Your heart is with you every moment of your life, but the way you take care of it shouldn't look the same at 25 as it did at 65. Cardiovascular Disease leading cause of death in the USand heart health risks increase with age. But the good news is that most of the damage can be prevented with the right habits and timely checks.
Here's a decade-by-decade guide, with advice from cardiologists on how to protect your heart from adolescence to your golden years.
Your heart health may be the furthest thing from your mind when you're in your twenties. But now is the time to develop habits that will support your heart for years to come, says Dr. Romit Bhattacharya, a preventive cardiologist at Massachusetts General Hospital. These heart-healthy habits include getting enough physical activity every day, not smoking or vaping, eating a plant-based diet, and getting seven to nine hours of sleep each night.
“These fundamentals promote long-term heart and brain health,” he says.
According to Bhattacharya, by age 20 the heart has reached its adult size and capacity. Cardiac output (how much blood the heart pumps per minute) is high and the heart muscle is very efficient. But research shows that even by this age, fatty streaks and cholesterol deposits (called plaque) can form in your arteries, especially if you smoke, have a poor diet, or have a family history of heart disease.
“That's why now is the time to think about screenings,” says Dr. Deepak Talreja, clinical director of cardiology at Sentara Cardiology Specialists in Virginia.
“Blood pressure should be checked starting at age 18, with follow-up checks every three to five years if it is normal or annually if it is elevated,” he says. “Cholesterol testing should begin by age 20 if risk factors exist, and early detection of abnormal blood sugar levels is also key.”
Your 30s are often peak years for career development, parenting, and financial stress. Although your heart is still strong and resilient, subtle changes often begin to appear during this decade.
“Chronic stress, anxiety, depression and poor sleep increase blood pressure and inflammation, and increase the risk of heart attack,” says Bhattacharya. “Work stress alone increases the risk of coronary heart disease by approximately 30%.”
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Exercise is especially important after age 30, says cardiologist Dr. Lars Sondergaard, chief medical officer and vice president of Abbott's heart business unit. “Even moderate exercise, such as brisk walking for just 20 minutes a day, can significantly improve a person's health,” he says.
Sleep is also vital, Sondergaard adds. Deep, restorative sleep not only reduces inflammation, but also supports emotional regulation, allowing you to better cope with life's challenges. Social connections may also play a protective role; strong social networks are correlated with lower stress levels and longer life expectancy.
And impressions remain important. Talreya emphasizes that stress can indirectly worsen cardiovascular health by encouraging unhealthy habits such as overeating, sedentary lifestyle and alcohol consumption, so regular checkups are crucial. Blood pressure, cholesterol levels and metabolic markers should be monitored, and lifestyle changes should be increased.
By middle age, you may not have any noticeable symptoms, but subtle changes in blood pressure, cholesterol, or glucose levels can be a sign of future heart problems.
“At age 40, hidden risks start to surface, so this is the decade to move beyond 'feel good' and start measuring what matters,” says Bhattacharya. “Blood pressure, cholesterol and blood sugar remain the basics, but consider advanced screening” if you have a family history of cardiovascular problems. Consult your doctor if your risk is unclear.
He adds that for those at higher risk, a coronary calcium scan or CT coronary angiography can detect early plaques long before symptoms appear.
Monitoring cholesterol levels continues to be critical during this decade. “The most important indicator of cholesterol levels is LDL, also known as bad cholesterol, followed by non-HDL cholesterol,” says Dr. Jeffrey Berger, director of the NYU Langone Hart Center for Cardiovascular Disease Prevention. “Even if HDL is highelevated LDL increases the risk of cardiovascular disease and the speed should be reduced.”
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Regular monitoring—annual blood pressure checks, regular lipid tests, and glucose monitoring—can identify problems early, and lifestyle changes or other interventions before serious disease develops can protect your heart.
Subtle warning signs can appear as early as age 40. Fatigue, shortness of breath during activity, pain in the calves when walking, or unusual exercise intolerance may signal problems with the cardiovascular system.
