart disease.
Make sleep a priority: Your heart needs its z's. Research shows that people who slept fewer than six hours a night were twice as likely as to experience a stroke or heart attack as those getting six to eight hours of shut-eye.
Know your numbers: At your annual checkup, make sure your doctor checks your cholesterol and blood pressure.
Take a 10-minute time-out: You might be feeling double-whammy stress from caring for kids and aging parents. Unchecked stress can lead to high blood pressure, higher cholesterol, and artery damage, so incorporate relaxation techniques into your daily routine, whether you do meditation, yoga, or easy deep breathing.
Have a baseline electrocardiogram: This test checks your heart rate and the strength of electrical signals as they pass through your heart's chambers. Ask your doctor for one around age 45.
Keep tabs on cholesterol: As you approach perimenopause, your numbers can change. Declining estrogen levels can cause LDL and triglycerides to increase and HDL to drop.
Check for diabetes: Start at 45 and, if results are normal, retest every three years, Goldberg says.
Remember the hormone connection: Recent research from Johns Hopkins University found that women who go through menopause before age 50 are at an increased risk of heart disease. Discuss the menopause-heart disease link with your regular health care provider.
Tell your doctor about any unusual fatigue: One study of more than 1,500 female heart attack survivors found that the majority had symptoms months before the event. The most common sign was unexplained fatigue that interfered with everyday activities, for example, having to rest between making sides of the bed. Describe to your physician how fatigue impacts your daily activities rather than just reporting that you're tired, advises Jean McSweeney, Ph.D., R.N., associate dean for research at the College of Nursing, University of Arkansas for Medical Sciences.
Fine-tune your diet: "You may not be as efficient at metabolizing starch and sugar as you get closer to menopause," Goldberg says. The American Heart Association recommends limiting your intake of added sugars to lower your heart disease risk. Also cut back on simple carbs -- like pretzels and other packaged snacks -- as well as processed foods, which are high in sodium. And eat plenty of fruits, vegetables, whole grains, and at least two 31⁄2-oz. servings a week of oily fish like salmon.
Test for C-reactive protein: Women who have elevated levels of C-reactive protein, a measure of inflammation in the blood, might benefit from going on cholesterol-lowering therapies, even if their cholesterol is normal, Goldberg says.
Maintain your social network: Research has found that strong social ties can help ward off heart disease, says Kathi L. Heffner, Ph.D., assistant professor of psychiatry at The Rochester Center for Mind-Body Research, University of Rochester Medical Center. Make time to see loved ones at least once a week. And consider forging new connections by joining a local club of your interest or doing volunteer work -- at a soup kitchen or community garden, for example. Studies show the more varied your network is, the healthier you'll be.