Cholesterol levels shift HDL (good) cholesterol sweeps up LDL (bad) cholesterol and shunts it to the liver for removal. Without enough HDL, the bad stuff builds up, causing plaque. Plaque causes clots Plaque is a mix of fatty substances, including LDL cholesterol, which burrows into and inflames artery walls. When a plaque deposit bursts, the body’s healing mechanism produces a clot. This can obstruct the artery and cause a heart attack. Arteries become weak and stiff High blood pressure hardens flexible arteries, which strains the heart, rips open plaque deposits, and promotes blood vessel leaks that can cause an aneurysm or stroke. Blood vessels are lined with the same kind of tissue as your skin. “It’s just as important to keep your inner skin as beautiful as the visible skin,” says Lori Mosca, MD, PhD, an associate professor of medicine at Columbia University in New York City. “Instead of protecting it from the sun, you need to prevent damage from a poor diet or lack of exercise.” Blood can become “sticky” High blood sugar is like a soda spill on a countertop—it permits plaque-forming material to fasten more easily to artery walls. It’s also a symptom of diabetes, which doubles your risk of heart disease or stroke. More from Prevention: Beat Your Sugar And Starch Addiction Waist size expands Slowing metabolism leads to weight gain, which contributes to diabetes, high blood pressure, and high cholesterol. “Large waist size is the most important risk factor—it compounds all the others,” says Annabelle Volgman, MD, medical director of the Heart Center for Women at Rush University Medical Center in Chicago. You Stay-Young Plan: Keep moving “Physical activity reduces every controllable risk factor,” says Volgman. Just 10 minutes of cardiovascular exercise on most days can cut a sedentary person’s heart attack risk in half. TRY: Intervals By boosting aerobic fitness and metabolism, twice-a-week interval training (short bursts of high-intensity exercise) for just 2 weeks can reduce heart risks by 20%, according to studies. (Get started with these 5 fat-burning strength moves.) More from Prevention: 25 Easy Ways To Fit In 10 Minutes Of Exercise [header = Monitor Your Markers] Monitor your markers Keep a copy of the blood work you have done during your annual physical and track changes over time. Make sure your numbers are always within these ranges:

Cholesterol: LDL under 100 mg/dL; HDL above 50Blood pressure: Below 120/80 mm HgFasting blood sugar: Less than 100 mg/dLTriglycerides: Less than 150 mg/dL

TRY: “Subclass” cholesterol tests If you have heart disease or are at risk, ask for a test called lipoprotein subfraction, which measures the size of your cholesterol particles. If your LDL particles are very small, they are better able to burrow into artery walls; despite normal or low cholesterol readings, you may need more aggressive monitoring and treatment. (Check out these 12 natural remedies for high cholesterol.) Test for inflammation Doctors now know that when LDL cholesterol damages the arterial wall, the artery becomes chronically inflamed, starting a cascade of events that may culminate in a heart attack. As part of this inflammatory response, your body produces a substance called C-reactive protein (CRP), which can be measured in a blood test. If you have normal cholesterol but a high level of CRP, you may need a more aggressive preventive plan or more intense monitoring of lipids. TRY: Screen out false positives Make sure to ask for the high-sensitivity test, which rules out other causes of inflammation, such as infection, injury, and arthritis. Brush your teeth, clean your arteries Cutting your risk of heart disease may be as easy as regularly flossing and brushing. Columbia University doctors have found that people whose mouths contain a high number of the bacteria that cause gum disease are more likely to have plaque-clogged arteries. TRY: Save every tooth Keep an eye out for gum recession. A study found that men ages 40 to 75 who had lost eight or more teeth because of gum disease had 57% higher risk of stroke than those who had lost less than eight. Get a baseline heart scan Prominent cardiologists recommend that women over age 50 who are postmenopausal and have any risk factors for coronary disease get a heart scan—several different technologies are available—to measure coronary artery calcium, which directly correlates to the total amount of plaque in your arteries. An early baseline enables your doctor to monitor signs of heart disease. TRY: A highly detailed picture Opt for the brand-new 64-slice CT scanner, which measures calcium and the amount of dangerous soft plaque in the arteries. Filled primarily with cholesterol, soft plaque is prone to rupture, resulting in a blood clot that can cause a heart attack. [header = 5 Heart Attack Fighters] 5 Heart Attack Fighters*

  1. Eat more omega-3 fatty acids. They curb inflammation, lower blood pressure, and slow plaque growth. To get more, eat oily fish such as salmon at least twice a week and consider taking EPA and DHA supplements of 850 to 1,000 mg a day if you have heart disease.
  2. Take aspirin with a doctor’s okay. Low doses prevent clots that cause heart attacks, but regular use can cause stomach bleeding and increased stroke risk. “Whether you should take it depends on your age and family history,” says Mosca.
  3. Avoid antioxidant supplements. Recent research suggests that high doses of beta-carotene, vitamin A, and vitamin E may increase the risk of premature death, and too much vitamin C may boost the risk of dying for women over age 50 with diabetes.
  4. Cut saturated fat even further. Artery-damaging fat should account for less than 10% of daily calories. Ideally, you should keep it below 7%. Be vigilant about reading food labels to avoid eating partially hydrogenated (trans) fats.
  5. Trim 200 calories a day after menopause. After 50, your metabolism slows about 5% a decade, so your body burns less energy even if you’re moderately active. Protect Your Heart Like the Mediterraneans Olive oil, leafy greens, whole grains, nuts, fruit, fish, red wine, tomatoes, oh my! Their rich blend of antioxidants, phytochemicals, vitamins, and healthy fats cuts cardiovascular risks. (And make for a very tasty lunch.) Just 3 months of Mediterranean-style eating in one recent study improved blood sugar, blood pressure, and cholesterol in people at high risk of heart disease. The Mediterranean diet offers good sources of chromium, which may lower bad and raise good cholesterol as well as prevent insulin resistance (the hallmark of diabetes)—but it’s hard to get enough of the mineral from food. Best bet: Take a daily multivitamin with chromium. Or toss them into your lunch. Quick tip Have a truffle for dessert : Eating a 30-calorie dark chocolate daily for 2 weeks will lower systolic blood pressure by 3 points and diastolic pressure by 2. More from Prevention: 28 Days to a Healthier Heart *courtesy of The American Heart Association Interested in other stay-young plans? See how you can Feel Fabulous After 40.