AARP Smart Guide to a Healthy Heart

Your heart prefers a good night’s sleep. A study of 2,032 older adults published in the Journal of the American Heart Association in 2023 found that those with inconsistent sleep patterns (such as getting six hours one night, eight another) were more likely to have artery-clogging plaque in their hearts.

An erratic sleep schedule may harm your heart by interfering with your metabolism, boosting depression and anxiety, or de-motivating you to exercise and follow healthy eating habits, says sleep researcher Jessica R. Lunsford-Avery, an associate professor of psychology at Duke University Medical Center. Her research shows that irregular sleep schedules, combined with less exposure to morning sunlight, could lead to obesity, high blood sugar and high blood pressure.

5. Manage your stress levels

Stress can significantly increase the risk for fatal heart disease, according to a landmark 2021 AHA report. Anger, anxiety, depression and pessimism all affect the heart and arteries. One reason is that they’re linked to other risk factors like obesity and lack of exercise, says Dr. Glenn Levine, director of the cardiac care unit at Michael E. DeBakey Veterans Affairs Medical Center in Houston and professor at Baylor College of Medicine. Those negative feelings may also make you less likely to take medications or instigate healthy lifestyle changes that control diabetes, high blood pressure and high cholesterol.

To Levine, the most crucial takeaway from the report was the impact of good mental health on heart health. “There is very good-quality scientific data that things as simple as optimism seem to have a very real bearing on one’s heart health,” he says. “They’re worth cultivating.”

6. Quit smoking — and not just cigarettes

Don’t fall for the myths about other smokable and smokeless tobacco products. A collaborative 2025 study of 103,642 mostly midlife and older adults found that those currently smoking pipes or cigars, or using smokeless tobacco, faced a higher risk for heart disease, heart failure and heart-related death compared to nonsmokers. Marijuana may not be safe for older adults, either. University of California San Francisco researchers warned in a 2025 study that THC, the compound in cannabis that gets you high, damages blood vessels in chronic users whether they smoke it or munch on edibles. As for those ultrasonic cigarettes, promoted as a healthier alternative to e-cigarettes and vape pens, University of California Riverside researchers in 2025 found troubling levels of harmful metals in them, including arsenic, a potential heart threat.

7. Be mindful of the ‘big 3’ risk factors

High blood pressure, high cholesterol and diabetes are among the top causes of heart disease. Doctors should screen for each of those conditions as part of your annual physical, says Dr. Micah J. Eimer, associate chief medical officer at the division of cardiology at Northwestern Medicine. Lifestyle, and medication if needed, can control all three by lowering your risk of heart attack, artery-clearing heart procedures, heart failure and other heart and blood vessel problems.

However, plenty of people skip this basic step: Between 20 and 30 percent of midlife and older adults are unaware they have diabetes; between 10 and 20 percent don’t know they have high blood pressure; and up to 10 percent are unaware of their high cholesterol, according to a 2025 study of 15,269 people by researchers at Beth Israel Deaconess Medical Center in Boston.

8. Take steps to get a more accurate blood pressure reading

Blood pressure measurement mistakes could throw your reading off by as much as 50 points, which means you may not be properly diagnosed or treated if you have hypertension, according to a 2023 expert analysis from the ACC. Even with automated blood pressure measurement in doctors’ offices and clinics, errors are made up to 42 percent of the time, according to a University of Maine report in the January 2021 issue of the journal Hypertension.

You and your health care provider can take steps to ensure that your blood pressure reading is as accurate as possible. Avoid caffeine 30 minutes before a blood pressure check, and make a bathroom trip to empty your bladder beforehand. Rest for five minutes before a reading. During the test, refrain from talking, sit with your feet flat on the floor and make sure your back is supported. Skipping any of these steps could have a five- to 20-point impact on the reading. The practitioner should use a cuff that isn’t too big or too small. (According to the AHA, “one finger should fit easily at the top and bottom of the cuff; two fingers should fit but will be very snug.”) The practitioner should also put the cuff over your bare upper arm, not over your clothing, and position it at the level of your heart. “Position matters when recording blood pressure,” Eimer notes.

9. Monitor your Lp(a) levels

One in 5 people have high levels of a type of cholesterol called lipoprotein a, or Lp(a). Compared to LDLs, Lp(a) is five to six times more likely to cause plaque buildup in artery walls and to boost inflammation levels. That can greatly increase your risk of a heart attack or stroke. “We might call it ‘ugly cholesterol,’” says Milks.

