Why it’s a risk factor: "Too much or too little sleep can increase blood pressure and levels of stress hormones," explains Jennifer Mieres, MD, a spokesperson for the American Heart Association. Over time, this causes wear and tear on the heart. You know what to do: Try to sleep eight hours per night. If that’s difficult, talk to your doctor about medication and getting screened for a sleep disorder.

Irregular Periods, Anemia, and Autoimmune Conditions

Clue 3: You’ve Always Had Irregular Periods

If your menstrual history is notable for unpredictable cycles, you may be at greater risk for heart disease. Menstrual irregularities arising from polycystic ovary syndrome, which affects some five to 10 percent of women, increase your risk. Often, PCOS isn’t diagnosed until a woman has trouble getting pregnant, and many women don’t get diagnosed at all.

Why it’s a risk factor: "Women with abnormal periods produce less estrogen, so they lose its protective effect of keeping coronary vessels elastic," Mieres says. "Stiff arteries are just more disease-prone." There’s another factor at work: PCOS is a chronic condition, so it keeps the immune system on high alert, creating a chronic inflammation of the whole body; heart disease is basically an inflammatory process involving the arteries. "Inflammation is a key factor for ischemic disease, in which a heart attack is triggered by insufficient blood flow," Mieres adds.

Women with PCOS are also more likely to have high triglyceride levels, diabetes, or excess belly fat, and all these are components of so-called metabolic syndrome, a potent predictor of coronary heart disease. If you have a history of irregular periods or have been diagnosed with PCOS, get your blood pressure, cholesterol, and triglyceride levels tested.

Clue 4: You Feel Tired and Sluggish

You could be suffering from anemia, and new evidence suggests that this condition may sap more than just your energy. Anemia, which affects 3.4 million Americans (mostly women), occurs when the red blood cells don’t have enough hemoglobin to carry oxygen efficiently from the lungs to other parts of the body.

Why it’s a risk factor: Lower hemoglobin levels force the heart to work harder, which means it wears out sooner. "Anemia can be a key risk factor, especially as women start getting close to menopause and their periods become irregular and they’re living with lower hemoglobin levels," Mieres says. Anemia also worsens the prognosis in those who already have heart disease. The Women’s Ischemia Syndrome Evaluation study, completed in 2006, tracked 963 women over four years and found that anemic women with heart disease had double the risk of dying compared with non-anemic women (10 versus five percent). "We found that women with anemia had higher levels of inflammatory markers, which is the primary process in cardiovascular disease," says study project officer George Sopko, MD, a cardiologist with the National Heart Lung and Blood Institute.

Find out your hemoglobin status: Get a CBC (complete blood count test) at your doctor’s office. If you are anemic, talk with your doctor about taking iron. (Remember, your need for iron also significantly drops once you are menopausal.)

Clue 5: You’ve Been Diagnosed with Certain Autoimmune Conditions

Having lupus or rheumatoid arthritis — both autoimmune diseases — means you’re at greater risk for heart disease. According to one study, women with lupus have five times more artery-clogging plaque than those without the disease. "The most common cause of death in women with lupus is cardiovascular disease," Goldberg says.

Why it’s a risk factor: The biological mechanisms and causes of these diseases are still not clear, but they may be related to inflammation, says Erica Jones, MD, associate professor at Weill Cornell Medical College, in New York City. If you have been diagnosed with either of these disorders, pay even closer attention to your numbers. Besides having your blood pressure measured and being tested for cholesterol and triglycerides, you need to know your level of C-reactive protein, which is produced by the liver in response to inflammation.