Menopause and Heart Health, Is There a Connection?
Bonafide Medical Advisor
With so much focus on cancer in the women’s health space these days, particularly breast cancer, it might be surprising to learn that 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 is CVD?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). In fact, more than 42 million American women are living with some form of cardiovascular disease and more than a 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.
What are the risk factors for CVD in women?Obvious and highly publicized universal risk factors for CVD include 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. For one, early age of first menstruation, menarche, appears to be related to future CVD. Pregnancy, complicated by gestational diabetes, or preeclampsia, elevates risk. The metabolic syndrome (abdominal obesity, high blood pressure, diabetes, and high cholesterol aka insulin resistance syndrome or syndrome X) is likely associated. Additionally, PCOS (polycystic ovarian syndrome) may increase risk 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.
What’s menopause got to do with it?Hot off the press 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 (MI) increases dramatically following menopause. The mechanism for this is unclear but is likely multifactorial.
The landmark WHI (Women’s Health Initiative) study which, despite some limitations in study design, resulted in the general recommendation that HRT (estrogen and progesterone) not be used for CVD prevention.
More recent studies suggest that women who take HRT (albeit different formulations) within 10 years of menopause and prior to age 60 may live longer and have lower mortality from all causes including CVD.
The current thinking expressed by NAMS (North American Menopause Society) suggests hormone therapy, given to symptomatic women within 10 years of menopause and before age 60 has more benefit than risk for women who are suffering significantly. It all comes down to individualizing care and recommendations, as well as quality of life.
How can CVD in women be prevented?Lifestyle and behavior modifications are paramount. Avoid smoking. Aim to engage in 150 minutes of cardiovascular exercise weekly. Keep weight in a normal range and monitor your dietary intake. The Mediterranean diet is favored for heart health. Mind your hormones! For many women, non-hormonal options for hot flashes and night sweats are favored and preferred. Relizen® is ideal for those women who cannot or will not take hormone therapy.
It’s time to open serious dialogue about heart disease in women as well as prevention at all life stages, including menopause. After all, cardiovascular disease does not discriminate.
Alyssa Dweck, MS, MD, FACOG, Bonafide Medical Advisor, is a practicing gynecologist in Westchester County, New York. She provides care to women of all ages and has delivered thousands of babies. A graduate of Barnard College, she has a Master’s Degree in Human Nutrition from Columbia University and her Medical Degree from Hahnemann University School of Medicine in Philadelphia, now named Drexel University. Dr. Dweck currently practices in Mount Kisco, NY and admits to Northern Westchester Hospital in Mount Kisco, NY. She has been voted “Top Doctor” in New York Magazine and in Westchester Magazine and has authored three books to date: “The Complete A to Z for your V,” “The Sexual Spark,” and “V is for Vagina.”