A Heart-Healthy Routine for Every Life Stage:
What to Focus on in Your 20s to Your 70s and Beyond

Heart disease develops over decades, so the habits that protect your heart matter at every age, but the priorities shift as you get older. The American Heart Association's "Life's Essential 8" sums up the foundations: not smoking, being active, eating well, sleeping well, and keeping weight, blood pressure, blood sugar and cholesterol in healthy ranges. In a study of 23,003 US adults, people with the highest scores on these eight measures could expect to live 8.9 years longer from age 50 than those with the lowest scores, and not smoking alone was linked to 7.4 extra years. Movement is one of the easiest wins: in 15 studies of nearly 50,000 people, the benefits of walking levelled off at about 6,000-8,000 steps a day for people over 60 and 8,000-10,000 for younger adults. This guide brings together the evidence from this section into a practical routine, with what to focus on in your 20s and 30s, 40s and 50s, and 60s and beyond.

Key numbers

The foundations: Life's Essential 8

The same eight factors protect the heart at every age:

• 1. Don't smoke or use tobacco, including smokeless tobacco and vaping.
• 2. Be physically active, combining aerobic and strength exercise.
• 3. Eat well: mostly vegetables, fruit, pulses, whole grains, nuts and fish, with less salt, sugar, refined carbohydrates and saturated fat.
• 4. Sleep 7-9 hours a night (see Sleep and Cardiovascular Health).
• 5. Keep a healthy weight and waist (see What Metabolic Health Really Means).
• 6. Control blood pressure (see Blood Pressure Explained).
• 7. Control blood sugar (see Insulin Resistance).
• 8. Control cholesterol (see LDL, ApoB and Lipoprotein(a)).

Why it's worth it

In a 2023 study of 23,003 US adults, those with the highest cardiovascular health scores on these eight measures had an average of 8.9 more years of life expectancy at age 50 than those with the lowest scores. Not smoking, sleep, physical activity and blood sugar control had the greatest individual effects, with not smoking alone linked to 7.4 extra years. In a UK study of 136,599 adults, people with ideal cardiovascular health spent a larger share of their lives free of chronic diseases such as heart disease, cancer, diabetes and dementia.

A weekly heart-healthy routine

Practical detail on each area is covered in Lowering Blood Pressure Without Medication, Lowering LDL Cholesterol and Zone 2 Training.

By life stage

Your 20s and 30s: build the foundations. Atherosclerosis starts early, and the LDL, blood pressure and blood sugar you have in these decades add up over a lifetime (see How Atherosclerosis Develops).

• Build an exercise habit you enjoy, including strength training.
• Establish healthy eating and cooking habits, and keep alcohol low.
• Never start smoking, or stop now.
• Know your numbers: blood pressure, a lipid profile from 20, and lipoprotein(a) once. South Asians and people with a family history should check blood sugar early.
• For women, pre-eclampsia, gestational diabetes and polycystic ovary syndrome are early warning signs worth following up (see Women's Heart Disease).

Your 40s and 50s: find and fix risk factors. This is when blood pressure, weight, blood sugar and cholesterol often start to drift, and when heart attacks begin to occur, earlier in South Asians (see South Asian Cardiovascular Risk).

• Get a 10-year risk assessment and act on it (see Cardiovascular Risk Scores and Heart Age).
• Screen for diabetes, fatty liver and, if you have risk factors, kidney disease (see Cardiometabolic Screening: Which Tests You Need, When, and Why).
• Protect muscle with strength training as muscle naturally declines.
• Watch your waist: abdominal fat drives insulin resistance.
• For women, blood pressure and LDL often rise around menopause; check them regularly.
• If medicines are recommended, such as for blood pressure or cholesterol, take them alongside lifestyle changes, not instead.

Your 60s, 70s and beyond: stay strong and active. The goals shift towards preserving function, independence and quality of life.

• Keep walking, aiming for 6,000-8,000 steps a day, and add strength and balance training at least three days a week to prevent falls.
• Keep blood pressure well controlled, which also protects the brain (see Hypertension and Longevity).
• Check your pulse for atrial fibrillation (see Atrial Fibrillation).
• Review your medicines regularly; for example, don't start aspirin for prevention without discussing it with your doctor (see Aspirin for Heart Disease Prevention).
• Keep eating enough protein and stay socially connected.

Recommendations by scenario

Practical notes

A heart-healthy life comes from a few habits repeated over years: not smoking, moving every day, eating mostly whole foods with less salt and coconut oil, sleeping well, and knowing and controlling your blood pressure, cholesterol and blood sugar. In your 20s and 30s, build the habits; in your 40s and 50s, find and fix risk factors; from your 60s, stay strong, active and connected. People with high cardiovascular health can expect to live years longer, and more of those years free of chronic disease. It's never too early, or too late, to start.