Protecting Your Heart: The Numbers That Matter and When to Check Them

Do this part first

If you are having chest pain, pressure, or tightness — especially with breathlessness, sweating, nausea, or pain spreading to the arm, jaw, neck or back — call 911. Do not drive yourself and do not wait to see whether it passes.

And know that a heart attack does not always present as chest pain. In women, in older adults and in people with diabetes it is more often breathlessness, unusual fatigue, nausea, back or jaw pain, or a vague sense that something is badly wrong. Those are not “atypical” in any useful sense — they are how a large share of heart attacks actually feel, and the belief that it must be crushing chest pain is one reason people wait.

Chew an aspirin while waiting for the ambulance, unless you have been told not to take it. The dispatcher will advise you.

Heart disease remains the leading cause of death for both men and women in the United States. That statistic is not the useful part. The useful part is that most of the risk is carried by a small number of measurable things, and most of them are treatable for years before anything goes wrong.

The numbers to know

You should be able to say roughly where you stand on five things. If you cannot, that is the appointment.

1. Blood pressure. Under 120 over 80 is the target for most adults. It has no symptoms until it has done damage, which is why it gets measured rather than felt. Our blood pressure page covers it properly, including the seasonal effect the Phoenix summer has on it.

2. Cholesterol — and specifically LDL, the one that drives plaque. HDL and triglycerides matter too. A simple blood test, usually from about age 20 and then periodically, more often with a family history.

3. Blood sugar. Diabetes and prediabetes are heart conditions as much as they are sugar conditions — the damage falls on blood vessels. Prediabetes is the stage where this is still reversible, and our page on it covers how.

4. Weight, and particularly waist. Where fat sits matters more than total weight. Weight around the middle is more strongly linked to heart risk than the same weight on hips and thighs.

5. Whether you smoke, and how much you drink. The first is the largest single modifiable risk there is.

Then there is the one you cannot change: family history. A parent or sibling with heart disease early — before about 55 in men, 65 in women — genuinely shifts your risk, and it changes when screening should start. It is worth actually asking your relatives, in specific terms: what happened, how old were they, was it a heart attack or a stroke. Most people have a vague answer and a vague answer is not much use to us.

What actually reduces risk

Stopping smoking. Nothing else on this list comes close. Risk starts falling within weeks and keeps falling for years. If you have tried and gone back, that is the normal pattern rather than a failure — most people who succeed have several attempts behind them, and the support that works is available.

Moving, about 150 minutes a week of something that raises your pulse. Brisk walking qualifies. Adding two sessions of resistance work helps more. The largest benefit is at the start of the curve, going from nothing to something — so if you currently do nothing, the first twenty minutes are worth more than any subsequent improvement.

Eating in the general direction of a Mediterranean pattern. Vegetables, fruit, beans, lentils, whole grains, nuts, olive oil, fish; less processed and cured meat, less refined carbohydrate, fewer sugary drinks. This is the dietary pattern with the strongest evidence for heart outcomes rather than just for numbers on a test — and it is a direction of travel, not a set of rules to fail at.

Cutting sodium, most of which is already in bread, cheese, cured meat, sauces and restaurant food rather than in the salt cellar.

Sleeping properly, and treating sleep apnoea if you have it. Untreated apnoea raises blood pressure, drives atrial fibrillation, and is very common in exactly the population most worried about their heart. If you snore heavily or wake unrefreshed, that is worth investigating.

Managing stress, honestly rather than aspirationally. The evidence here is softer than for the items above, and it is not nothing.

And taking the medication if you are prescribed it. Statins, blood pressure medicines and anticoagulants prevent events that would otherwise have happened, and they do it without you feeling anything — which is why they get quietly abandoned. If a medicine is causing side effects, tell us rather than stopping. Muscle aches on a statin are a common and specific reason to switch; there are several and they are not interchangeable in how people tolerate them.

What does not have the evidence: fish oil supplements for most people, multivitamins, and the general supplement aisle. Aspirin is no longer recommended for most healthy adults who have never had an event — the bleeding risk outweighs the benefit for many, and it is now an individual decision rather than general advice. If you are taking daily aspirin because you heard you should, that is worth a conversation.

When to get checked

• Blood pressure at least every couple of years from adulthood, annually from 40, and more often if readings have been high
• Cholesterol from about 20, then periodically — the interval depends on the result and your other risks
• Blood sugar, generally from 35, sooner with extra weight, a family history, or a past gestational diabetes
• Sooner and more often for all of these with a family history of early heart disease, with diabetes, with kidney disease, or if you smoke
• After a pregnancy complicated by gestational diabetes, pre-eclampsia, or high blood pressure. These are now recognised as markers of later cardiovascular risk and are very commonly treated as having ended with the birth. They did not

All of it happens at an ordinary visit. Our annual visits page covers what else gets done at the same time.

The Arizona part

Two things here work in your favour and one works against you, and the conventional advice gets it backwards.

In our favour: the winter. From October to April this is close to the best climate in the country for being outdoors, and a walking or cycling habit built in November is the one that survives. Most heart-health advice is written for places where winter is the obstacle. Here it is the opportunity, and treating it that way is the single most useful local adaptation on this page. Our winter-in-Phoenix page covers what else the cool months are good for.

Also in our favour: the light. Getting outside early is easy nearly every day of the year, which helps sleep, which helps blood pressure.

Against us: five months where outdoor exercise is genuinely hazardous rather than merely unpleasant, and people lose the habit and do not get it back. The workable answers are early mornings — genuinely early, before the pavement holds heat — indoor options through the worst of it, and accepting that summer is a maintenance season rather than a progress one.

And a real cardiac caution, not a general one. Heat makes the heart work considerably harder: it raises heart rate, dilates vessels, and fluid loss thickens the blood. For anyone with known heart disease, or taking blood pressure medicine, beta blockers, or diuretics, a summer exertion that felt routine in March can be a genuine cardiac event in July. Beta blockers blunt the heart-rate response you would normally use to judge your own effort, and diuretics compound the fluid loss. That is not a reason to stop exercising or to stop the medicine. It is a reason to move the workout, drink more than you think you need, and know the difference between hot and in trouble — which is what our heat safety page is for.

February is when everyone talks about this. February is also the best month of the year here to start walking. That is a better reason to pay attention to it than the calendar.

Sources

43. Coronary heart disease — MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine. https://medlineplus.gov/ency/article/007115.htm

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