Insider Secrets from a Top Cardiologist

14 ways to keep your ticker in great shape as you age

As told to

Robin Roenker and Eric Spitznagel,

AARP

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Published February 24, 2025

Cardiologist Martha Gulati says how you talk to your doctor can make a big difference for heart health.

Kathleen Fu

February is American Heart Month, the perfect time to take a closer look at your heart health. Let’s start with the bad news: Yes, your risk of developing heart disease increases with age. After 50, your blood vessels start stiffening, your heart wall gets thicker and inflammation sets in, setting you up for a possible cardiovascular event.

But we’re not telling you this to send you into a spiral of despair. Heart disease is serious and scary — but not unavoidable. There have been some remarkable new therapies and technologies for treating heart disease introduced in recent years, and we know more than ever about the importance of diet and exercise. But if you really want to outsmart heart disease, you’ve got to be one step ahead of it. That means getting insider tips from a person whose entire job is to ensure our hearts keep working as long as possible.

Martha Gulati, MD, the Director of Preventive Cardiology at Cedars‑Sinai's Smidt Heart Institute, and the author of Saving Women’s Hearts shares 14 steps everyone over 50 can take for a stronger, healthier, more resilient heart.

Don’t treat your cardiologist like a traffic cop

Patients think they know what we doctors want to hear. If I ask them about the negative things, like how much alcohol they drink or whether they smoke, they always underestimate it. And they overestimate how much exercise they’re doing. But cardiologists and patients need to work together like partners, not adversaries. You shouldn’t talk to us like you’re trying to talk your way out of a speeding ticket. We’re on your side. We’re your partner in this journey. And we can only help if we really know what’s going on. You should think of your doctor’s office as a safe space. And if for any reason you don't feel that way, then find a new doctor.

Keep track of any chest discomfort or shortness of breath

I see both men and women downplaying their symptoms as if they almost don’t want to bother their doctor with them. They’ll say, “I get this chest discomfort, but it’s probably nothing.” And they minimize it. But actually, we really need to hear about those symptoms honestly. We want to hear exactly what you’re feeling. We need to know the real facts of when and how those symptoms appear. Then, we’ll go through it with you and determine whether it’s related to your heart. In addition to chest discomfort, you should always talk with your provider if you experience shortness of breath while doing an activity you formerly could do without any problem.

Find a reason to laugh every day

A few studies of older adults have demonstrated how laughter can be an effective way to keep your heart healthy. Specifically, these studies looked at the artery function and found a benefit from a coronary artery standpoint. We’re not sure exactly what’s happening, but we know that endorphins get released when you laugh, which can actually latch onto receptors in the blood vessels, which may be one of the reasons why we see benefits in the artery function. Once they attach, the arteries themselves may be better able to release nitric oxide, which relaxes the arteries and improves blood flow.

Have more (worry-free) sex!

There’s that old Hollywood cliche where an older man sleeps with a younger woman and has a heart attack. Somehow that’s evolved into anxiety that all older adults having sex could end up with heart failure. Sex does increase our heart rate and blood pressure, but don’t overestimate it as a physical activity. You probably exert more energy with a brisk walk. (Of course, if you’re doing something really athletic and interesting, that might be a different story!) But regular intercourse is fine. If you start having chest pain during sex, or you’re feeling a shortness of breath, that’s something you should talk to your doctor about. But otherwise, sex has been found to reduce the risk of heart disease, not encourage it.

You don’t need to drink alcohol to reduce stress — you need a dog

For years now, we’ve been telling people that there’s no real amount of alcohol that we recommend, from a heart health perspective. If you don’t drink, don’t start. If you do drink, then drink moderately. The recommendation for men is two or fewer drinks per day. For women, it’s one glass of wine or the equivalent daily.

But an even better recommendation is not to drink at all, and find a healthier way to deal with your stress. So consider getting a dog. There’s some evidence that owning a dog can reduce your risk of heart disease and stroke by over 30 percent. Dogs can reduce stress, anxiety and depression. And nobody has ever gotten a hangover from living with a dog.

A heart attack doesn’t always have “classic” symptoms

Most people are well aware of the traditional symptoms of cardiac disease, like chest pain, shortness of breath and a shooting pain down their left side. But many symptoms are either easy to ignore or people don’t associate with a possible heart attack. Like pain in the neck or jaw, or a sense of profound fatigue, or sudden nausea, which can often be mistaken for indigestion.

I had a female patient who felt shoulder pain and just assumed it was from carrying a purse. Just a few hours later, I was treating her for a heart attack in the emergency room. If you’re feeling something different in your body that comes on suddenly and is more intense than usual, talk to your doctor immediately.

