• Smoking (ups the odds at least two- to fourfold-more if you take birth control pills)
• Diabetes (raises your risk four to six times)
• Blood pressure higher than 135/85
• Family history of early heart disease
• Premature (before age 38) menopause (either naturally or through removal of the ovaries) and not taking hormone replacement therapy (HRT)
• Overweight
• Sedentary lifestyle

Don't settle for the treadmill test, where you simply walk on a treadmill while your blood pressure and heart's electrical activity are measured. "Although it's a good starting point for men, a treadmill test is counterproductive for women because it produces so many false positives and false negatives," says Dr. Legato.

So where do you begin? With an exercise echocardiography, also known as a stress echo test. While you're on a treadmill, a machine translates sound waves into pictures that show your heart's size, shape, movement, and pumping ability.

Redesign your diet.
A low-fat diet is appropriate for most women, but certain women with a low HDL level can actually increase their risk for heart disease from cutting back on all fats. Most women (and men) will improve their health with a Mediterranean-style diet consisting of lots of fruits and vegetables, with most of the fat coming from olive oil, canola oil, olives, avocados, and nuts. Olive oil raises good HDL and lowers your risk, says Stephen Devries, MD, director of the Heart Center at the University of Illinois in Chicago. (Prevention recommends that you limit total fat to 25% of daily calories, with no more than 7% as saturated fat.)

Because diabetes increases the risk of heart disease more for women than men, you should use whole grain carbohydrates such as whole wheat bread and brown rice rather than refined ones such as white bread and white rice, says Walter Willett, MD, chairman of the department of nutrition at the Harvard School of Public Health.

In his study of more than 64,000 nurses, Dr. Willett and his colleagues found that those who ate large amounts of refined carbohydrates doubled their chances of developing type 2 diabetes, while those who consumed mostly whole grains didn't raise their risk at all.

Deal with hormones.
Doctors think that women have heart attacks later in life than men because estrogen protects them until menopause, says Dr. Legato. But lately, doctors are being a little more careful about prescribing HRT because a large study suggested that it actually increased the risk of death in women who already had heart disease when they began treatment.

Although doctors won't have the lowdown on HRT until even bigger studies are completed in 2005, many physicians think that HRT is safe-and beneficial-if you have risk factors for heart disease but haven't developed the condition yet. Your best bet: "Discuss HRT with your doctor before meno- pause so that you'll have a plan in place once it happens," advises Dr. Judelson.

In a recent study, women cited low self-esteem as their biggest barrier to a heart-healthy lifestyle, says Lori Mosca, MD, PhD, director of preventive cardiology research and education at the University of Michigan in Ann Arbor.

And how are you going to break free? "Work on becoming more optimistic," suggests Maryann Troiani, PhD, a psychologist in Barrington, IL, and author of Spontaneous Optimism (Castlegate, 1998). "Optimism and confidence go hand in hand."

She suggests ridding your vocabulary of negative words such as "try" and "but" because they don't give you a sense of commitment to your goal. Try to talk more to cheerful people and less to unhappy ones. "We feed off of each other's emotions," she says. And walk tall rather than shuffle your feet. "If you look the part and talk the part, chances are you'll feel the part," says Dr. Troiani.

Recognize the symptoms.
"In women, the signs of a heart attack can be very different than they are in men," says Lynn Smaha, MD, president of the American Heart Association. Instead of crushing chest pain, you may have lighter chest, stomach, or abdominal pain; nausea or dizziness; shortness of breath; heart palpitations; fatigue; and weakness.

If you experience these symptoms, Dr. Judelson advises that you immediately chew a full-strength (325 mg) aspirin (it'll significantly improve your survival rate if you are indeed having a heart attack; if not, it won't hurt) and head to the ER immediately. And if the docs say that they can't find anything wrong? "Don't let them dismiss you until you've received a thorough evaluation, including an electrocardiogram," says Dr. Judelson. "I've had too many patients who were sent home with a clean bill of health from the ER who indeed had heart disease."

Stop being the king of denial. One out of every two men currently 40 and under will eventually develop heart disease; more than 450,000 men died from it in 1996-12 times more than died of prostate cancer.

"You may think that it's the other guy who will get heart disease," says Kenneth Goldberg, MD, director of the Male Health Center in Dallas. "But all my patients with heart disease thought it was going to be the other guy. At least open yourself up to the possibility that it could happen to you. And then work as hard as you can to prevent it."

Think "down with cholesterol." Shoot for a total cholesterol of less than 150 milligrams per deciliter (mg/dl), an LDL (bad) of less than 130 mg/dl, an HDL (good) of 45 mg/dl or higher, and triglycerides of less than 150.

The most important number in that equation is LDL. "In men, studies show that a high LDL increases the risk of developing heart disease more than a low HDL or high triglycerides, and treatment of LDL is most effective in reducing cardiac risk," says Debra Judelson, MD, medical director of the Women's Heart Institute at the Cardiovascular Medical Group in Los Angeles.


An abnormal cholesterol level is not the only tip-off that a heart attack may be in your future, says Stephen Devries, MD, director of the Heart Center at the University of Illinois in Chicago.

Consider these other clues: