When it comes to taking care of your heart, you know you should watch what you eat and should get in some physical activity on a regular basis. But did you know you might also need to be extra careful during the winter months?

Studies show deaths from heart-related problems rise around the winter holidays and shortly after the new year and then start declining with the approach of spring. Low temperatures play a role in this seasonal trend, since deaths from heart attacks, circulatory problems and coronary heart disease go up as the mercury drops. But cold weather isn’t the only factor. Research has shown heart-related deaths increase across the nation, even in mild locations like Los Angeles, during winter.

Here are a few seasonal threats to your heart and how you can avoid them.

Cold Weather

If you live in a cold climate, be aware that chilly weather causes arteries to narrow, limiting blood flow to the heart. When paired with low temperatures, strenuous activities like shoveling snow can put significant strain on the heart and trigger a heart attack. If you have heart disease, you might have chest pain when it’s cold because your body is working harder than usual to stay warm.

• What you can do: If you have medical issues such as heart disease or high blood pressure, ask your doctor if it’s safe to shovel snow. You might consider hiring someone to do it for you. If you do your own shoveling, stay hydrated, work slowly and take breaks. Use a shovel with a small blade to lighten the load. Dress in layers so you can remove clothing if you get too warm, since overheating can lead to a heart attack. Know the signs of heart attack and pay attention to how you’re feeling.

Seasonal Flu and COVID

We are now in the midst of peak flu season and the COVID-19 virus is spiking. Effects of the flu include inflammation, dehydration and fever – all of which can increase stress on your heart. COVID-19 may cause siimilar symptoms. A 2018 study found that people with heart disease had a six times higher risk of heart attack after getting the flu. A growing number of studies indicate that COVID-19 may lead to heart damage in some patients.

• What you can do: Typical recommendations to avoid getting the flu include getting a flu shot, washing your hands often and staying away from people who are sick. With the coronavirus spiking across the nation, added precautions include wearing a mask, staying home as much as possible and keeping at least 6 feet away from anyone not living with you, even if they don’t appear to be sick. If you get the flu or COVID-19, rest, stay hydrated and follow your doctor’s advice.

Too Much Time Indoors

When temperatures drop, many of us retreat indoors and become more sedentary.

• What you can do: Stay active with at-home workouts, like circuit training, yoga or cardio dance videos, and household chores, like vacuuming. Exercising may also help relieve stress, which can harm your heart.

Overindulgence

Alcohol and comfort foods, which are high in salt, fat and sugar, may be harder to resist, especially during the holidays and winter months.

• What you can do: Warm up with healthy foods like low-sodium, cream-free soups, oatmeal, roasted carrots and other winter vegetables.

If you have heart disease, high blood pressure or other heart conditions, continue your treatment plan and maintain heart-healthy habits to help avoid heart-related complications.

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