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" As you hit one of those big birthdays, you probably worry more about new wrinkles than about less visible body parts \u2014 like your heart. But recent research has found that each decade of your life is a crossroads, with new health concerns to worry about. What&amp;#039;s more, you need to be aware of these issues \u2014 because your doctor may not be. &amp;quot;Many physicians fail to recognize how much a woman&amp;#039;s risk factors for heart disease evolve over her lifetime,&amp;quot; says Nieca Goldberg, M.D., medical director of New York University&amp;#039;s Women&amp;#039;s Heart Center. So throw a party, buy a more potent wrinkle cream, then learn how to keep your heart healthy now \u2014 and at each milestone ahead. Your 30s: Get Smart You know that your kid&amp;#039;s unfinished fries and burger do not qualify as heart-healthy. Ditto for birthday cake, cheese puffs (even if they&amp;#039;re organic), and all the other fat-laden, artery-clogging fare you may encounter as a mom of young children. But your biggest heart hazard may be in your head, not on your plate. &amp;quot;Women in their 30s often think they&amp;#039;re too young for heart disease, even though they&amp;#039;ve already developed serious risk factors,&amp;quot; says Sarah Samaan, M.D., a cardiologist at Legacy Heart Center in Plano, TX. In fact, as many as 60 percent of women under 40 have at least one high-risk factor, such as smoking, elevated cholesterol, or obesity \u2014 which triples their heart attack odds. To lower those chances, you need to know where you stand. Almost 20 percent of women have never had a blood cholesterol test, although the American Heart Association recommends one at least every five years starting at age 20 (see &amp;quot;Your Checkup Checklist,&amp;quot; below). You still have plenty of time to shape up before you hit the really high-risk years. Make an appointment with your doctor to review where you stand; then get serious about quitting smoking, losing weight, eating right, and exercising. (For how-tos, go to &amp;quot;Jump-Start a Healthy Heart&amp;quot;.) Do you need to reconsider the Pill? Yes \u2014 if you&amp;#039;re over 35 and have high cholesterol, uncontrolled high blood pressure, or a BMI over 30, or you smoke. Oral contraceptives \u2014 especially older versions with high doses of estrogen \u2014 worsen these heart disease risk factors and increase the chance of blood clots. Newer, lower-dose Pills may be safer, though there aren&amp;#039;t data yet to confirm this. But as long as you don&amp;#039;t have any of those risk factors, &amp;quot;you can safely use the Pill until age 50 or until you reach menopause,&amp;quot; says C. Noel Bairey Merz, M.D., director of the Women&amp;#039;s Heart Center at Cedars-Sinai Medical Center in Los Angeles. Surprising Hidden Risks \u2022 Missed periods. Just about everyone skips from time to time, but women with long histories of irregular cycles at age 35 have a 50 percent greater chance of eventually having a heart attack, a large Harvard study reported. It may be because erratic cycles are frequently linked with obesity. They&amp;#039;re also a sign of polycystic ovary syndrome (PCOS), a common hormonal disorder that raises the risk of high cholesterol, high blood pressure, and diabetes, as well as infertility and acne. Medication and weight loss (if needed) can get symptoms under control \u2014 and should reduce your heart risk, says Anuja Dokras, M.D., an ob-gyn at the Hospital of the University of Pennsylvania. Still, to be on the safe side, she advises her PCOS patients to get cholesterol and blood sugar checks every other year. \u2022 High blood sugar in pregnancy. You don&amp;#039;t have to have had full-blown gestational diabetes \u2014 even the suspicion of the disorder is heart-risky. A University of Toronto study found that women who &amp;quot;fail&amp;quot; the glucose screening test that&amp;#039;s routinely given in pregnancy have a 19 percent increased risk of heart disease over the next 12 years \u2014 even if they pass the second, definitive test and do not have the disease. (For women who do have it, odds jump by 66 percent.) This scenario \u2014 a positive screening and negative diagnostic test \u2014 may be an indication that a woman&amp;#039;s glucose control and arteries aren&amp;#039;t quite as healthy as they could be, says lead author Ravi Retnakaran, M.D. What can you do now? Ask your doctor about more targeted checkups for potential heart problems \u2014 and keep your weight down. \u2022 Low vitamin D. In a large Finnish study, adults over age 30 who had the lowest blood levels of vitamin D were 25 percent more likely to die from cardiovascular disease later in life than those with the highest levels. &amp;quot;Vitamin D may keep the muscle cells that line the artery walls healthy and flexible, helping to maintain good blood flow to the heart and brain,&amp;quot; says Michal Melamed, M.D., of Albert Einstein College of Medicine in New York City. Only 23 percent of Americans have adequate D levels; to find out where you stand, ask your doctor for a blood check. What&amp;#039;s a &amp;quot;good&amp;quot; level? Experts aren&amp;#039;t sure what number is ideal, but agree it should be at least 30 nanograms per milliliter. As for supplements, current guidelines recommend 200 IUs of D daily for people ages 19 to 50, 400 IUs for ages 51 to 70, and 600 IUs for those over 70, but most experts think 1,000 IUs is more in line with what you really need.       