How Do You Actually Lower Your Heart Disease Risk as a Woman?

In Part 1, we covered why heart disease is the #1 killer of women and why your risk climbs specifically in midlife. Now let’s dig into the empowering part - what you can actually control, what genuinely matters, and what to talk to your doctor about at your next appointment.

What's actually in your control

A 2025 American College of Cardiology study found that when women carry several heart disease risk factors, their risk climbs more steeply than a man's with the same profile. This means the same risk factors hit women harder. That's especially concerning because women's risk factors and symptoms are often the ones that go unnoticed, and get dismissed, in the first place.

There are eight factors that matter most when it comes to heart disease risk and you have the power to control these. They are: diet, physical activity, sleep, smoking status, weight, blood glucose, cholesterol, and blood pressure.

A few worth calling out:

• Blood pressure deserves its own spotlight. It's one of the biggest risk factors for heart disease, damaging and stiffening your arteries over time and making your heart work harder. The sobering fact is that 45.7% of women have high blood pressure or take medication for it, but less than half have it under control. High blood pressure has no symptoms. You can't feel it. You can only know it, by actually checking it.

• Movement matters, and you may need less of it than you think. The CDC's baseline recommendation is at least 150 minutes of activity a week. Research published in late 2025 also found women gained meaningful heart protection from less moderate-to-vigorous exercise than men needed to see the same benefit. This isn't your permission to skip activity but it is a reason to stop assuming you need to train like a crazy person to protect your heart. It may not take as much as you think. 

• The Mediterranean diet has the strongest evidence. Diets rich in nutrient dense veggies, fruit, whole grains, legumes, nuts, olive oil, and fish, with less ultra-processed food, is consistently linked to meaningfully lower cardiovascular risk.

• Alcohol has a real ceiling. The CDC's guidance is no more than 1 drink a day. More than that is an actual risk factor. 

• Sleep and stress aren't soft factors. Sleep is literally one of the AHA's 8 official cardiovascular health metrics, with a specific target: 7-9 hours a night. Poor sleep is linked to higher blood pressure, higher blood sugar, and higher cholesterol, not just feeling tired. Chronic stress is a real contributor to cardiovascular risk.

• Smoking cessation remains one of the single highest-impact changes available, at any age. This one is a no brainer - I’m not thinking many smokers are reading my content. ;) 

None of this requires you to live the perfect healthy lifestyle. It’s about taking an honest look at the way you’re living and pick a couple of areas you know you could improve upon. Now you know what truly moves the needle, so you know where to focus for the biggest bang for your buck.

What labs and testing actually matter

Start with the basics that are mostly covered at your annual physical: blood pressure (and you can buy an inexpensive cuff and track at home as well!), a fasting glucose, A1c, a fasted insulin if your doctor will pull it, and a full lipid panel (including Lp(a) checked at least once, and ApoB). With my clients I’ll often pull other markers to give us a much more thorough picture to use alongside of their lifestyle and family history, but this is a good starting point. 

Family history is definitely a valid reason to also dig deeper outside of just serum labs. This is exactly why my own doctor recommended a coronary artery calcium (CAC) score for me after I mentioned my dad's heart disease.

Here's what a CAC score actually does: it uses a non-contrast CT scan to measure calcified plaque in your coronary arteries and gives you an Agatston score. Zero is reassuring. Higher scores indicate more plaque burden. It's quick, low radiation (about the same as a mammogram), and often $100 to $200 out of pocket since many insurers don't cover it as a screening test in people without symptoms.

Here's what it doesn't do: catch soft (non-calcified) plaque. Soft plaque is earlier-stage, lipid-rich, and hasn't hardened yet, which also makes it more prone to rupture (yes soft plaque can often times be more problematic than calcified plaque). One study found that among patients with a zero CAC score, nearly 29% still had some degree of soft plaque present on more detailed imaging. Non-calcified plaque shows up disproportionately in women, younger adults, and people with diabetes or metabolic conditions, which is exactly why "zero" doesn't automatically mean "clear."

This is where a lot of the confidence I heard in my IG comments ("I had one, my score was zero, I'm fine!") needs a caveat. A zero score is genuinely good news and a strong predictor of low risk. It's just important to understand that it’s not the complete picture, especially for women.

The test that can see soft plaque: coronary CT angiography (CCTA) uses contrast dye to visualize both calcified and non-calcified plaque. It involves more radiation and cost than a CAC scan, and it's generally reserved for people with symptoms, an ambiguous CAC result, or a doctor's clinical judgment that more information is needed, not as a general screening tool. Coverage varies but depends heavily on medical necessity documentation, so this is very much a "your doctor has to build the case" test rather than something you can self-order the way you often can with CAC.

How to talk to your doctor

The most important thing here is to advocate for yourself. I always recommend going to your doctor with a plan to bring this up instead of hoping it comes up:

• "I’d like to talk about  my family history: [specifics]. Given that, should I have a CAC score done? And what else can we check to make sure we are on top of this as much as possible? 

• "Can we run some additional cholesterol markers like a full lipid panel as well as ApoB and Lp(a)?” 

• "I'm in perimenopause/menopause and I understand my risk goes up. Does that change what you'd want to monitor for me?"

• "If my CAC score comes back at zero, but I have other risk factors or symptoms, would a CCTA make sense for me?"

You don't need to walk in as your own cardiologist. You need to walk in with enough language that your risk factors don't get waved off as "you look healthy." And if you are dismissed, we can get labs ordered for you usually very reasonably while you look for a doctor who will actually not dismiss your concerns to be proactive. 

Your move

You can't control your family history but you can control whether you know your numbers, ask the right questions, and catch what's preventable before it becomes an emergency. We truly do have so much power! If you want support building a lifestyle plan around your actual risk factors, not a generic one, that's exactly the kind of work we do together in 1:1 healthy lifestyle coaching and I’d love to see if we’d be a fit to work together!