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You fall into this age bracket if you’re a man between the ages of 35 and 65 or a woman between the ages of 45 and 75.

Men generally have a higher risk for heart disease than women. Middle-aged men especially have a tendency to gain weight around the waistline (referred to as abdominal obesity), which increases their tendency to become resistant to their own insulin (or suffer from a condition called insulin resistance). Insulin resistance can impair your ability to handle blood sugar properly, increase your triglycerides, and lower your HDL (“good”) cholesterol. (Check out the section, “Recognizing the silent syndrome,” later in this chapter for more details about insulin resistance.) These conditions lead to a dramatically increased risk of heart disease. A sizable portion of all heart disease in men occurs in middle age. Exercise and even a moderate weight loss can dramatically improve the condition.

Heart disease is generally delayed in women by 10 to 15 years compared with men. Therefore, most heart disease in women occurs after the age of 65. Yet, at this later age, heart disease accounts for a third of all deaths in women. Three million women die from stroke each year. These deaths are more than the deaths from all types of cancer. Heart disease can occur in women younger than 65 if they’re heavy smokers, have high blood pressure, have insulin resistance, have diabetes, or if they have a family history of early heart disease. The good news is women can be proactive in their health education in preventive lifestyle choices such as diet and exercise.