Dr. Srihari S. Naidu, director of the cardiac catheterization laboratories and hypertrophic cardiomyopathy program at Westchester Medical Center, says most people think they are asymptomatic because they don't feel chest pain or obvious shortness of breath, but it's often because they've subconsciously stopped overexerting themselves.
“It's important to pay attention to how your body reacts during exercise,” he adds.
During this stage, hormonal changes begin to alter the risk of cardiovascular disease.
In women, menopause often leads to LDL cholesterol levels increaseincreased blood pressure and a shift in fat distribution from the hips and thighs to the abdomen. Men experience a gradual decline in testosterone levelswhich may increase the risk of developing metabolic syndrome and diabetes.
“Traditionally, we thought that loss of estrogen eliminated the protective effects of lipids, but hormone replacement trials have shown that this is more complex than previously thought,” Talreya says.
“Because of this, hormone replacement therapy is not recommended for the prevention of cardiovascular disease and should only be considered for severe vasomotor symptoms.”
Read more: Why does menopause treatment always involve diet?
Testosterone replacement therapy in men is also not recommended for primary prevention due to potential risks. Instead, Berger recommends focusing on maintaining a healthy lifestyle and regular screenings to detect early illnesses during this time.
“Healthy habits, especially diet and exercise—both aerobic activity and strength training—support better hormonal balance and heart health,” he says.
By the time you reach 60, your heart has been working hard for decades, and changes that began earlier in life may become more noticeable. The heart muscle may have thickened slightly and the arteries may have tightened, which could increase blood pressure. In women, the protective effect of estrogen wanes after menopause, so the risk of cardiovascular disease in women has increased by this decade.
Because of these factors, many people already have one or more cardiovascular diagnoses: hypertension, high cholesterol or type 2 diabetes. In these cases, the emphasis shifts from prevention to careful management of existing conditions.
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“Even for people with risk factors or a strong family history, preventive treatment is the key to preventing the disease,” says Berger. “We need to be proactive in primary prevention (before disease develops) to avoid disease progression and the need for secondary prevention (after a heart attack).”
Adherence to treatment, cardiac rehabilitation after a heart attack or stroke, and vaccinations to prevent infections that put strain on the heart are critical. “It’s time to acknowledge the hidden disease,” says Naidu.
“Heart valve problems often start unnoticed,” says Dr. Columbus D. Batiste, a cardiologist and co-founder of the nonprofit Healthy Heart Nation. “Stay alert, report any changes to your doctor, and decide together whether an echocardiogram is right for you.”
By the time you reach 70, your heart will be beating non-stop. over 2.5 billion hits. Even if you took excellent care of it, age-related changes become more pronounced this decade. Some changes are a normal part of aging, while others reflect accumulated cardiovascular risk.
Blood pumping efficiency decreases, arteries become less flexible, valves often wear out, and rhythms become more frequent.
At age 70 and older, heart health becomes as much a quality of life issue as prevention.
“Growing older in the 70s is no longer a single story,” says Bhattacharya. “Those who have maintained healthy habits throughout their lives often look and feel like people in their 50s or 60s. For others, the priority is making medications easier to take, establishing safe blood pressure and glucose levels, and avoiding falls or drug interactions.”
Staying active, eating well and taking prescribed medications is still important, Berger said. Just as important, he adds, is making sure your care is well coordinated. Focus on mobility, safety, and activities that bring you happiness because emotional well-being directly supports heart health.
Shared decision-making with family and health care teams helps ensure health care meets personal goals, especially as complex conditions accumulate. At this stage, the goal is independence and quality of life: using the least amount of the most effective measures to keep people strong, resilient and connected to the things they value most.
“As far as possible, patients of all ages, but especially the elderly, should consider who else can help them make medical decisions when needed,” says Talreya. Think about exactly how you want your heart health (and overall health) to be addressed at this stage, such as whether you want CPR performed in an emergency or on a ventilator if you're incapacitated. Having made heart health a habit over the previous decades, thinking about what's best for your heart will by now become second nature.
Correction, September 24.
The original version of this story misinterpreted two quotes about heart problems. These were quotes from Dr. Columbus D. Baptiste and not from Dr. Srihari S. Naidu.
