Once you understand what might make you predisposed to heart disease, you can concentrate on all the ways to minimize the other risk factors. There are many things you can do to reduce or postpone your chances of developing heart disease.

High Cholesterol

High blood cholesterol is a major risk factor for developing heart disease. After menopause, women tend to develop high levels of triglycerides (a form of fat), in addition to high levels of low-density lipoprotein (LDL), cholesterol. At the same time, their levels of high-density lipoprotein (HDL) can diminish. All of these factors lead to out-of-balance blood cholesterol levels, too much fat in the bloodstream, and the buildup of artery-clogging plaque in the pathways that channel oxygen-rich blood to the heart and brain. For every 1 percent reduction in elevated blood cholesterol levels, you get a 2 to 3 percent reduction in your chances of having a heart attack.

Don't misunderstand the issue about cholesterol; cholesterol is a natural, essential substance in the bloodstream. HDL cholesterol is actually a protein that helps keep all fats and cholesterols moving through your bloodstream (and not glued to your arterial walls), so it actually helps you stave off a potential heart attack. LDL cholesterol moves cholesterol through the rest of your body — but it also has a tendency to linger in your arteries and stick to the walls. Elevated levels of triglycerides may or may not indicate that you're headed for a heart attack, but as another type of fat in the bloodstream, their levels need to be monitored.

So how much is too much (or not enough) of these substances? While your total blood cholesterol level should remain below 180 mg/dl (milligrams per deciliter of blood), and anything over 239 mg/dl needs to be considered a high risk, here's how the individual cholesterol numbers should stack up:

• HDL: more than 60 mg/dl is a good number here, less than 40 mg/dl puts you at high risk.

• LDL: less than 100 mg/dl is desirable, 130 to 159 mg/dl is considered borderline high, and 160 mg/dl to 189 mg/dl is high risk, with 190 mg/dl very high risk.

• Triglycerides: less than 150 mg/dl is considered normal, 150 to 199 mg/dl is borderline high, 200 to 499 mg/dl is high, and over 500 mg/dl is way too high.

A low-fat diet and regular exercise can help most people maintain healthy blood cholesterol levels. Where those efforts fall short, a variety of cholesterol-lowering drugs, called statins, have entered the market over the past several years. Recent studies have shown that these drugs do actually reduce your risk of dying from a heart disease. Although some of these drugs may have side effects, the medications currently on the market are considered safe and effective. Consult your physician; do not rely on a homeopath or other alternative health care if your lipid profile is abnormal.

High Blood Pressure

High blood pressure (hypertension) is another silent plague of women age fifty-five and over. More than half of all women in that age group have blood pressure greater than 140/90 (the high-blood-pressure threshold), but few of them feel its effects. In fact, though some estimates say that one in four people in the United States suffers from high blood pressure, nearly one-third of those individuals are unaware of their condition. Even if you have had normal blood pressure all of your life, you might develop high blood pressure after menopause. And having high blood pressure makes you a prime candidate for developing heart disease. High blood pressure also contributes to kidney disease and can lead to congestive heart failure, heart attack, and stroke.

Like cholesterol, everyone needs blood pressure. After all, blood pressure results from the force of your heart pumping your blood through your veins. If you exercise or become excited, your heart rate increases, sending more blood through your system. If your arteries are clean and wide open, the blood flows freely; if they're narrow or blocked, the buildup of blood trying to course through your veins puts pressure on the arterial walls — and that's high blood pressure. If your arteries are clean and healthy, your blood pressure rises for a short period of time, then returns to normal. If you have hypertension, however, your blood pressure is greater than 135/80–85 even when you're at rest; the extra pressure on your heart and arteries never lets up. If high blood pressure occurs in a person with atherosclerosis, the walls of the vessels are toughened and less elastic, and even less able to cope with stress.

Most doctors consider a blood pressure reading under 120/80 to be ideal. Though some people have suffered from low blood pressure, it's pretty uncommon and not life threatening. Regular exercise and a diet high in vegetables and fruit, but low in sodium, can help control high blood pressure. If diet, exercise, and weight loss (when indicated) don't bring blood pressure down, your health care provider may prescribe drug therapy. Biofeedback and relaxation techniques can also be helpful in keeping your blood pressure down.

Diabetes

Diabetes is another heart disease risk factor that is of particular concern to women. Nearly 6 million women in the United States have been diagnosed with diabetes, and another 2.5 million women have undiagnosed diabetes. Women who have diabetes are at a significantly greater risk of developing heart disease than their non-diabetic “sisters.” Having diabetes ups your risk of heart disease and stroke by two to four times. Every year, over 60,000 Americans die of complications of diabetes, and the disease can lead to a host of other conditions, including kidney failure, blindness, and nerve disease.

