Julie Kubala went to the hospital last year thinking her flu had progressed to pneumonia.

It hadn’t. She was having a heart attack caused by a significant blockage found in her left anterior descending aorta.

Kubala, 48, required a stent and months of constant attention to her health, including an overhaul of her diet. It was through cardiac rehab that she realized just how much her risk factors – both lifestyle and family history – played roles. She realized she would have to make significant changes to prevent a second heart attack.

“I was an overweight woman with lots of risk factors who didn’t exercise and now I had to exercise at least 45 minutes a day. Before my heart attack, I really didn’t understand what heart disease meant,” said Kubala of Superior, Wisconsin.

About 21 percent of women and 17 percent of men age 45 and older will have another heart attack within five years of their first one. Fortunately, research shows there are steps that survivors can take to lower their risk. These include: taking medications as directed; having a follow-up appointment with the doctor; completing a cardiac rehabilitation program; managing risk factors; and developing a strong support system.

In addition to educating her and motivating change, Kubala found that participating in cardiac rehab  also helped her work through the emotional toll of having survived a heart attack.

“It’s really daunting, understanding that it could happen again,” she said. “It’s really important that you have someone to talk to and to understand that this was a trauma.”

Learning about her family history of heart disease was particularly eye opening.

“Everyone always said, ‘Be careful with your weight,’ because of diabetes in our family, but no one ever talked about heart disease and it’s on three of the four sides off my family,” Kubala said. “I just never looked beyond diabetes.”

Overhauling her diet was a challenge. Kubala, who was diagnosed eight years ago with Type 2 diabetes, had been focused on limiting sugar intake, but she hadn’t paid much attention to the sodium and fats in her diet.

Minimizing sodium has been difficult since she always has favored salty snacks. Still, she threw out everything in her cupboards that wasn’t heart-healthy and began to scrutinize labels after her heart attack.

“There is a lot of hidden sodium in things you wouldn’t expect, even things like tomato sauce or frozen chicken breasts. Every day, I struggle with what to put in my mouth,” she said.

Kubala’s cupboard is now filled with new spices to add flavor. She uses smaller plates during meals to help her control portion size. At work, Kubala brings her own snacks, such as low-sodium chips and popcorn with healthy fats.

“That way when everyone is having popcorn, I can have some too,” she said.

Meanwhile, incorporating more activity into her day has taken some creativity for Kubala, who says she “hates exercise.” She goes on late night walks with her husband and tries to sneak in more walking into her everyday activities by doing such things as choosing the farthest parking spot or making extra trips to handle work tasks.

“If I’m shopping for something, I make myself do a lap around the mall first,” she said.

Before her heart attack, Kubala took medication for high blood pressure, high cholesterol and her Type 2 diabetes. She struggled to manage her medications, taking them as directed only about 60 percent of the time.

Now, she uses a weekly pill organizer and a spreadsheet of medication information created by her husband Joe.

“I’m one of those people who misplaces things easily, so managing all those pills scared the hell out of me because I realized that if I don’t take them, I could die,” she said. “It led to a new partnership with my husband and now I’m 95 percent compliant.”

Finding support has been crucial as Kubala navigates the necessary changes. She’s found insight through other survivor’s stories and she now realized that her heart attack could have been much worse.

“I really just felt so alone when it happened and there are still days when tears come out of my eyes. As painful as it was to read all those stories and realize this happens more often than I thought, it was good to know that others were battling the same issues,” she said.

“It made all the difference in the world.”