Stop thinking of heart disease as a “man’s disease”

In the ’60s, the American Heart Association hosted a conference called “How Can I Help My Husband Cope with Heart Disease?” That was more than half a century ago, but some patients still believe that men are more likely to have heart disease than women. One survey found that women are more concerned about weight and breast health than their hearts. Women need to understand that heart disease is the leading killer of women and that they’re 10 times more likely to die from heart disease than breast cancer. And you can’t always count on your doctor to remind you. We constantly remind women to get mammograms and Pap smears, but no one’s really telling them to get their heart checked.

There is no magic number of steps

We get conflicting information on how much physical activity we should get in a day. For a while, the rule of thumb was 10,000 steps a day for better heart health. Then there was a study from the University at Buffalo last year that found for people over 60 years old, 3,600 steps per day at a normal pace was associated with a 26 percent lower risk of heart failure. (A previous study published in 2023 found that people who took just upwards of 3,800 steps per day reduced their risk of dying from any cause, and those who took at least 2,337 steps lowered their odds of dying from cardiovascular disease.)

But the truth is, there’s no magic number of steps. We did a study at Cedars-Sinai last year, where we looked at the physical activities of 400,000 men and women, and we found that any activity was better than no activity. Most people live very sedentary lives. We just need to move. It’s not about getting the right number of steps, but trying to incorporate movement every hour in some way, except when we’re sleeping.

Let's talk about aspirin ... again

There’ve been some confusing headlines about aspirin. A few years ago, the U.S. Preventive Services Task Force recommended that people over 60 not take a daily aspirin to prevent stroke or heart attack. But that’s only true for people who don’t have any heart disease or heart attack risks. Aspirin isn’t effective, it turns out, as a preventative therapy. However, if you’re already taking aspirin for heart disease, you shouldn’t stop. We have not changed our recommendations for people with heart disease, and that has not fluctuated at all in the last three-plus decades.

Don’t overdo it with the energy drinks

A safe daily amount of caffeine is around 400 milligrams per day. If you consume canned energy drinks, you should be looking closely at the labels. Some of them have as much as 200 to 300 milligrams per can. Consuming that much caffeine so quickly can raise your heart rate and blood pressure.

If you need caffeine to get through your day, stick with coffee. When I started out in medicine, we’d tell people with heart conditions like arrhythmias to avoid coffee entirely. But now there’s evidence that coffee in moderation can be heart-healthy, including a 2022 study that showed people who drink between two and three cups of coffee every day — at just under 100mg of caffeine per cup — have a lower risk of cardiovascular disease.

Shovel snow differently

For those in their 50s, shoveling snow can be especially dangerous for your heart. The cold temperatures increase your blood pressure and constrict the coronary arteries, and the heart rate can go up to about 85 percent of its maximum rate after just a couple of minutes of heavy shoveling. Too often, people don’t realize just how hard they’re working and what an intense aerobic activity snow shoveling can be — and that can lead to heart attacks.

I recommend taking plenty of breaks, and if you’re able, push the snow rather than lift it. People tend to hold their breath when lifting something heavy, and that just causes the blood pressure and heart rate to go up. If you’re able to push snow to the side rather than lifting it over your head and throwing it, that’s always better. If you have to lift, invest in a smaller shovel so you’re not lifting as much snow. Or better yet, pay the neighborhood kid who wants to shovel for you!

Include your pharmacist about potential drug interactions

If you’re taking medications for a cardiac condition or for high blood pressure, you should make a habit of talking with your pharmacist about potential drug interactions before adding a new prescription or over-the-counter medication. The potential for negative interactions with cough suppressants and grapefruit are ones that everyone knows about. But, really, before adding any new medication or even a new over-the-counter nutritional supplement, you should always ask, “Is this going to interact poorly with any medications I’m already taking?”

Pay attention to your breathing

I’m a big fan of tai chi and yoga, not just because they help with things like stress and blood pressure, but also because they teach you to pay attention to your breathing. That conscious manipulation of breathing makes you slow down and really be aware of what’s happening in your body.

In general, I think it’s useful to pause every once in a while and just listen to your breathing. There are so many apps now that can help with this. My smartwatch reminds me to take deep breaths for ten seconds every so often. When I listen to it, I can see my heart rate come down in real-time.

Pre-existing heart disease? Evaluate hormone therapy carefully

There’s a misconception out there that hormone replacement therapy (HRT) reduces women’s risk of heart disease. I’ve even seen misguided claims on social media lately that HRT can replace your statin therapy. Let’s be clear: there’s nothing magic about HRT that’s going to prevent heart disease or take away your need for statins. In fact, if a woman has pre-existing heart disease, the data is very clear that using HRT could increase her chance of having a future cardiac event. Decisions on whether or not to use HRT for menopausal symptom relief should include an evaluation of these risks and be a shared decision between a woman and her provider.

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Robin Roenker is a contributing writer who covers health, travel, education and lifestyle stories. She has also written for USA TODAY and Wine Enthusiast.

Eric Spitznagel is a features writer for AARP Members Edition. He was also a cofounding editor of The Arrow, AARP’s newsletter for Gen X men.