Your levels can be high even if your other cholesterol numbers look good, Milks adds. Women’s numbers trend higher, especially at menopause. And because high Lp(a) is linked to genetics most of the time, healthy habits won’t put a dent in it. Ask about a blood test for Lp(a) if you know close relatives have high levels, if high cholesterol runs in your family or if there’s a family history of heart disease. Several Lp(a)-lowering drugs are in development;  however, none have been approved by the U.S. Food and Drug Administration (FDA). But knowing that your Lp(a) levels are high can help you and your doctor decide on other steps to protect your heart, such as cholesterol-lowering statin drugs. 

10. Know your ApoB number

Your LDL number doesn’t show all the heart-threatening gunk in your bloodstream. A test for ApoB, a protein found on LDLs and other risky lipoproteins, effectively counts up all the bad stuff, Milks says. The test can detect heart risks even in people with normal LDLs, according to a 2024 study led by researchers at the University of Texas Southwestern Medical Center. It may be especially important for people with high triglycerides, diabetes and/or obesity, Milks says, as well as anyone who’s concerned about their cholesterol.

“ApoB is a better metric of how much of the truly bad lipoproteins are present,” Milks explains. “It can be helpful if there’s a decision to be made about adding more medications and more lifestyle changes to lower heart risks.” However, less than 1 percent of U.S. adults get this test, according to a 2024 study by researchers from Regeneron Pharmaceuticals and Stanford University of more than 80 million people.

11. Measure the plaque in the arteries of your heart

In just 10 minutes, an X-ray scan can detect plaque in the arteries inside your ticker — a potent heart-attack risk —  and give you and your doctor your coronary artery calcium score. Scoring ranges from 0 to over 400. A higher number means more plaque and a higher heart attack risk. This test can help you decide whether or not you need a statin, according to Milks. It’s useful if you have heart disease risk factors such as diabetes, high blood pressure, raised cholesterol or a family history of heart problems but haven’t had a heart attack, stroke or chest pain. “It can be impactful for people over age 40,” says Milks. “You may be at lower risk but have a family history. If the score identifies plaque, you may be able to start statins to prevent a heart attack.” The test is not typically covered by Medicare, but some private insurers are beginning to cover it. The out-of-pocket cost is $100 to $400, according to the AHA.

HELP FOR BIG HEART RISKS

12. Seek out medications for a healthier heart

Treatments for high blood pressure, high blood sugar and cholesterol are better than ever. Newer medications can replace or complement old standards for better results with fewer side effects. That’s good news if your current drugs aren’t working well or you’re having trouble taking them, Milks says.

The newer options for diabetes include glucagon-like peptide-1 (GLP-1) agonists and sodium-glucose cotransporter-2 inhibitors that lower blood sugar and reduce heart risks by 12 to 30 percent, according to various studies. The FDA recently approved a new treatment that combines three blood pressure medications in one pill.  The agency also OK’d the first new kind of blood pressure drug in decades, aprocitentan, for hypertension that isn’t responding to lifestyle changes and other drugs. And for high cholesterol, two newer medications can help when statins aren’t enough.

“Statins are the backbones of therapy for high cholesterol,” Milks says. “If that doesn’t lower numbers enough, I will try non-statin drugs such as ezetimibe [which prevents cholesterol from being absorbed in the intestine] or PCSK9 inhibitors such as alirocumab and evolocumab,  which can reduce cholesterol by 60 percent in people with very high cholesterol, such as genetic familial hypercholesterolemia. Another kind of amazing cholesterol-lowering drug is inclisiran, given as one injection every six months.”

13. If you’re not taking medications as prescribed, speak up

Three out of 4 people with high blood pressure — and about half with diabetes and high cholesterol — don’t have these heart threats under control. There are plenty of reasons — you may have trouble sticking with a healthy diet or getting exercise, for example. (Read on for ways to make it easier.) But skipping or skimping on prescription medications because of cost, side effects or other factors is a major stumbling block.

Whatever the reason, don’t be embarrassed. Tell your doctor what’s going on, says Dr. Madeline Sterling, a general internist and associate professor at Weill Cornell Medicine in New York City. “My best advice is to be transparent,” she says. “The danger is stopping medications and not saying anything. Then we can’t help you. These are silent killers. You can feel good for a long time until you have a heart attack or stroke.” Sterling says your doctor can help you find affordable alternatives or medications with fewer side effects, and work with you on a healthy lifestyle strategy.

