The rate of heart disease in the U.S. has declined steadily over the last 40 years. But even though heart attacks are uncommon in young women, the rate for deaths in women 35 to 44 years of age has remained about the same. Researchers wondered if this could be explained by certain lifestyle choices and set out to test their theory.

What they found is that young women — and presumably men — can avoid many heart problems simply by developing six healthy lifestyle habits that greatly reduce the risk of having a heart attack or developing a risk factor for heart disease as they get older.

Even those women with a diagnosed risk factor for heart disease who adhered to at least four of the healthy practices had a lower risk of developing the disease.

Up to 75 percent of heart attacks that occur in women could be prevented had they followed healthy lifestyle practices, the study found. Even those women with a diagnosed risk factor for heart disease who adhered to at least four of the healthy practices had a lower risk of developing the disease.

Researchers defined the six healthy lifestyle practices as:

  • Not smoking
  • Exercising at least 2 ½ hours per week
  • Eating a diet low in red meat, refined grains and sugar, and high in vegetables and whole grains
  • Having a body mass index in the normal range
  • Watching less than seven hours of television weekly
  • Consuming no more than one alcoholic drink per day

The study followed nearly 70,000 women for 20 years who were, on average, 37 years old at the beginning of the study. During the course of the study, 456 women had heart attacks, and over 31,000 women were diagnosed with at least one risk factor for heart disease.

The women in the study who practiced all six healthy habits had a 92 percent lower risk of having a heart attack and were 66 percent less likely to develop a risk factor for heart disease, such as type 2 diabetes, hypertension, or high cholesterol, compared to women who ignored the six healthy habits.

Those women who were diagnosed with a risk factor, yet who practiced at least four of the healthy practices, had a markedly lower risk of developing heart disease as they got older, compared to those who didn’t adhere to any of the practices.

Looking at the healthy practices independently, exercise, not smoking, healthy diet, and lower BMI each were associated with a lower risk of heart disease, and women who consumed one drink a day had the lowest risk, compared to those who didn’t consume any alcohol or those who consumed a larger amount.

A surprise finding was that 140 of the 456 women who suffered heart attacks during the study had a normal body mass index or BMI meaning that a healthy weight isn’t necessarily a protective factor. Their lack of exercise, unhealthy diets, and smoking status are factors that may well have contributed to their heart problems.

Lifestyle plays a huge role in a person’s risk of developing heart disease, and lifestyle changes are often the first recommended intervention when someone is diagnosed with a risk factor. Unfortunately, more often than not, people don’t decide to make changes to their lifestyle until after a coronary event has occurred.

The study sends an important message to young women (men, too). The time to establish healthy habits is early in life — in your 20s. Waiting until something happens to decide to “get healthy” can be a gamble that may not pay off.

The study is published in the Journal of the American College of Cardiology.