Winter can bring many challenges at once, including:

• Cold temperatures
• Holiday stress
• Respiratory illnesses
• Changes in eating habits
• Strenuous physical activity, such as shoveling snow

Together, these factors can increase the workload on the heart and raise the risk of serious cardiovascular events.

Understanding these risks can help you take simple steps to protect your heart and stay safe during cold weather.

What Happens Inside the Body When It’s Cold Outside?

Cold temperatures cause blood vessels to narrow, a process called vasoconstriction, which helps your body conserve heat. As blood vessels tighten, blood pressure rises and the heart must work harder to circulate blood.

For people with heart disease, high blood pressure (hypertension) or other cardiovascular conditions, this extra strain can increase the risk of heart attack, stroke and angina (chest pain caused by reduced blood flow to the heart).

Cold exposure also triggers the body’s fight-or-flight response, releasing stress hormones like adrenaline, which increase heart rate and blood pressure. At the same time, the heart must work harder to keep the body warm. Activities that may feel routine during warmer months, such as walking uphill or carrying heavy items, can become more demanding in cold weather.

Wind and damp conditions can increase heat loss, forcing the body to work even harder to maintain its temperature. If your body temperature falls below 95 degrees Fahrenheit, hypothermia can occur. Severe hypothermia can increase your risk of heart rhythm problems.

Signs of hypothermia include:

• Intense shivering
• Confusion
• Slurred speech
• Extreme fatigue

Seek immediate medical attention if you notice these symptoms in yourself or someone else.

Who Is Most Vulnerable to Winter-Related Heart Problems?

Anyone can experience heart-related issues during cold weather, but some people face higher risks, including:

• Adults age 65 and older
• People with heart disease, high blood pressure, high cholesterol or diabetes
• People who have had a previous heart attack or stroke
• People who are not regularly physically active
• People who smoke
• People with obesity

If you fall into one of these groups, talk with your doctor about safe activity levels during the winter months.

Is Shoveling Snow as Risky as People Say?

Shoveling snow can be one of the most demanding winter activities for the heart. Many people are not accustomed to this level of exertion. Lifting heavy snow, pushing a shovel and breathing in cold air at the same time can sharply increase your heart rate and blood pressure.

Snow shoveling is particularly risky because many people do it first thing in the morning, when blood pressure is naturally higher and temperatures are often at their coldest.

“Shoveling snow can put a significant strain on your heart because it combines several challenges at once,” says Alana A. Lewis, MD, a cardiologist at Northwestern Medicine. “It requires strenuous physical activity while breathing cold air, and this sudden increase in demand on the heart can be particularly concerning for those who aren’t accustomed to that level of exertion.”

While shoveling snow gets the most attention, other activities can increase risk, including:

• Walking through deep snow
• Pushing a stalled vehicle
• Carrying heavy bags or equipment outdoors
• Winter sports performed without proper conditioning
• Long periods spent outdoors in extreme cold

Staying physically active throughout the year can help prepare your body for seasonal demands.

Does Holiday Stress Affect Heart Health?

The extra demands of the holiday season can take a toll on both your emotional well-being and heart. When you’re under stress, your body releases hormones that can raise your blood pressure and heart rate. Over time, this may increase your risk of heart attack or stroke.

Holiday stress can also make it harder to maintain healthy habits that protect your heart. You may get less sleep, exercise less, eat differently or spend more time sitting due to traveling.

Stress may also cause some people to smoke more, drink more alcohol or skip routine medications, which can further increase cardiovascular risk.

Common holiday stressors include:

• Financial pressures and gift shopping
• Busy schedules and travel demands
• Family obligations or relationship conflicts
• Changes to daily routines
• Feeling lonely or grieving the loss of a loved one

Self-care activities can help lower stress and support your heart health:

• Prioritize quality sleep.
• Get regular exercise.
• Practice deep breathing.
• Set realistic expectations.
• Take breaks when you need them.

Does Alcohol Affect Winter Safety?

Alcohol is often part of holiday celebrations, but it can increase winter health and safety risks.

Although alcohol may make you feel warm, it causes your blood vessels to widen, which can increase heat loss and lower your body’s core temperature.

Drinking alcohol can also impair judgment, coordination and reaction time, increasing the risk of:

• Falls
• Accidents
• Frostbite
• Hypothermia

Alcohol may also make it harder to recognize warning signs that your body is under stress from the cold, including symptoms of a cold-related illness or heart problem.

Combined with cold temperatures, holiday stress and physical exertion like shoveling snow, alcohol may further increase strain on your heart during the winter months.

How To Protect Your Heart Outdoors During Winter

Cold weather doesn't have to keep you indoors, but taking a few precautions can help reduce strain on your heart and lower your risk of cold-related illness.

• Dress in layers: Wear a moisture-wicking base layer and a wind-resistant outer layer to help retain body heat. Don’t forget a hat, gloves and warm socks.
• Warm up before heading outside: Spend five to 10 minutes doing light activity indoors, so your heart rate rises gradually.
• Take care when shoveling snow: When possible, push snow rather than lift it. Use a smaller shovel and take frequent breaks. Talk with your doctor about whether shoveling is safe for you.
• Take breaks inside to warm up: If you’re spending extended time outdoors, go indoors periodically to warm up.
• Stay hydrated: You may not feel as thirsty in cold weather, but drinking plenty of water is important for heart health.
• Help prevent illness: Wash your hands frequently, get adequate sleep and stay current on recommended vaccinations. Respiratory infections can increase the risk of heart attack.
• Don’t ignore symptoms: If you develop chest pain, shortness of breath or other new heart-related symptoms, call 911 immediately or go to the nearest emergency department.

What Symptoms Should Never Be Ignored?

Chest pain is one of the most common warning signs of a heart attack. Get medical help right away if you have chest pain that is severe, does not go away or happens along with other symptoms.

Other possible heart attack symptoms include:

• Shortness of breath

• Nausea or vomiting
• Dizziness or lightheadedness
• Cold sweat
• Pain, pressure, numbness or tingling in the jaw, neck, back, shoulders or arms
• Unusual fatigue or weakness
• A sensation of heartburn, indigestion or pressure in the chest

Not everyone has the same symptoms during a heart attack. Some people have little or no chest pain. Women, people age 65 and older, and people with diabetes may experience symptoms that are easy to miss.

The most important thing is to pay attention to how you feel and take symptoms seriously, even if they do not seem like the “classic” signs of a heart attack.

“One of the biggest mistakes people can make is waiting too long to seek medical attention,” says Dr. Lewis. “When it comes to a heart attack, every minute matters.”

Heart-Healthy Habits for Every Season

Keep your heart healthy all year with these always-in-season tips:

• Stick to a heart-healthy diet.
• Be sure to exercise regularly and remain physically active year-round.
• Know your blood pressure, cholesterol and blood sugar numbers, and work with your doctor to keep them in a healthy range.
• Manage stress and anxiety.
• Listen to your body and see your doctor for an annual visit.

“You can’t control the weather, but you can control how you prepare for it,” says Dr. Lewis. “Being aware of the risks, planning ahead and paying attention to symptoms can help protect your heart throughout the winter.”