14. Weight-loss drugs can help your heart, too

GLP-1 agonists like semaglutide (Ozempic, Wegovy) and tirzepatide (Zepbound) are wildly popular as injectable weight-loss drugs, not just diabetes meds. In a review of 10 studies involving 29,325 overweight and obese adults published in Current Problems in Cardiology in 2024, those who used GLP-1s for weight loss were 29 percent less likely to have a major cardiovascular event such as a heart attack or stroke, and 24 percent less likely to need an artery-clearing heart procedure, compared to people who didn’t use those medications. In June 2025, the ACC recommended that doctors prescribe them as a first-line treatment for obesity, noting their heart-protecting benefits. “Exciting new trials are also demonstrating benefits in obstructive sleep apnea and in a common type of heart failure called HF-pEF, [which occurs] when the squeeze function of the heart is normal but relaxation is suppressed,” Milks says. “Talk to your doctor about them.”

15. Get these three vaccines with a surprising heart bonus

Catching the flu, pneumonia or shingles (herpes zoster) is a surprising threat to your heart and blood vessels. Those illnesses can ratchet up inflammation and rupture fat deposits in artery walls, triggering dangerous blood clots. This can boost risk for a heart attack by 30 percent or more. The good news: The vaccines that guard against these common infections protect your ticker, too. In a 2025 study that followed 1.2 million midlife and older adults for six years, getting a shingles vaccine — which is recommended by the U.S. Centers for Disease Control (CDC) for adults age 50 and older — lowered the risk of several types of cardiovascular events by 16 percent. Recipients of a flu vaccine, recommended annually by the CDC, were 34 percent less likely to have heart attacks, per a 2022 meta-analysis of six studies involving 9,001 midlife and older adults. And getting the pneumococcal pneumonia vaccine — also recommended by health officials for adults aged 50 and older — lowers heart attack risk by 12 percent, according to a 2020 meta-analysis of 18 studies involving 716,108 adults.

16. Monitor your blood pressure at home

“Home blood-pressure recordings are more reliable than office blood pressures due to white coat hypertension [anxiety at the doctor’s office],” says Eimer. “For that reason, all of my patients with high blood pressure have home blood pressure cuffs.” Eimer recommends using a home monitor with an arm cuff rather than a wrist cuff. (Choose one from the American Medical Association’s list of independently validated monitors.)  For an accurate reading, “a helpful hint is that one should take the blood pressure three times in a row, and keep the third value as the one to record,” Eimer says. Measuring at home can help you stick with blood-pressure medications and report changes before your next doctor’s appointment.  

17. Low-dose aspirin? You probably don’t need it

If you’re among the 1 in 4 midlife or older Americans who still pop a low-dose aspirin frequently for its purported heart perks, listen up: It could do more harm than good. Previously, low-dose aspirin was dubbed a “wonder drug” and a “miracle” that was thought to slash heart attack risk by discouraging blood clots. Six years ago, the AHA recommended limiting its use. The reason: Aspirin does lower heart risks a little,  and can be helpful if you’ve already had a heart attack, but it also increases the risk of bleeding in the brain by 31 percent, and in the digestive system by 58 percent.

The U.S. Preventive Services Task Force recommends against adults age 60 and older taking low-dose aspirin to prevent a first heart attack or stroke, and that people ages 40-59 at high risk for heart or blood vessel problems should discuss it with their doctor first.

HEART-HEALTHY EATING

18. Get heart-healthy protein at every meal

Over 40 percent of U.S. women and 30 percent of U.S. men age 50 and older don’t meet the national guidelines for daily protein, according to a study of national nutrition data by researchers at Abbott and the Ohio State University that was published in 2019. That can lead to muscle loss, making everyday activities and formal exercise, two key components of heart-healthy living, difficult. However, some nutrition experts argue that older adults need more protein than the recommended amount to meet the increased demands associated with aging and chronic health conditions. Instead of .8 grams of protein for every 2.2 pounds you weigh, nutrition researchers recommend getting 1 to 1.6 grams instead. If you weigh 150 pounds, that means aiming for 68 to 109 grams a day. Spreading it across three meals instead of loading up at dinner may be better for retaining more muscle, too.

