People between ages 20 and 40 should be taking steps now to prevent heart attacks and strokes, according to new recommendations from the American Heart Association.

“Heart disease prevention is no longer something we start later in life,” Dr. Estelle Jean, a cardiologist at MedStar Montgomery Medical Center in Olney, Maryland, told WTOP. “You can feel completely healthy in your 20s or 30s but still be developing many … risk factors.”

Jean urged people in that age group to know their current blood pressure, cholesterol and blood sugar numbers, and take action early to prevent disease.

One in every two adults over age 20 has high blood pressure, Jean said.

“Normal blood pressure is considered less than 120 over 80, but the more recent hypertension guidelines define high blood pressure more than 130 over 80,” she added.

To help people determine their risk, it’s now recommended that all adults get what’s called a “lipoprotein(a)” cholesterol test. It checks for levels of a cholesterol carrying lipoprotein in your blood, which is inherited.

“It stays pretty consistent and steady within our life span, and so the new guidelines do recommend getting it checked at least one time throughout your life,” Jean said.

Eating poorly in your 20s and 30s can lead to high blood pressure and high cholesterol. Jean recommended thinking of food as medicine, eating plenty of fresh fruits and vegetables, and avoiding saturated fats.

She also urged patients to get at least two and half hours per week of moderate intensity exercise, which can be broken up into 30 minute sessions five times a week, along with strength training at least twice a week.

In some cases, doctors determine that lifestyle changes aren’t enough to head off heart trouble.

“For some patients, especially those with higher risk, we are starting medications earlier to prevent disease,” Jean said. “There are lots of things that we can do — from a healthy lifestyle and working towards that goal of maintaining a healthy weight — that can go a long way in reducing your risk for heart disease and stroke.”