Heart disease is the leading cause of death for men and women in the United States. As people with HIV live longer thanks to effective treatment, they are more likely to develop age-related conditions, including cardiovascular disease (CVD). The large—and sometimes conflicting—body of research on CVD in HIV-positive people can be confusing, but you can take steps, like exercising and quitting smoking, to minimize your risk.

Cardiovascular disease is a general term for conditions that affect the heart and blood vessels. The most common is atherosclerosis (sometimes called “hardening of arteries”), which occurs when deposits of cholesterol and other material build up on blood vessel walls and impede the flow of blood. Coronary artery disease, or blockage of the arteries that supply the heart muscle, can lead to chest pain (angina) and heart attack (myocardial infarction). Bits of plaque or blood clots can block blood vessels in the brain, causing a stroke. Other heart problems include congestive heart failure (when the heart can’t pump enough blood), irregular heartbeat (arrhythmia) and heart valve disease.

CVD is one of the most complex areas of HIV medicine, and countless studies have looked at associations between HIV and cardiovascular outcomes. HIV and its treatment have been linked to conditions including coronary and peripheral artery disease, arrhythmia, heart failure, heart attack and stroke, but findings are not consistent across studies. One recent analysis found that people with HIV had a 60% greater risk for heart attack than HIV-negative people, and the difference appeared to widen over time. Early data from the REPRIEVE trial, a large study evaluating whether a statin medication can prevent heart disease in people with HIV, found that HIV-positive people develop more cardiovascular problems at a younger age than their HIV-negative peers.

The reasons for higher rates of heart problems among people living with HIV are not fully understood. HIV itself can cause chronic inflammation even in people on effective antiretroviral therapy. Specific antiretroviral medications have been either directly linked to heart problems or shown to contribute to metabolic problems—such as high blood sugar, elevated blood lipids and weight gain—that increase CVD risk. However, research clearly shows that promptly starting and staying on antiretroviral therapy leads to better outcomes than delaying treatment.

What’s more, people with HIV have higher rates of traditional CVD risk factors, such as smoking, diabetes and high blood pressure (hypertension). Male sex, Black race and family history also play a role. But studies have shown that scoring systems designed to predict cardiovascular risk in the general population can underestimate the risk for people living with HIV.

The good news is that you can take steps to reduce your risk for heart disease. Perhaps the most important is smoking cessation. Studies of HIV-negative people have shown that CVD risk starts to drop soon after quitting and reaches the level of nonsmokers in 10 to 15 years. Quitting is easier said than done, but experts have developed effective interventions for people with HIV.

Eating a well-balanced diet, maintaining a healthy weight and exercising can also reduce CVD risk. A healthy diet includes plenty of vegetables, fruits and whole grains and is low in processed foods, added sugar and sodium (which can raise blood pressure). Try to move more and sit less. Experts recommend 150 minutes of moderate-intensity physical activity per week. Getting enough sleep and reducing stress also contribute to good heart health.

Regular checkups, including monitoring blood pressure, blood sugar and cholesterol and triglyceride levels, can detect heart problems at an early stage, when they’re easier to treat. In some cases, medications—such as drugs to control blood pressure and statins to lower cholesterol—may be beneficial. Ask your doctor for advice about lifestyle changes and treatments that can help keep your heart healthy.