Start screening early \u2014 then don&amp;#039;t slack off. These are the tests all women should have, says the American Heart Association, but ask your doctor about special exams or more frequent checks if you&amp;#039;re at higher risk.     YOUR 30S \u2022 Blood pressure, pulse, waist circumference, and BMI: Have these measured every two years \u2022 Family history: Update at every doctor&amp;#039;s visit \u2022 Fasting cholesterol: Test every five years    Your 40s: Get Moving When you&amp;#039;re a mom of tweens or teens, days can go by in which your chief form of exercise is shifting your right foot from the gas pedal to the brake. Even if you&amp;#039;re not constantly carpooling, it can be hard to fit in workouts between your job, caring for aging parents, and checking in with your husband once in a while. But exercise is particularly important in these years: It works to counteract the slowdown of your metabolism, which tends to start in your 40s, and it helps you avoid weight gain.  Related Video  Alas, working out won&amp;#039;t necessarily lead to a dramatic drop in pounds, but research suggests it&amp;#039;s key for holding the line \u2014 and that may be enough to protect your heart. A study at the University of North Carolina at Chapel Hill found that overweight adults who maintained their weight, gaining no more than five pounds over 15 years, were less likely to have unhealthy changes in their glucose, cholesterol, and blood pressure than those who put on more.  You may have great intentions, but if you&amp;#039;re like 78 percent of women, you&amp;#039;re not quite fulfilling them. Best trick: Find a routine that you like and that fits into your day. For inspiration, go to goredforwomen.org and click on BetterU, a free 12-week program you can personalize. Do you need special screening tests? More and more doctors are turning to cool, high-tech scans to identify new risk markers for heart disease. But a recent analysis from the U.S. Preventive Services Task Force concluded that there is little proof that these improve your treatment. What&amp;#039;s more, some tests are potentially harmful: For instance, electron beam computed tomography (EBCT) \u2014 a scan that identifies calcium deposits in your arteries \u2014 exposes you to radiation equivalent to 10 chest X-rays. &amp;quot;In general, women should skip these tests until there&amp;#039;s more evidence they&amp;#039;re beneficial,&amp;quot; cautions Lori Mosca, M.D., a preventive cardiologist at New York-Presbyterian Hospital in New York City. But that doesn&amp;#039;t mean you don&amp;#039;t need any tests, especially if you&amp;#039;re at high risk. A stress echocardiogram or a nuclear imaging stress test, which are both done as you walk on a treadmill, can provide key warnings about your heart&amp;#039;s health. And doctors for all women should be doing a &amp;quot;global risk estimation&amp;quot; every five years. Basically, this is a mathematical formula used to calculate your odds of having a heart attack in the next 10 years, based on such factors as your age, blood pressure, cholesterol levels, whether you have diabetes, and other risks. Your doctor may or may not share the actual number with you (you can ask), but the information helps her make decisions about the best care for you. Surprising Hidden Risks \u2022 Hysterectomy. Until recently, women who were having this surgery because of problems like uterine fibroids often chose to have their ovaries taken out along with their uterus, as protection against ovarian cancer. But now there&amp;#039;s good reason to rethink that decision: A recent study of almost 30,000 women found that those who had both ovaries removed before age 50 and who never used estrogen therapy had up to a 98 percent higher risk of heart disease than those who kept them. Ovaries continue to make small amounts of hormones for years after natural menopause, guarding against heart disease as well as stroke.  But what about ovarian cancer? &amp;quot;The heart protection far outweighs the less than 1 percent lifetime risk of ovarian cancer,&amp;quot; notes lead author William H. Parker, M.D., of the John Wayne Cancer Institute in Santa Monica, CA. The exception: If you have a relative \u2014 a mother, sister, grandmother, aunt, or cousin \u2014 who&amp;#039;s had ovarian or breast cancer, especially before menopause, then it might make sense for you to have your ovaries out, says Dr. Parker. \u2022 Breast calcifications. If your mammogram shows specks of calcium deposits in the arteries of your breast, you might not have to worry about cancer, but you do need to pay more attention to your cardiovascular health: You may have more than triple the risk of heart disease of a woman without these deposits, a recent University of Missouri School of Medicine study found. Don&amp;#039;t count on your primary-care doc to alert you: Even if the calcifications are noted on the mammogram report (and they may not be), since they&amp;#039;re not cancerous, your doctor may not mention them, says lead author Paul S. Dale, M.D. But you shouldn&amp;#039;t miss out on this chance for lifesaving information. &amp;quot;Ask if vascular calcifications were noted, and if they were, ask if your heart health needs to be looked at differently,&amp;quot; says Dr. Dale.       