The Connection Between Cardiovascular Disease and Menopause

Many of us may categorize heart disease as something only our male counterparts need to be concerned with, however, as women age, we too become vulnerable to a myriad of health conditions, including those related to the heart.

Women approaching or currently in menopause may be at a heightened risk for heart disease, with studies demonstrating that this condition may be more common in postmenopausal women than premenopausal women, due to the volatile hormonal fluctuations experienced during the menopause transition.¹

So, what exactly is the connection between the risk of cardiovascular disease and menopause, and how can women reduce their risk? We sat down with Shannon Brasil, MSN, RN, CNP to learn more.

The Menopause Transition and Cardiovascular Disease Risk

Menopause and heart disease go hand in hand for a reason – your risk increases with age. As with so many menopausal symptoms, the underlying cause of this increased risk for heart disease is connected to a decline in estrogen production.

“One in three women have some form of cardiovascular disease as they age. Ten years after menopause has ended is the time of highest risk. This is when estrogen production has completely shut down,” explains Nurse Brasil.  “Estrogen is protective of the heart. It increases the flexibility of blood vessels and arteries, which in turn, is supportive of better blood flow. When you lose your estrogen, that protection goes away. This increases the risk of heart disease and stroke as you age,” she says.

Nurse Brasil goes on to explain that estrogen also affects your lipid levels. “Lipids are a certain type of fat molecule found in blood. The less estrogen your body is able to produce, the more likely you are to have elevated cholesterol, which is a leading marker for heart disease.” These are the most common reasons that menopause and heart disease are often connected.

Early Menopause and Heart Disease

Women who enter menopause early may not be at an increased risk of heart disease necessarily, but they are at a risk earlier in life. “Premature menopause is defined as menopause that occurs before the age of 40 [most often due to surgical intervention or certain genetic factors]. If you’re in this category, your 10-year risk for heart disease will occur earlier. This doesn’t mean you’ll definitely have a heart attack or stroke at a young age. But it does, however, mean you’re at a heightened risk for early heart disease,” Nurse Brasil explains.

Heart Disease Prevention Techniques: Do They Exist?

While we unfortunately can’t control when our periods will end, or the fact that we’re all naturally aging, there are other, more controllable lifestyle factors that we can manage in order to reduce our risk or even potentially prevent heart disease, no matter how old we are. Here are a few ways that may help prevent heart disease during menopause and beyond.

Manage Weight Gain

The first heart disease risk factor you can exercise some control over is weight gain, especially when the weight is centered around your middle-section. According to Nurse Brasil, fluctuating estrogen levels play a role here as well. “Estrogen helps to distribute fat more equally in the body. It also helps with insulin sensitivity. Without enough estrogen, you gain weight more easily in your middle-region, which can increase the risk of heart disease,” says Nurse Brasil. This doesn’t mean you can never have another piece of birthday cake, but it does mean you should be paying closer attention to what you eat and how much exercise you get.

Eliminating Tobacco

Smoking cigarettes is a leading risk factor for a wide range of health conditions, including cancer and heart disease. Data indicates that women have a higher risk of earlier death and stroke from smoking as compared to men,² so working to reduce or eliminate your exposure to cigarette smoke and tobacco products during menopause can certainly only help reduce this heart disease risk factor.

Calm Heightened Stress Levels

Stress of all kinds has been shown to increase the risk of heart disease and cardiovascular events, such as heart attack and stroke, in women.³ Specifically during menopause, stress levels can increase due to increased responsibilities such as parenting young children, juggling financial responsibilities, caring for elderly family members, dealing with divorce…the list goes on.

Simply put, everyone experiences stress, and it can be hard to eliminate it completely, but there are ways to reduce the severity of it. Think about experimenting with stress reducers that appeal to you. These can include exercising, meditating, being in nature, or spending time with friends. And try to get enough sleep. Studies have shown that too little sleep can exacerbate stress, which in-turn can negatively impact health, and adversely affect mood.⁴ These can all contribute to a greater risk of heart disease in women.

It’s never too late to start improving on the self-care habits outlined above in order to reduce your risk or to help prevent heart disease during menopause. For some women, keeping a food diary may help with weight loss, if needed. Nurse Brasil also recommends following a low-fat eating plan, like the Mediterranean Diet. For others, increasing exercise and incorporating more physical activity on a day-to-day basis can help. And, if you smoke, this is a great time to stop.

Mitigating Cardiovascular Disease Risk Ahead of the Menopause Transition

In addition to taking control of the above risk factors, you can further mitigate your risk of heart disease and other conditions, such as diabetes, through living a healthy lifestyle at any age. “I tell my patients, ‘Let’s take you into menopause being as healthy as you can be.’ Once you’re in your thirties, it’s time to start getting rid of risk factors,” adds Nurse Brasil.

In addition to adopting and maintaining healthy lifestyle habits, Nurse Brasil recommends taking any prescribed medications to reduce your heart disease risk further when they are recommended by your healthcare provider. This includes taking a statin (prescription medications that lower cholesterol) if you already have high cholesterol.

Underlying conditions, such as diabetes, can increase heart disease risk at any age. If you have diabetes, taking your medications and following dietary guidelines is essential for maintaining your overall health through menopause and beyond and may help with heart disease prevention.

Also, keep an eye on your mental health. “Mental health affects physical health. When women become depressed, serotonin, a chemical in our brains, becomes low,” says Nurse Brasil. Data indicates that low serotonin coupled with stress can promote heart disease.⁵

Balancing serotonin levels is important for heart health and mood. For some women, exercise and yoga will be enough. For others, taking an antidepressant such as a selective serotonin reuptake inhibitor (SSRI), will be beneficial. Be sure to check-in with your healthcare provider to determine the most appropriate treatment option for you.

Hormone Replacement Therapy – Should You, or Shouldn’t You?

Hormone replacement therapy (HRT) can be a way to reintroduce estrogen back into your system during menopause, but Nurse Brasil cautions, it’s not without debate. The Women’s Health Initiative study, done over 20 years ago, found that HRT has both pros and cons. This landmark study concluded that the use of HRT for chronic disease prevention, including heart disease, was not indicated.⁶

“It’s still up for debate if HRT is good or bad for your heart. If you use HRT, I recommend only using a low dose over a short period of time. Bioidentical hormones, which are all natural, are controversial, but may be better,” Nurse Brasil says. Remember to always check-in with your healthcare provider first when considering hormonal treatment options to determine what is or isn’t right for you.

It’s never too early (or too late) to adopt heart-healthy habits. No matter what your age, or where you are on life’s journey, you have beautiful memories to make. Protecting your heart health is essential for living your best, and possibly longest, life. 

Resources

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3972600/
2. https://pubmed.ncbi.nlm.nih.gov/32497122/
3. https://pubmed.ncbi.nlm.nih.gov/31957961/
4. https://newsinhealth.nih.gov/2021/04/good-sleep-good-health#:~:text=But%20sleep%20is%20as%20important,stroke%20to%20obesity%20and%20dementia.
5. https://corporate.dukehealth.org/news/combination-stress-low-serotonin-may-promote-heart-disease
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963523/