8 Things Cardiologists Wish Every Older Adult Knew to Prevent Heart Attacks 

By Jerilyn Covert |

These heart health principles go way beyond the run-of-the-mill advice. 

smiling older female with a hip style

Did you know that someone has a heart attack every 40 seconds in the United States? It’s true—and the risk gets higher with age. The average heart attack age for men is 65, and 72 is the average age for women.

Of course, you’ve probably heard advice before for how to prevent a heart attack. And it probably goes something like this: Be active, give up hamburgers and fries, and stop smoking if you smoke.

“Those are the three mainstays,” says Nick Ruthmann, M.D., a cardiologist at the Cleveland Clinic. Still: “There are other factors, especially for an older population, that can be just as important.”

From improving your sleep, to knowing your risk factors, to prioritizing mental health—turns out, there’s a lot you can do to lower your heart attack risk that goes beyond the traditional advice.

So do your heart a favor, and read on.

Heart Health Principle #1: Lose a Little Weight, Help Your Heart a Lot

Ideally for heart health, you want a BMI (or body mass index) that’s under 25, or 23 if you’re Asian-American, says Eleanor Levin, M.D., a cardiologist and clinical professor at Stanford. But if that feels out of reach for you, don’t worry—just try to get a little closer.

“Even losing 10 pounds will improve all of your risk factors,” Dr. Levin says. The research backs her up: In one long-term study, overweight adults who lost just 5 to 10 percent of their body weight—as little as 10 pounds for a 200-pound person—saw significant improvements in their blood sugar, triglycerides, and cholesterol.

If you have excess body weight, instead of cutting out entire food groups, trim back portion sizes first. One suggestion from Dr. Ruthman: Put half as much food on your plate as you normally would. (You can always go back for seconds.) Too hard? Stick with it for a week or two, he says.

“Consuming less food over time will lead to your stomach not needing as much to signal to the brain that it’s full,” says Dr. Ruthman. Translation: It’ll get easier.

Related: Want to eat healthier? Here’s what to do first.

Heart Health Principle #2: Watch the “Bad” Cholesterol

Different cholesterol types are often described as “good” and “bad.” HDL (short for high-density lipoproteins) is the so-called good stuff that clears out the harmful LDL (or low-density lipoproteins) that’s known to block arteries.

So yes, having a higher HDL may help your heart, Dr. Ruthmann says. But in fact, HDL-boosting medications have failed to curb heart attacks. That’s why cardiologists generally focus more on lowering LDL than increasing HDL, Dr. Ruthmann says.

The best way to do that is through a heart-healthy eating pattern (like the Mediterranean diet) that focuses on:

  • Whole grains (e.g., oats, whole wheat bread and pasta, brown rice)
  • Vegetables (e.g., leafy greens, carrots, eggplant)
  • Whole fruits (e.g., apples, avocados, peaches)
  • Healthy fats (e.g., almonds, walnuts, olive oil)
  • Lean protein (e.g., salmon, poultry, eggs)

Eating patterns like this that limit red meat, processed meat, and full-fat dairy are also naturally lower in saturated fat. And that’s a good thing: Cutting back on saturated fat can help lower LDL—and may even reduce the risk of heart disease by 17 percent, according to a Cochrane review.

Heart Health Principle #3: Quit Smoking — Marijuana Too!

Saying no to smoking is a huge way to lower your heart attack risk. But turns out that tobacco isn’t the only culprit to quit. “Some people think smoking marijuana is healthy,” says Dr. Levin. And while medical marijuana can be prescribed for chronic pain, “there is no heart-healthy indication for marijuana,” adds Dr. Levin.

In fact, research suggests that the risk of a heart attack is several times higher in the hour after smoking marijuana. Also, “if you smoke marijuana and then have a heart attack, it’s more likely to be fatal,” Dr. Levin says. A 2021 study even linked cannabis use with an increase in heart attacks among young adults.

It could have something to do with the effect cannabinoids have on the cardiovascular system—like raising resting heart rate, dilating blood vessels, and making the heart pump harder. Marijuana smoke also has a lot of the same substances found in tobacco smoke that can be harmful to the lungs and heart.

Dr. Ruthmann’s advice: Put a stop date on the calendar and ask a trusted friend or family member to help hold you accountable. The American Lung Association (lung.org) offers a Freedom From Smoking program. Or you can try the tools and tips at Smokefree.gov. You can also talk to your primary care doctor about how to scale back.

