How to Protect Your Heart at Every Decade: Practical Steps From Your 20s to Your 70s

Cardiovascular disease remains the leading cause of death in the United States, but much of the risk is modifiable through lifelong habits and timely screening. Cardiologists who study prevention say the actions people take in their 20s, 30s and beyond can alter the course of heart health decades later.

Prevention begins with routine measures — physical activity, a heart-healthy diet, good sleep and avoidance of tobacco — and with screening for blood pressure, cholesterol and glucose. How those steps are prioritized and when more advanced testing is appropriate differs by decade as age, hormones and cumulative exposures change risk.

In the 20s, heart health specialists emphasize building durable habits. “These basics drive long-term heart and brain health,” said Dr. Romit Bhattacharya, a preventive cardiologist at Massachusetts General Hospital. By the early 20s the heart has reached adult size and efficiency, but early arterial fatty streaks and cholesterol deposits can appear, particularly in people who smoke, eat poorly or have a family history of heart disease. Clinicians recommend daily physical activity, quitting smoking or vaping, emphasizing plant-forward foods, and getting seven to nine hours of sleep. Blood pressure screening should begin at 18, with follow-ups every three to five years if normal and more often if elevated, and cholesterol testing is advised by age 20 when risk factors are present.

In the 30s, competing demands from careers and family, as well as chronic stress, can begin to influence cardiovascular risk. “Chronic stress, anxiety, depression, and poor sleep push up blood pressure and inflammation and are tied to higher heart-attack risk,” Bhattacharya said. Moderate exercise remains especially beneficial; Dr. Lars Sondergaard, chief medical officer for Abbott’s structural heart division, noted that brisk walking for as little as 20 minutes a day can substantially improve health. Sleep and social connections also lower inflammation and help with emotional regulation. Routine checks of blood pressure, cholesterol and metabolic markers remain important because stress can drive unhealthy behaviors such as overeating, inactivity and increased alcohol use.

In the 40s, clinicians describe a shift from feeling well to measuring what matters. Subtle changes in blood pressure, LDL cholesterol or blood sugar often emerge in this decade and can foreshadow disease years later. “Your 40s are when silent risks begin to surface, so this is the decade to move beyond ‘feeling fine’ and start measuring what matters,” Bhattacharya said. For people with unclear risk or a family history of early cardiovascular disease, physicians may consider advanced screening such as coronary artery calcium scans or CT coronary angiography to detect plaque before symptoms appear. Paying attention to exertional symptoms — fatigue, breathlessness with activity, calf pain on walking or reduced exercise tolerance — is also important because many people unconsciously reduce activity and assume they are asymptomatic.

Hormonal shifts in the 50s can reshape risk profiles. Menopause commonly brings rises in LDL cholesterol and blood pressure and a redistribution of body fat toward the abdomen; declining testosterone in men can increase the chance of metabolic syndrome and diabetes. Dr. Deepak Talreja, clinical chief of cardiology at Sentara Cardiology Specialists, cautioned that hormone replacement is not recommended for cardiovascular disease prevention and should be reserved for severe vasomotor symptoms after careful discussion of risks and benefits. Similarly, testosterone replacement in men is not advised for primary prevention. Clinicians stress the continued importance of aerobic activity and strength training, diet, and routine screening to identify and treat risk factors early.

By the 60s, many people carry diagnoses such as hypertension, hyperlipidemia or type 2 diabetes, and care often shifts from prevention alone to management of established disease. Arteries stiffen with age, the heart muscle may thicken, and the loss of estrogen’s protective effects after menopause increases women’s cardiovascular risk. “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),” said Dr. Jeffrey Berger, director of the Center for the Prevention of Cardiovascular Disease at NYU Langone Heart. Medication adherence, cardiac rehabilitation following heart attacks or strokes, and vaccinations to prevent infections that stress the heart become priorities. Clinicians also watch for silent conditions such as valve disease and may recommend echocardiography when symptoms or risk factors suggest it.

In the 70s and beyond, age-related changes to the heart and vessels become more pronounced, but goals often broaden to focus on quality of life, independence and safety. Pumping efficiency can decline, valves commonly show wear, and arrhythmias become more frequent. “Aging in the 70s is no longer one uniform story,” Bhattacharya said. Those who maintained healthy habits earlier in life often function at higher levels than peers with greater cumulative risk. For older adults, clinicians emphasize simplifying medications where appropriate, defining safe blood pressure and glucose targets tailored to overall health and fall risk, ensuring coordinated care, and engaging in shared decision-making with family and care teams about treatment preferences.

Across all decades, clinicians emphasize several consistent themes: stop smoking, maintain regular physical activity that includes aerobic and strength elements, center meals on whole foods and plants while limiting processed foods, prioritize restorative sleep, and maintain social connections. Regular screening for blood pressure, lipids and blood sugar identifies risks early; when risk is unclear or family history is strong, advanced imaging such as coronary artery calcium scoring can refine risk estimation. Vaccination, medication adherence and cardiac rehabilitation are integral when disease is present.

Experts stress that prevention is cumulative. Small, sustained changes begun in young adulthood often reduce the need for intensive interventions later, while delayed detection can allow reversible risk factors to progress. Clinicians recommend that people discuss individualized screening schedules and thresholds with their primary care clinicians or cardiologists, particularly when family history, symptoms or multiple risk factors are present. In older age, aligning care with personal goals and planning who will help make medical decisions if needed are also important steps.

Heart disease remains a leading public-health challenge, but cardiologists say the combination of early habit formation, routine screening and targeted use of diagnostics can substantially reduce risk and preserve quality of life at every age.