Your heart is with you for every moment of your life—but the way you care for it shouldn’t look the same at 25 as it does at 65. Cardiovascular disease is the leading cause of death in the U.S., and heart health risks increase with age. But the good news is that much of the damage is preventable with the right habits and timely screenings.
Here’s a decade-by-decade guide, with insights from cardiologists, for protecting your heart from young adulthood through your golden years.
Your heart health may be the furthest thing from your mind in your twenties. But it’s the right time to build the habits that will support your heart for years to come, says Dr. Romit Bhattacharya, a preventive cardiologist at Massachusetts General Hospital. These heart-healthy habits include getting enough physical activity daily, quitting smoking or vaping, focusing on eating a plant-based diet, and getting seven to nine hours of sleep each night.
“These basics drive long-term heart and brain health,” he says.
By your early 20s, the heart has reached its adult size and capacity, Bhattacharya says. Cardiac output—how much blood the heart pumps per minute—is strong, and the heart muscle is highly efficient. But research shows that even by this age, fatty streaks and cholesterol deposits (called plaques) can form in the arteries, especially if you smoke, eat a poor diet, or have a family history of heart disease.
That’s why this is the time to start thinking about screenings, says Dr. Deepak Talreja, clinical chief of cardiology at Sentara Cardiology Specialists in Virginia.
“Blood pressure should be screened starting at age 18, with follow-ups every three to five years if normal, or annually if elevated,” he says. “Cholesterol testing should start by age 20 if risk factors exist, and early identification of abnormal blood sugar is also key.”
Your 30s are often peak years for career-building, parenting, and financial stress. While your heart is still strong and resilient, this decade is when subtle changes often begin to emerge.
“Chronic stress, anxiety, depression, and poor sleep push up blood pressure and inflammation and are tied to higher heart-attack risk,” says Bhattacharya. “Job strain alone carries around a 30% higher coronary heart disease risk.”
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Exercise in your 30s is particularly important, says cardiologist Dr. Lars Sondergaard, chief medical officer and vice president of Abbott’s structural heart division. “Even moderate exercise, such as brisk walking for as little as 20 minutes a day, can significantly improve a person’s health,” he says.
Sleep is also vital, Sondergaard adds. Deep, restorative sleep not only reduces inflammation but also supports emotional regulation, allowing you to better cope with life’s pressures. Social connection can also play a protective role as well; robust social networks correlate with lower stress levels and longer lifespan.
And screenings remain important. Talreja highlights that stress can indirectly worsen cardiovascular health by encouraging unhealthy habits—like overeating, inactivity, and alcohol use—so maintaining routine checkups is crucial. Blood pressure, cholesterol, and metabolic markers should be monitored, and lifestyle interventions should be reinforced.
By midlife, you may not have any noticeable symptoms, but subtle changes in blood pressure, cholesterol, or glucose can foreshadow future heart problems.
“Your 40s are when silent risks begin to surface, so this is the decade to move beyond ‘feeling fine’ and start measuring what matters,” says Bhattacharya. “Blood pressure, cholesterol, and blood sugar remain the foundation, but consider advanced screening” if you have a family history of cardiovascular issues. Consult your doctor if your risk is unclear.
For those who are at higher risk, a coronary calcium scan or CT coronary angiogram can reveal early plaque long before symptoms arise, he adds.
Monitoring your cholesterol levels continues to be crucial during this decade. “The most important cholesterol measure is LDL, also known as bad cholesterol, followed by non-HDL cholesterol,” says Dr. Jeffrey Berger, director of the Center for the Prevention of Cardiovascular Disease at NYU Langone Heart. “Even if HDL is high, elevated LDL increases risk for heart disease and stroke and should be lowered.”
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Routine monitoring—annual blood pressure checks, regular lipid panels, and glucose monitoring—can detect problems early, and implementing lifestyle changes or other interventions before serious disease develops can protect your heart.