Heart Health Principle #4: Get Checked for Sleep Apnea

Obstructive sleep apnea impacts roughly 20 percent of the population, and the majority—up to 80 percent—go undiagnosed, says Dr. Ruthmann. Worse: Untreated sleep apnea can increase the risk of dying of heart disease by as much as 500 percent.1

Sleep apnea—when your breathing stops repeatedly during the night—can deprive all your vital organs of oxygen, putting strain on the body and, over time, increasing the risk of heart disease and heart attack, Dr. Ruthmann says.

Signs to watch out for include:

  • Loud snoring
  • Episodes where you stop breathing during sleep (likely someone else would notice this, not you)
  • Feeling really, really sleepy during the day
  • Waking up with a headache or dry mouth
  • Having a hard time staying asleep

If you notice any of those signs, talk to your primary care doctor. He or she may refer you to a sleep specialist for evaluation.

Related: Here are 5 sneaky signs you might have sleep apnea

Heart Health Principle #5: Stay Active, with Help

Stuff happens as we age — injury, illness, even general aches and pains — that can keep us from being active. But resources are available to you that can help, says Dr. Ruthmann. And they’re often underutilized.

For example, a physical therapist can help you get active again following a fall or surgery. And it may also be an option for frail individuals to help gradually improve their activity level. In fact, it’s common for patients to build up the confidence and ability to stay active on their own after just several weeks of physical therapy, Dr. Ruthmann says.

Likewise, cardiac rehab isn’t just for people who’ve already had a heart attack. It can help you prevent one, too, especially if you’ve been diagnosed with chest pain, pulmonary hypertension, or coronary artery disease. You’ll work with a team of healthcare professionals — cardiologists, nutritionists, physical therapists — to develop a customized program to improve your heart health. Programs typically last for at least 3 months.

Talk to your primary care doctor about whether these — or other resources — might be a good fit for you.

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Heart Health Principle #6: Know Your Numbers

There are three key numbers you should know that could literally save your life:

  • Blood pressure
  • Blood cholesterol
  • Blood sugar

All three must be managed either with lifestyle or medication in order to keep down heart attack risk, says Dr. Levin. And you won’t know what your status is unless you have them checked — because elevated levels of any of these usually have no signs or symptoms. (Plus, these kinds of preventive screenings are often free with insurance and Medicare, so really, you have no excuse.)

When you receive your results, talk to your doctor about what your numbers mean and what you can do to stay on track.

Heart Health Principle #7: Prioritize Your Sleep

Some evidence suggests that poor sleep can impact your heart. One study from Chicago Medical School found that, of a sample of 6,500 Americans, those who slept less than six hours a night were twice as likely to have a heart attack as those who slept more. This matters especially as we age because insomnia tends to become more common.

“Many of my older adult patients, when I ask them about their sleep hygiene, do often admit they have trouble falling asleep,” says Dr. Ruthmann. “I think it’s habit forming. They often sleep in and start the day later, and then they stay up later and it starts a vicious cycle.”

Dr. Ruthmann tells patients to set an alarm 30 minutes to an hour before bed, as a reminder that it’s time to wind down.

If you’re retired (and every day feels like Saturday), consider scheduling some fun activities during the day — pickleball, swimming, or meeting with a friend. “The more you have to do, the more driven you may be to get up and start the day,” Dr. Ruthmann says.

Heart Health Principle #8: Take Care of Your Mental Health

Stress, anxiety, and depression can stress your heart rate and increase blood pressure, according to the American Heart Association. Over time, this can put you at risk for a heart attack. One study out of Indiana University found that adults age 60 and older with depressive symptoms were 46 percent more likely to develop heart disease.

Find whatever de-stressor works for you — mindfulness, yoga, meditation, daily walks. SilverSneakers classes are a great way to unwind. In fact, two SilverSneakers LIVE classes teach different stress management techniques. Check our class list here for Mindfulness & Meditation (Express) 15-minute classes or the longer Stress Management Series.

“If you are feeling depressed, lonely, or having trouble with daily tasks, communicate that with your health provider,” says Dr. Ruthmann. You may consider seeing a therapist. Contrary to what you might think, therapy isn’t just for people with severe mental illness — it can benefit anyone, Dr. Ruthmann says. “It’s good to seek out those resources,” he adds.

As you can see, what’s good for your head-to-toe health is good for your heart, too.

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