Diabetes mellitus occurs when the body is unable to produce adequate amounts of insulin or efficiently use the insulin it produces (insulin resistance). Type 2 or adult onset diabetes is the most common form of the disease, and it usually occurs at middle age. Symptoms of diabetes include weight loss, blurred vision, intense thirst, fatigue, excessive urination, and hunger. Doctors test for diabetes through assessing the level of glucose (sugar) in your blood. If a random (non-fasting) glucose screening test is borderline or abnormal, or if your family history is very strong, the doctor may decide to repeat the test. In that test, the doctor may ask you to fast before the first blood sample is taken; then, after you drink a specifically prepared glucose solution, blood samples are taken again at two one-hour intervals. If two of the samples show an elevated blood sugar level, you're considered to be diabetic.

Doctors don't know what causes the development of diabetes, and no drug can cure it. However, diabetes can be controlled — and sometimes disappears altogether — through diet, exercise, and weight loss. Statistics show that 80 to 90 percent of people with diabetes are overweight, and many have high blood pressure and/or lead inactive lives. Though a large number of diabetics require insulin or drug therapy, many others are able to control their disease through behavior modification, such as diet, exercise, and weight loss — a lifelong change that offers big rewards.

Obesity

Few conditions are as common and as potentially damaging (both emotionally and physically) as obesity. In fact, obesity has never been more common; the numbers of obese people in the United States continue to rise at alarming levels. The percentage of overweight Americans has risen so dramatically that now nearly two-thirds of all American women are overweight or obese — conditions defined in general by a body weight more than 30 percent over the ideal for the body's height and frame, or having an abnormally high body mass index (BMI). Obesity is damaging in ways few non-obese people can imagine; unlike most other diseases, obesity is commonly viewed as a disease of weakness, self-indulgence, and laziness. Obese people often are the object of ridicule and disdain. Unlike other heart disease risk factors, obesity is plainly visible.

Though obesity can result in obvious emotional distress, its health-damaging effects are even more insidious. Obesity is strongly linked to heart disease in ways that are still under study, but some research indicates that nearly 70 percent of diagnosed cases of heart disease may be directly linked to obesity.

Women are at special risk for heart disease from postmenopausal weight gain. The reason is the location of the added weight; many women tend to add weight in their abdomen and upper body during menopause. This type of fat seems to be linked very closely with a number of other risk factors for heart disease, including diabetes. Because the body's metabolism begins to slow down during perimenopause, you burn fewer calories, even at rest. So if you continue to consume the same number of calories you consumed in your youth, you will almost certainly gain weight.

Though so many Americans suffer from obesity, researchers are still trying to determine all of the factors that contribute to it. Some contributors are controllable — things such as leading a sedentary lifestyle and consuming a high-fat, high-calorie diet. But if those factors were the only causes of obesity, fewer individuals would suffer from the disease. In fact, gender, age, individual biological and genetic makeup, psychological condition, and environment each appear capable of playing a major role in the development of obesity.

Smoking

Smoking tobacco is hard on your entire body, but it delivers a particularly hard blow to your heart. Each time you draw in a lungful of tobacco smoke, you temporarily increase your heart rate and blood pressure and deplete the oxygen in your bloodstream that should be going to feed your heart and other body tissues. If you smoke even one to four cigarettes a day, you're doubling your chances of having a heart attack — and very few smokers smoke four or fewer cigarettes in the average day. Smoke a pack or more, and your risk goes up four times. Over 30 percent of all deaths due to coronary heart disease are attributable to smoking.

Of course, you also know that smoking-related diseases are usually preventable — and it is never too late to quit! Stopping smoking can give you health benefits right away. According to the American Cancer Society (ACS), within twenty minutes after you quit, your body starts regenerating and your blood pressure begins to return to normal. Within eight hours, the carbon monoxide level in your blood drops to normal. Twenty-four hours after you quit, your chance of heart attack begins to decrease. One to nine months later, you should lose that smoker's cough and the sinus congestion, fatigue, and shortness of breath smokers suffer. Within ten years of quitting, you will have cut your risk of lung-cancer death in half; after fifteen years, your chance of contracting coronary heart disease is the same as that of a nonsmoker.

Smoking is an incredibly addictive habit that hooks you physically, psychologically, and emotionally. If you are struggling with quitting, talk to your doctor or health care provider about smoking cessation programs, nicotine replacement therapy, and other techniques that can help you kick the habit. If you have children, remind yourself of how important you are to them as a role model; your quitting smoking may help them decide not to start.