Subtle warning signs can also emerge in your 40s. Fatigue, shortness of breath during activity, calf pain with walking, or unusual exercise intolerance may all signal cardiovascular issues.
Dr. Srihari S. Naidu, director of the cardiac catheterization laboratories and the hypertrophic cardiomyopathy program at Westchester Medical Center, says most people assume they’re asymptomatic because they don’t feel chest pain or obvious shortness of breath—but often that’s because they’ve unconsciously stopped pushing themselves.
“Paying attention to how your body responds during exertion is key,” he adds.
At this stage, hormonal changes begin to reshape cardiovascular risk.
For women, menopause often leads to increases in LDL cholesterol, rising blood pressure, and shifts in fat distribution from hips and thighs to the abdomen. Men experience gradual testosterone decline, which can increase risk for metabolic syndrome and diabetes.
“Traditionally we have believed that the loss of estrogen removes protective lipid effects, but trials of replacing hormones have shown this is more complex than once believed,” says Talreja.
“Because of this, hormone replacement therapy is not recommended for cardiovascular disease prevention and should only be considered for severe vasomotor symptoms.”
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Testosterone replacement in men is also not advised for primary prevention due to potential risks. Instead, Berger recommends focusing on maintaining a heart-healthy lifestyle and routine screenings to identify early disease during this time.
“Healthy habits, especially diet and exercise—both aerobic activity and strength training—support better hormone balance and heart health,” he says.
By the time you reach your 60s, your heart has worked hard for decades, and the changes that began earlier in life can become more noticeable. The heart muscle may have thickened slightly, and arteries have likely stiffened, which can raise blood pressure. For women, the protective effects of estrogen subside after menopause, which is why women’s cardiovascular risk has increased by this decade.
Because of these factors, many people already carry one or more cardiovascular diagnoses: hypertension, high cholesterol, or Type 2 diabetes. In these cases, the focus shifts from prevention alone to careful management of existing conditions.
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“Even in people with risk factors or those with a strong family history, proactive management is key to avoiding disease,” says Berger. “We need to be aggressive with primary prevention (before disease develops) to avoid the development of disease and the need for secondary prevention (after a cardiac event).”
Medication adherence, cardiac rehab after heart attacks or strokes, and vaccinations to prevent infections that stress the heart are all critical. This is also the time to recognize silent disease, Naidu says.
“Heart valve problems often start quietly,” he says. “Stay alert, share any changes with your clinician, and work together to decide if an echocardiogram is right for you.”
By the time you reach your 70s, the heart has been pumping nonstop for more than 2.5 billion beats. Even if you’ve taken excellent care of it, age-related changes become more pronounced in this decade. Some shifts are normal parts of aging, while others reflect accumulated cardiovascular risk.
Pumping efficiency declines, arteries are less flexible, valves often show significant wear, and irregular rhythms are more frequent.
In your 70s and older, heart health becomes as much about quality of life as prevention.
“Aging in the 70s is no longer one uniform story,” says Bhattacharya. “Those who have maintained lifelong healthy habits often look and feel more like people in their 50s or 60s. For others, simplifying medications, setting safe blood pressure and glucose goals, and avoiding falls or drug interactions take priority.”
Staying active, eating well, and taking medications as prescribed are still essential, says Berger. Equally important, he adds, is making sure your care is well-coordinated. Focus on mobility, safety, and activities that bring happiness, because emotional well-being directly supports heart health.
Shared decision-making with family and care teams helps ensure medical care aligns with personal goals, especially as complex conditions accumulate. At this stage, the goal is independence and quality of life: using the fewest, most effective interventions to keep people strong, steady, and connected to the things they value most.
“As much as possible, patients at all ages—but especially older patients—need to think about who else can help them make medical decisions when needed,” says Talreja. Consider spelling out exactly how you want your heart health (and overall health) handled at this stage, like whether you want CPR performed in an emergency or a ventilator if you are incapacitated. By making heart health a habit throughout the prior decades, considering what’s best for your heart will be second nature by now.