Start screening early \u2014 then don&amp;#039;t slack off. These are the tests all women should have, says the American Heart Association, but ask your doctor about special exams or more frequent checks if you&amp;#039;re at higher risk.     YOUR 40S \u2022 Routine screens: Follow the schedule for your 30s  \u2022 Glucose: every three years starting at 45  \u2022 A &amp;quot;global risk estimation&amp;quot; \u2014 the score that indicates your odds of having a heart attack in the next 10 years. Repeat every five years    Your 50s: Be Symptom-Savvy Although the transition through menopause can be rough, the hormonal &amp;quot;peace&amp;quot; you finally achieve afterward may be pretty sweet. But there is one sour note: Your risk of heart disease rises two- or threefold. This may be due, in part, to the loss of protection from natural estrogen, but it&amp;#039;s also a matter of age and other risk factors finally catching up with you. The bottom line: It&amp;#039;s time to learn what a heart attack feels like. &amp;quot;Women often delay dialing 911 because they doubt their symptoms signal a heart attack. And that hesitation can cost you your life,&amp;quot; says Dr. Goldberg. Aside from the classic warning signs \u2014 a bursting chest pain that spreads to jaw, neck, and shoulder \u2014 look for these subtler symptoms, which can build in intensity over days or weeks: unusual fatigue, nausea, dizziness, shortness of breath, heaviness in the chest, or upper abdominal pain. Should you start taking a baby aspirin? If you&amp;#039;re younger than 55 and have never had a stroke or heart attack, probably not. Even aspirin that is buffered or enteric-coated increases the risk of life-threatening gastrointestinal bleeding \u2014 up to four times if you also take another NSAID such as ibuprofen, the U.S. Preventive Services Task Force just reported. But if you&amp;#039;re older than 55, when heart attacks and strokes become more common, a daily aspirin might make sense. Ask your doctor to help you weigh the pros and cons. Surprising Hidden Risks \u2022 Loneliness. If an empty nest or early retirement leaves you feeling isolated, the heartache may be more than emotional. In a 19-year study, women who reported feeling lonely most of the time had a 76 percent increased risk of heart disease. The connection? Chronic loneliness, like stress, may trigger inflammatory and hormonal changes that promote cardiovascular disease. It may also lead to poorer health habits that increase your risk, notes lead study author Rebecca C. Thurston, Ph.D., of the University of Pittsburgh School of Medicine. Her Rx: Nurture your friendships and forge close social connections by volunteering at a local charity, joining a book club, or undertaking any other social activities that appeal to you.  \u2022 Prediabetes. Elevated blood glucose levels \u2014 higher than normal, but not high enough to be diabetes \u2014 can lead to big risks. To find out if you&amp;#039;re among the 57 million Americans who have prediabetes but don&amp;#039;t know it, ask your doctor for a fasting plasma glucose test. If the result is between 100 and 125, it&amp;#039;s considered prediabetes. Your next move: Up your exercise and lighten your diet, decreasing especially your intake of processed foods, sweets, and starchy snacks. \u2022 Misdiagnosis. Here&amp;#039;s a scary \u2014 and common \u2014 scenario. A woman in her 50s complains to her doctor about persistent chest pain. He sends her for a stress test, but even if that&amp;#039;s abnormal, as long as testing reveals no major blockages, he assures her nothing&amp;#039;s wrong. The reality: Almost 50 percent of women with abnormal stress testing and open coronary arteries have microvascular coronary dysfunction, in which the heart&amp;#039;s smallest arteries don&amp;#039;t dilate properly and blood flow is restricted. It can increase your risk for sudden cardiac death, heart attack, or other serious problems by 2.5 percent each year. &amp;quot;Your doctor may dismiss your symptoms as gastroesophageal reflux disease (GERD) or anxiety,&amp;quot; says Dr. Bairey Merz, &amp;quot;especially if initial tests come back borderline.&amp;quot; So insist on getting a full evaluation that could reveal micro problems. Your 60s &amp;amp;amp; Beyond Stay Tuned In Did you know that a recent study, called JUPITER, found that healthy women over age 60 might lower their heart attack risk still further by taking a cholesterol-lowering statin (Crestor) \u2014 even if their cholesterol levels are normal? This advice may not apply to you, but it does point up that you should keep up-to-date on the latest advances (along with following heart-healthy diet and exercise routines, of course). So at every visit, ask your doctor about new research, and then find out if there&amp;#039;s a way for you to benefit. After all, it&amp;#039;s your heart \u2014 and you don&amp;#039;t want it to be broken.       Start screening early \u2014 then don&amp;#039;t slack off. These are the tests all women should have, says the American Heart Association, but ask your doctor about special exams or more frequent checks if you&amp;#039;re at higher risk.     YOUR 50S, 60s &amp;amp;amp; BEYOND  \u2022 Routine screens: at least every two years; more often if you have multiple risk factors  \u2022 Redo a &amp;quot;global risk estimation&amp;quot; every time a risk factor, such as your blood pressure or weight, changes    From RealAge.com: Find out about heart attack symptoms only in women "^^<http://www.w3.org/2001/XMLSchema#string>
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