DEAR MAYO CLINIC: I am 35 and in good health. I am diligent about getting an annual physical. At my last one, the doctor said that while my numbers look good, since high blood pressure and high cholesterol run in my family, I should consider medications to lessen my risk of a heart attack or stroke. I am not inclined to take medication if I do not need it yet. Is there anything else I can consider in terms of lifestyle modifications?

ANSWER: Congratulations on being aware of your family history and being proactive about your overall health. While genetics does play a role in heart disease, it is important to remember that family history does not mean you automatically will have cardiac problems or suffer a stroke.

Heart disease remains the No. 1 cause of death in the U.S., with over 655,000 people dying annually, according to the American Heart Association. Heart disease actually leads to more deaths in women annually than breast cancer.

Likewise, strokes affect more than 795,000 people annually in the U.S. and are the leading cause of disability in the country. Strokes can occur at any age.

While medication can be an option for some patients, I recommend that you consider the following recommendations to keep your heart, brain and body in shape.

Know your numbers

Aiming to maintain a healthy weight is important, but it also is important to be aware of other numbers, especially your blood pressure and cholesterol.

The biggest challenge is that there generally are no symptoms associated with high blood pressure, also known as hypertension, which is why it's often called the silent killer. Having high blood pressure long term, however, can cause many serious health problems, such as heart disease and stroke, as well as kidney disease, so it's vital to keep blood pressure numbers down.

High blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.

Ideally, a normal blood pressure is below 120/80 mmHg. You are said to have prehypertension if your top number ranges from 120 to 139 mmHg or your lower number ranges from 80 to 89 mmHg. Prehypertension tends to worsen over time. And anything over 140/90 mmHg is considered hypertensive.

You should check your blood pressure two to three times a week because you don't know if it's high or if it's at goal unless you check it.

If you already have had a baseline cholesterol check at your last physical, talk with your clinician about how often you might need to repeat the test, given your family history. Cholesterol is a waxy substance that's found in the fats in your blood. When you have too much cholesterol, you can develop fatty deposits in your blood vessels that can make it difficult for blood to flow through your arteries. An estimated 29 million adults in the U.S. have high cholesterol.

Make sure you also are having your blood glucose checked regularly because diabetes also can contribute to vascular issues.

Feed your heart and cut the salt

Research shows that consuming food high in sugar, salt and saturated fat can increase the risk of heart disease. While it can be difficult to change your eating habits, I encourage my patients to eat at least five servings of fruits and vegetables per day. Besides being low in calories and rich in dietary fiber, fruits and vegetables are full of important vitamins and minerals. Eat at least one serving of fish per week. Consider using olive oil when you cook or in salads instead of mayonnaise or other rich condiments. Also, be aware of salt. As good as it tastes, too much sodium can cause high blood pressure. Avoid processed foods, and stock up on a variety of herbs and spices to use in your cooking. Try to avoid anything that comes in a box or a package.

Move more

It's important to keep your heart healthy by getting active. American Heart Association guidelines recommend 150 minutes a week of moderate-intensity aerobic activity or 75 minutes per week of vigorous activity. Ideally, the goal would be five times a week, but it's important to find something — anything — you love to do that gets you moving, even if it's in small increments. For instance, park farther away at the grocery store or take the stairs instead of the elevator. Any movement can count toward your fitness goals.

Lessen stress

Stress can be a trigger for many people, which can increase your blood pressure and lead to other unhealthy habits, such as smoking, overeating and difficulty sleeping. I recommend making mindfulness a part of your daily routine, as well as activities to help reduce stress and anxiety. Consider massage, yoga or meditation. Make a cup of tea and curl up with a good book. You can get your exercise by going for a walk. Whatever you choose, your heart will benefit.

Be open with your health care team about your desire to delay medication as long as possible and discuss your goals for living a healthier lifestyle. Together, you can come up with the best follow-up schedule that suits you. Just remember that change takes time. Focus on one thing you can do today, and then add in another change the next week. — Dr. Tina Ardon, Family Medicine, Mayo Clinic, Jacksonville, Florida

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• Mayo Clinic Minute: Obesity and heart disease published 2/23/23
• Mayo Clinic Minute: Heart disease in African American women published 2/17/23
• Mayo Clinic Minute: Success in reducing heart disease deaths, except for young women published 2/7/23
• Mayo Clinic Minute: What is heart disease? published 1/31/23
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