When cardiologist Malissa Wood assesses a patient’s health, she is as concerned about her mind as she about her heart. “The biggest driver of heart risk is our brain and our attitude,” Dr. Wood explains. “We know now that being depressed clearly increases the risk of heart disease and being anxious increases the risk of heart disease. Stress in and of itself, not only increases the risk, but it can undermine our efforts to do things to protect our health.”

Malissa Wood, MD

Malissa Wood, MD

Dr. Wood, who is Co-Director of the Corrigan Women’s Heart Health Program at the Massachusetts General Hospital Heart Center, is the co-author of Smart at Heart: A Holistic 10 Step Approach to Preventing and Healing Heart Disease in Women. She asserts that if cardiologists only pay attention to “black and white data,” like cholesterol, blood pressure and heart rate, they will be missing out on other subtle major risk factors that are not so easily quantified. Instead, she advocates a different approach that she calls behavioral cardiology.

“Many cardiologists think of the heart as a little tiny organ that pumps blood but they forget about the mind, the blood vessels, a patient’s eating and nutrition habits, and what’s going on throughout the entire body. In my approach, I try to integrate all these other aspects into a treatment plan so I can work with the patient as a whole person,” Dr. Wood says.

Stress in particular is a risk factor that can be toxic, but is often overlooked by both physicians and patients. Dr. Wood has had firsthand experience with the negative impact of stress: After a particularly heart wrenching year that included among other things death of a loved one and divorce, she was diagnosed with breast cancer, despite the fact that she was in excellent health and had no obvious risk factors. As she explains, “I think the stress in my body lead to a health crisis which ultimately forced me to focus on my behaviors and change my behaviors to try to create a more healthy environment, not only for myself, but for my family and also for my patients.”

If not managed correctly, stress can lead to a downward spiral that sets the stage for a whole host of diseases, including heart disease, the # 1 killer of both women and men. “People who are stressed don’t sleep well, and we know that sleep is an incredibly important health variable for a lot of different health concerns, but especially heart disease, “ she adds, “They’re not going to eat right, they’re not going to exercise and they’re probably going to have a much higher level of stress hormones circulating throughout the body.”

A telltale sign of excess stress hormones is abdominal obesity—belly fat— which as Dr. Wood explains, can be dangerous. “We know that those hormones produce fat deposits in your back and your abdomen, that increases the risk of high blood pressure and diabetes, and in general, a bad looking risk profile.”

Dr. Wood notes that although we can’t always control the stressors that confront us everyday, we can control how we respond to it. The bottom line: Every woman needs to take an active role in maintaining her health. Below, in her own words, Dr. Wood provides a checklist of what every woman needs to do, whether she’s 15, 45 or 75 or beyond, to preserve her physical and emotional health.

Get 45-50 minutes of physical activity everyday
I recommend that you track your activity, whether it’s with a Fitbit or MyFitnessPal, or you just write it down on paper. Make sure that the total activity time that you’re moving is at least 45 to 50 minutes for the day. That means getting up every hour or so if you’re sitting, take the stairs whenever you can, look for opportunities to take a walk or move around.

Don’t be a mindless eater
Be very aware of your eating patterns, what you’re eating and when you’re eating. People always ask me, ‘What is the diet I should be on?’ and I say, ‘You shouldn’t be on a diet, just eat the right things for the rest of your life!’ That means eating food that’s good for you: Fresh fruits and vegetables, whole grains if you eat carbs; healthy proteins like lean meat, poultry and fish. Minimize saturated fat, and try to eat foods that are less inflammatory because inflammation is the final common denominator of all illness, whether it’s heart disease, cancer, or immunological diseases.

Take time out for yourself
Find an activity or behavior that allows you to really become centered and relaxed even if it’s just for minutes per day, whether swimming, walking, knitting or whatever it is that you find relaxing. Getting into that space everyday gives your brain a break, your stress levels drop and your body gets a little bit of a leg up on your health.

Have somebody on your team
Every woman should make sure that she has somebody on her team supporting her health. Whether it’s a partner, a child, a best friend, a colleague at work, have a teammate who comes over to you and says, ‘Let’s go for a walk’ or ‘Let’s make sure we’re eating the right thing,’ because it’s really hard to do these things in a solitary fashion. You’re much more likely to succeed if you have people behind you pushing you along the way.

Take advantage of your annual preventive visit
Most people visit the doctor for a specific reason, but this usually results in a brief, 15-minute appointment that tends to focus on that one thing. This doesn’t give the doctor time to review all the body systems as well as discuss lifestyle issues, like diet, stress and exercise. Thanks to health care reform, most health insurance plans provide for a free annual preventive health visit in which the “non emergency” issues can be covered in a thoughtful way. It is very important for women to use this opportunity to review all of their health concerns and issues.

Finally, Dr. Wood says that contrary to popular opinion, women need to understand that heart attacks just don’t happen to women in their later decades, they can occur in younger women too. In fact, younger women, under age 50, are twice as likely to die from a heart attack as their male peers. At any age, the symptoms for a heart attack in women can be dramatically different than the symptoms experienced by men, and therefore, ignored until it’s too late. Follow this link to learn more.