In the book Heart Smart for Women: Six Steps in Six Weeks to Heart Healthy Living, leading cardiologists Jennifer H. Mieres, MD, and Stacey E. Rosen, MD, issue an urgent message to women not only to assess their risk of cardiovascular diseases but also to take action to prevent, minimize and reverse these illnesses, which are the leading cause of death for African-American and Hispanic women, according to the American Heart Association.

Here, Mieres and Rosen focus on the key points for women to consider when evaluating the changes necessary for a more heart-healthy lifestyle.

What role do lifestyle stressors, such as gender expectations, work and relationship dynamics, play in putting women at a higher risk of developing heart disease?

Women are the chief medical officers of their families and are hardwired to take care of the needs of everyone first and their needs last. This formula leads to, in many instances, women dealing with increased stresses on a daily basis. Research confirms that exposure to chronic stress can lead to elevated blood pressure, limited or interrupted sleep, obesity, depression and anxiety—all of which increase a woman’s risk of heart disease.

Women need to recognize the importance of placing their heart health first on their daily to-do list and begin by choosing to move at least 30 minutes every day, knowing their heart-healthy numbers and having a discussion about their heart health and their risk for heart disease with their doctors.

What should women do when tests don’t show symptoms of heart disease but their gut tells them something is wrong?

All women should know their risk for heart disease and their heart-health numbers. If a woman is having acute symptoms and in her gut feels something is wrong, she should immediately consult her doctor and call 911 if her symptoms are not resolving. “Time is muscle,” and so if she is having a heart attack, getting to the hospital to be eligible for the time-sensitive lifesaving strategies is critical to her survival. Cardiovascular diseases, which include stroke, claim the life of a woman about every 80 seconds. But about 80 percent of cardiovascular diseases may be prevented.

Why do young, physically fit women develop heart disease?

The facts are that by the time heart disease is manifest, it usually has been a silent condition for decades. Therefore, it is essential that women begin prevention strategies for heart disease in early adulthood. Eighty percent of heart disease can be prevented by lifestyle changes and controlling risk factors for heart disease.

New research has led to the discovery of certain new risk factors for heart disease in women that may account for the increasing number of young women affected the condition. These include such pregnancy-related complications as gestational hypertension, gestational diabetes, preeclampsia (high blood pressure and significant amounts of protein in the urine) and eclampsia (seizures that occur during the final stage of preeclampsia), which five to 15 years later place women at risk for heart disease, autoimmune diseases (rheumatoid arthritis, lupus, etc.), early menopause and sleep disorders and stress.

Additional unmodifiable risk factors for these women include a family history of heart disease (having a parent or sibling develop heart disease before age 55). Many factors are modifiable, however, such as smoking, hypertension, diabetes, obesity, having a sedentary lifestyle, abnormal lipid (cholesterol) levels, chronic stress, limited sleep, a high body mass index, or BMI (a ratio of your height to weight), and a waist circumference that’s greater than 35 inches for women (40 inches for men).

How can women with unmodifiable risk factors, such as age and family history, reduce their chances of developing heart disease?

Women need to control risk factors by following a heart-healthy lifestyle and taking medication if needed. This means individuals should quit smoking and avoid secondhand smoke, engage in a minimum of 150 minutes of activity each week, limit red meat and salt and sugar, avoid processed or fried foods and eat five or more servings of fruits and vegetables every day and fish twice weekly.

In addition, women should sleep at least six to seven hours each night, manage stress with meditation and mindfulness and find time for at least five minutes of laughter every day.

Why are outcomes for women who suffer a heart attack often worse than outcomes for men?

First, many women fail to recognize their symptoms as being related to a heart attack and so may delay calling 911 or going to the emergency room. Second, when women exhibit less classic symptoms of heart attack, the medical team may not suspect heart disease. Both situations cause a delay in recognition of symptoms and diagnosis, which cause women to arrive to the ER too late for lifesaving heart attack treatments, such as stent placement.

For more information about the “Get Heart Smart for Women” campaign, click here. Heart Smart for Women: Six S.T.E.P.S. in Six Weeks to Heart-Healthy Living is available here. Proceeds benefit the ongoing work at the Katz Institute for Women’s Health.