It’s easy to get protein at lunch and dinner: Think tuna salad, grilled chicken breast, three-bean chili or baked salmon. Breakfast can be more of a challenge, notes Kate Patton, a preventive cardiology registered dietitian with the Cleveland Clinic’s Center for Human Nutrition. Healthy foods like oatmeal and a little milk won’t get you there, Patton says. Breakfast meats are high in saturated fat, sodium and often preservatives. Even lower-fat versions can be salty. Instead, enjoy a couple of eggs several times a week. (“Eggs shouldn’t be villainized,” says Patton.) Top your Greek yogurt with nuts and berries. Repurpose dinner leftovers like roast chicken or lean beef into a breakfast sandwich, or create a breakfast burrito by adding beans to warmed-up leftover veggies in a whole-wheat tortilla with a scattering of grated cheese.

19. Focus on fiber

Your heart loves produce, whole grains, beans and nuts because they’re packed with fiber and other nutrients that cool inflammation, regulate blood pressure and keep blood sugar levels healthy.  Women age 50 and older need 25 grams of fiber daily, and men need 38 grams, yet less than 8 percent reach that goal. The U.S. Department of Agriculture recommends that older adults munch 3½ to 5½  cups of fiber-rich fruit and vegetables, and three to five servings of fiber-packed whole grains daily. It makes a difference: Getting five daily servings of fruits and vegetables cut the risk for fatal heart disease by 12 percent in a recent Harvard University study that tracked 108,735 Americans for 28 to 30 years.

20. Go for omega-3s

Heart-healthy omega-3 fatty acids reduce high blood pressure, nurture artery walls, lower triglycerides and even cool inflammation. Cold-water fish like salmon, herring, sardines and mackerel are packed with two potent omega-3s:  eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). No other foods come close. Alpha-linolenic acid (ALA), another type of omega-3 with heart benefits,  is found in flaxseed, walnuts, chia seeds and canola oil.

The AHA recommends eating two 3-ounce servings of fish, especially fatty types, a week. Getting omega-3s from food reduced coronary heart disease risk by up to 24 percent in a 2023 study of 31,184 Americans. If you’ve already had a heart attack, aiming for 1 gram a day of EPA and DHA, preferably from fish, might be a good idea, the AHA says. You’ll find that amount in 2 to 3 ounces of Atlantic salmon. For easy fish meals, turn canned salmon into salmon salad or croquettes, or snack on canned sardines, mackerel or herring, Patton suggests.

If you don’t like fish, talk to your doctor about whether highly purified EPA capsules would be a good alternative, the ACC says. Several studies have found that prescription-grade EPA offered protection against heart attacks and heart failure in people who already had heart disease. 

21. Make a colorful, crunchy salad

Toss together three cups of leafy greens, a cup of cherry tomatoes and a splash of olive oil. Sprinkle with blueberries and a few chopped pecans for crunch. Three cups of raw leafy greens a day lowered heart disease risk by 25 percent in a large 2023 meta-analysis. Lycopene, found in tomatoes, protects the heart’s muscle tissue and blood vessels from damage. Polyphenol compounds in berries guard against plaque buildup, help tame blood pressure and discourage dangerous blood clots. Nuts deliver fiber, nutrients and good fats, Patton says.

22. Kick ultra-processed foods to the curb

Eating lots of ultra-processed foods (UPFs) such as sugar-sweetened drinks and processed meats such as lunch meat, bacon and sausage could increase your risk for heart disease by 17 percent, according to a 2024 Harvard University meta-analysis of 19 studies involving 1.25 million people. UPFs are packed with calories, added sugar, saturated fat and sodium, and compounds added during processing likely contribute to the risk.

Midlife and older U.S. adults get half of their daily calories from ultra-processed foods, according to a 2024 University of Michigan study of 6,220 people. In addition to choosing unsweetened drinks, cutting back on processed meats and eating fresh food instead of processed or fast food, Patton suggests creating your own grab-and-munch snacks, such as carrot sticks and hummus, grapes, cherries, raspberries, dark chocolate and nuts.

23. Have a plant-based lunch or dinner

Stir up a hearty bean soup, make bean chili or grill a bean-based burger. The fiber, nutrients and plant compounds in beans make them great for your heart, while the protein they pack makes them a satisfying centerpiece at dinnertime, Patton says. A cup of black beans, for instance, delivers 15 grams each of protein and fiber, along with cell-protecting antioxidants. You don’t have to stop eating animal proteins like chicken, fish, beef or pork — just swap some for plant proteins like beans or tofu. In a 2024 Harvard University study that tracked about 203,000 people for 30 years, those whose ratio of plant- to animal-based proteins was close to 1:1 were 19 percent less likely to develop cardiovascular disease and 27 percent less likely to have clogged or narrowed arteries in their hearts than Americans who ate four times more animal protein than plant protein. It also found that heart benefits for those who ate twice as much animal as plant protein, but a ratio of 1-to-1.3 was even more protective.

