The Connection Between Heart Health, Blood Pressure & Cholesterol in Menopause

With so much focus on cancer in the women’s health space, particularly breast cancer, it might be surprising to learn that changes in heart health, mainly cardiovascular disease (CVD), is actually the leading cause of death in women. In fact, more than 200,000 women die each year from heart attacks; that’s five times the number of women who die of breast cancer each year. 

What Can Impact Women’s Heart Health? 

There are a few different heart health issues that can impact women (and men). Coronary artery disease (CAD) can manifest as hypertension, heart attack, sudden cardiac death and heart failure. Cerebrovascular disease includes stroke and transient ischemic attacks (TIAs). 

More than 42 million American women are living with some form of cardiovascular disease and over one third of deaths in American women over the age of 20 are due to cardiovascular disease each year.  Shockingly, more women than men die of heart disease each year. This puts particular emphasis on the importance of prioritizing women’s heart health during menopause and beyond. 

Heart Health and Menopause: Cardiovascular Disease Risk Factors for Women 

Obvious and highly publicized universal risk factors for CVD include family history, advancing age (over 55), high blood pressure, an unfavorable lipid profile (elevated cholesterol, triglycerides and LDL), diabetes, obesity and of course, smoking. Women have a unique set of additional risk factors to consider when it comes to their heart health. 

For one, an early age of first menstruation, menarche, appears to be related to future cardiovascular disease and other potential women’s heart health issues. Pregnancy, complicated by gestational diabetes, or preeclampsia, elevates this risk further. Metabolic syndromes (such as abdominal obesity, high blood pressure, diabetes, and high cholesterol; aka insulin resistance syndrome or syndrome X) are likely associated. 

Additionally, PCOS (polycystic ovarian syndrome) may increase the risk of heart health issues in women and PMS (premenstrual syndrome) is potentially associated with risk for high blood pressure. Use of the combination birth control pill can increase risk of heart attack and stroke, although this risk is quite low since women in this group are typically younger. 

Cardiovascular Risk After Menopause 

You may be wondering if menopause can directly affect your heart health. Well, recent research suggests that early menopause is linked to increased CVD risk, particularly in those who experience premature menopause, prior to age 40. The incidence of heart attack increases dramatically following menopause. The cause for this is unclear but it’s likely multifaceted. 
  
The landmark WHI (Women’s Health Initiative) study which, despite some limitations in study design and data interpretation, resulted in the general recommendation that hormone replacement therapy (HRT) (estrogen and progesterone) should not be used for CVD prevention. 
  
More recent studies suggest that women who take HRT (albeit different formulations) within 10 years of the onset of menopause and prior to age 60 may live longer and have lower mortality from all causes, including CVD. 
  
Confusing, yes! 
  
The thinking expressed by  The Menopause Society (previously known as NAMS) suggests that hormone therapy, given to symptomatic women within 10 years of onset of menopause and before age 60, has more benefit than risk for women who are suffering significantly with vasomotor symptoms. It all comes down to individualizing care and recommendations, as well as optimizing quality of life. 

Menopause and Heart Health: Prevention and Management of CVD 

Lifestyle and behavior modifications are paramount in managing women’s heart health issues, or even preventing them. 

It’s time to open serious dialogue about women’s heart health and heart disease as well as prevention at all life stages, including menopause. After all, cardiovascular disease does not discriminate.