One of the most important things to understand about heart health is that a woman’s needs change over time. Risk factors for heart disease like high blood pressure and high cholesterol can become more important as a woman ages. Hypertension and high cholesterol are not things we may feel. This is why hypertension is called the silent killer.

Even women who have always maintained normal cholesterol and blood pressure levels could be in for some surprises as they enter into menopause. That is why annual physicals are so important. Aside from regular checkups, eating well, exercising, and not smoking (or quitting smoking), there are a few other things you can do to keep your heart strong.

Sleep

Lack of sleep increases high blood pressure and “belly fat” through the release of stress hormones. This, too, is an issue that changes over time, as women move from the sleep patterns of adolescence through the disrupted sleep patterns of motherhood and into the disrupted sleep patterns of menopause and post-menopause.

Each one of these phases of life (and all the phases in between) come with their own challenges, but simple changes can be made to reset a woman’s circadian rhythm. I recommend fewer stimulants, such as caffeine, particularly after 12 p.m. and enough exercise to ensure your body is worked out and tired by the end of the day. Additionally, some postmenopausal women might benefit from hormonal patches to help with perimenopausal symptoms that can aid in better sleep.

Move your body

Too often, our daily schedules don’t allow for exercise, particularly for women who prioritize the needs of their families above their own. Small shifts in the way we do things can help, like taking the stairs instead of the elevator. But it’s important for women to remember that running after children and doing errands does not really count as exercise. Take time for yourself to get the recommended 30 minutes of cardiovascular exercise every day. Your heart – and your loved ones – will thank you.

Eat well

“Yo-yoing” between weight extremes can increase your risk for heart disease, so it is important to maintain a healthy weight. Taking the time to plan meals and snacks can help head off bad food choices – which, in turn, can become bad food habits. Meditating and reducing stress can also play a critical role, as many of us tend to eat (or drink) our feelings.

Know what to look for

Just as important as knowing how to prevent your risk of heart disease is knowing whether you have it. Too often, women delay going to the ER with heart symptoms because heart attacks and heart disease don’t always look the same in women as in men. If you experience sudden tightness or pressure in your chest radiating to the arm, neck, or jaw, or exertional shortness of breath or fainting, go to the ER immediately. The longer you delay care for possible heart attack symptoms, the more you are at risk for losing heart muscle function.

Dipti Itchhaporia is director of disease management, Jeffrey M. Carlton Heart & Vascular Institute, Hoag Memorial Hospital Presbyterian, Newport Beach, CA.