24. Reconsider that extra cocktail

The “French Paradox” is passé. Red wine was once considered heart-healthy due to 30-year-old research that suggested it guarded our arteries from a diet rich in artery-clogging saturated fat. Now, a growing number of better-designed studies suggest that having more than two alcoholic drinks a day boosts our risk for high blood pressure, coronary artery disease, offbeat heart rhythms and heart failure.

For those who already have high blood pressure, even moderate drinking (1-2 drinks per day) can exacerbate it. For those individuals, “reducing or eliminating alcohol intake may be an important part of managing hypertension,” says Dr. Mariann Piano, a Vanderbilt University professor who studies the cardiovascular effects of alcohol.  

In one U.K. study, people who cut out alcoholic drinks for a month saw their systolic blood pressure levels fall by 11 points, Piano notes.   

MOVE FOR HEART HEALTH

25. Take mini breaks from sitting

Stroll around the house for five minutes every hour when you’ve been sitting at the computer or watching TV. Sweep the hallway in addition to the kitchen, take out the trash, walk the dog. All of this counts as extra steps your heart craves, and breaks up sitting time. In a 2025 study from Massachusetts General Hospital of 89,530 midlife and older adults, those who spent the most time sitting each day (10.6 hours or more) had a 54 percent higher risk for fatal cardiovascular disease, and a 40 percent higher risk for heart failure, than those who sat for less than 8.2 hours a day.

Even people who did regular, formal exercise had higher heart risks if they’d also spent long periods of time sitting.

“What’s important is to be very cautious about how long we’re sitting,” says Balfour. “Too many hours without any movement isn’t good for your heart. Your body needs to move throughout the day. Anything that gets your heart rate up even a little helps. Take a couple of 10-minute walks. Play with your kids or pets. Do some yard work.”

26. Stretch to support healthier blood pressure

Moves that stretch out your muscles, like gentle yoga or stretching your thigh and calf muscles, could do your blood pressure some good, too.

In a 2020 Canadian study of older adults with above-normal blood pressure, a daily stretching routine reduced blood pressure readings as much as seven points. In 2024, a Georgia Southern University study of midlife and older adults found that torso stretches reduced blood pressure by two to three points. The researchers who did the 2020 Canadian study say stretching muscles also stretches arteries, improves blood flow and activates the parasympathetic nervous system, which regulates the body’s relaxation response. People in the study stretched for 30 minutes a day, five days a week, for eight weeks. But Chilibeck says yoga or a few moves that stretch the major leg muscles could have similar effects.

27. Give your heart a workout

“If exercise were a pill, everyone would take it,” says Dr. Benjamin Levine, a cardiologist, director of the Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas and professor of internal medicine and cardiology at the University of Texas Southwestern Medical Center. For adults of any age, he explains, physical activity helps control or prevent high blood pressure, diabetes, cholesterol problems, stress, depression, weight gain and sleep problems. In 2021, Levine and his colleagues found that exercise improved heart function in people with heart failure, too. Aim for 150 minutes a week of moderate-intensity exercise, such as a brisk walk, riding an exercise bike or swimming, the AHA recommends.

Want to mix it up?  Levine recommends getting 30 minutes of moderate-intensity activity two to three days a week; an hour of active fun once a week (hiking, dancing, playing a sport); a set of high-intensity intervals once a week (four minutes of brisk activity plus three minutes of recovery at a moderate pace, repeated four times); plus strength training for 30 minutes once or twice a week.

You can get started with any part of the plan. “After a couple more weeks, add another day where you’re active for an hour. Then gradually add the other components,” says Levine. “The idea is to build a habit. Exercise should be part of personal hygiene, like brushing your teeth or changing your underwear.”

28. Start slow if you haven’t been exercising

If you’re not used to regular exercise, talk to your doctor first, Levine advises. And go at your own pace. “Take an easy stroll three days a week. After a few weeks, add more minutes or make it more intense until you’re up to 30 minutes at a pace where you can talk but not sing,” he says. Sterling agrees. “Even being a little bit more active is good for cardiovascular health. You feel better, you sleep better,” she says. “In addition to walking and everyday activity, get some activities that strengthen muscles and improve balance.”