1. Her father or brother below age 55 or her mother or sister below age 65 have had a heart attack, stroke, angioplasty or bypass surgery.
  2. She is over 55 years old. (After age 65, the death rate increases sharply for women)
  3. She smokes or is exposed to second-hand smoke every day.
  4. Her blood pressure is over 135/85 mm Hg. Optimal blood pressure is 120/80 mm Hg. Drug therapy is indicated when blood pressure is >140/90 mm Hg, or an even lower blood pressure in the setting of chronic kidney disease or diabetes (> 130/90 mm Hg).
  5. She does not exercise for at least 30 minutes that includes moderate–intensity physical activity, like taking a brisk walk, on most days. For weight control, women need to exercise for 60–90 minutes with moderate–intensity activity on most days.
  6. She has diabetes. After age 45, diabetes affects many more women than men. If diabetic, aim to achieve glycosylated hemoglobin (HbA1c) level less than 7%.
  7. Her HDL (High Density Lipoprotein or “good” cholesterol) is less than 50mg/dL.
  8. LDL goals are dependent upon risk. The following levels of lipids and lipoproteins in women should be encouraged through lifestyle approaches: LDL–C <100mg/dL; HDL–C >50mg/dL; triglycerides <150mg/dL and non–HDL–C (total cholesterol minus HDL cholesterol) <130 mg/dL. If a woman is at high risk or has hypercholesterolemia, intake of saturated fat should be <7% and cholesterol intake <200 mg/d. For diabetic women, LDL should be <100. For vascular disease and very high risk women, LDL should be<70. HDL of 60 mg/dL is considered cardioprotective. One can raise HDL by taking in 2–3 tbsps of olive oil daily, quitting smoking, getting regular aerobic exercise and maintaining a healthy weight.
  9. She is overweight by 20 pounds or more (More than one–third of women are more than 20 pounds overweight.)
  10. Either natural or through surgery, early menopause, before the age of 40 is associated with increased risk for cardiovascular disease.
  11. Taking birth control pills greatly increases risk of heart attack and stroke, especially after age 35.
  12. She has a high demand/low control job with sustained high levels of stress. Stress is a normal part of life.
  13. A healthy diet consists of eating fruits, vegetables and whole grain high–fiber foods (aim for 5 servings of vegetables and 2 servings of whole fruit daily); eating fish, especially oily fish, at least twice a week; limiting saturated fat to < 10% of energy, and if possible to <7%, cholesterol to <300 mg/dL. Limiting alcohol intake to no more than 1 drink per day; limiting sodium intake to <2.3 g/d (approximately 1 tsp salt) and avoiding all trans–fatty acids (listed as “hydrogenated oil” in the ingredients section)
  14. Pregnant and lactating women should avoid eating fish potentially high in methylmercury.
  15. Having at least three of a cluster of symptoms that are listed below put her at risk:
  1. High blood sugar >100 mg/dL after fasting
  2. High triglycerides, at least 150 mg/dL
  3. Low HDL (<50 mg/dL in women)
  4. Blood pressure of 130/85 or higher
  5. Waist >35 inches (Waist measurement of 35 inches or more or waist–to–hip ratio greater than 0.80 is a predictor of high triglycerides and low HDL levels).