The effects of menopause on heart health

In the U.S., cardiovascular disease is the leading cause of death for women, causing more deaths than all types of cancer combined. Unfortunately, a report from the American Heart Association published in Circulation found that only 44% of women were aware of this fact, a percentage that declined from 65% awareness noted in the same survey in 2009. While heart disease can and does affect women of all ages, the risk rises starting with perimenopause and menopause.

Before menopause, the average woman’s risk of cardiovascular disease is lower than that of the average man. That’s because the hormone estrogen has a protective effect on heart health—it helps dilate the blood vessels and has anti-inflammatory effects. But during perimenopause and menopause, the body’s production of both estrogen and progesterone declines significantly and a woman’s risk of heart disease increases, becoming about equal to the risk of a similarly aged man.

Lower estrogen levels have also been linked to increased cholesterol levels and higher blood pressure, conditions that increase heart disease risk. Other metabolic changes associated with menopause affect heart disease risk as well. The distribution of fat on the body shifts, with more fat accumulating around the middle of the body, a pattern that is associated with plaque build up and stiffening in the arteries.

Some studies have found an association between hot flashes during menopause and the health of the blood vessels, although more study is needed. Women who had hot flashes earlier in the transition to menopause and had more frequent and severe hot flashes had arteries that did not relax appropriately when they exercised or experienced stress. Studies also noted an association between depression and sleep disturbances during menopause and an increase in heart disease risk.

Experiencing menopause earlier (before the age of 40) or having your ovaries surgically removed before age 40 was another risk factor associated with developing heart disease and the risk of experiencing a stroke. One study found that women who entered menopause this early were twice as likely to die as a result of heart disease compared to women who entered menopause later.

Build a plan to manage your lifetime heart disease risk

There are factors that increase your risk of developing heart disease that you cannot control, including:

• a family history of heart disease
• pregnancy complications such as high blood pressure, gestational diabetes, and anemia
• having endometriosis or polycystic ovarian syndrome
• having autoimmune disorders or inflammatory conditions like lupus or rheumatoid arthritis
• older age

But many of the factors that can significantly increase your risk of heart disease and stroke can be mitigated with lifestyle changes and, if needed, medications. To lower your risk, follow these strategies:

• Know your family medical history and share it with your healthcare providers. If you have a family history of heart disease, your provider may suggest earlier, more frequent, or more extensive monitoring and screening of your heart health, especially if a first-degree family member had a heart attack before the age of 50.
• Get all your recommended screenings. Depending on your personal and family medical history, your healthcare provider will recommend a schedule of blood pressure, cholesterol, and blood sugar screenings. Your provider may also want to measure your waist circumference to track the accumulation of abdominal fat and monitor the calcium in your coronary arteries.
• Make activity a priority. Regular physical activity can significantly lower your risk of cardiovascular disease. Work up to 150 minutes of moderate to vigorous activity per week. If you’re not currently active or are living with heart disease or other health conditions, talk with your healthcare provider first to find out how much activity and what types of activity are recommended for you.
• Don’t smoke and limit alcohol use. People who smoke have a two times greater risk of having a heart attack than people who don’t. The increased risk occurs because the chemicals in cigarette smoke shrink the heart’s arteries, restricting circulation, and can cause the lining of the arteries to become sticky, increasing the risk of blood clots that can lead to a stroke. Avoid secondhand smoke as well. Drinking more than a moderate amount of alcohol has been found to increase triglyceride levels, increase blood pressure, cause heart rhythm problems, and weaken the heart muscle.
• Choose a healthier diet. A heart healthy diet should include foods that are high in fiber and healthy unsaturated fats, a variety of fruits and vegetables, lean, unprocessed proteins, seafood high in omega-3 fatty acids, legumes, nuts, low- or non-fat dairy products, and minimal added sugar and salt.
• Manage stress and get good quality sleep. Work to find a stress management strategy that works for you and that you can stick with over time, whether that’s meditation or breathing exercises, spending time with friends, listening to music, exercising, or taking a walk. Sleep is also important for better heart and overall health. Most adults need seven to nine hours of sleep each night.
• Aim for a healthy weight. If your healthcare provider has said you are overweight or obese, losing between 5% and 10% of your body weight can have a positive impact on your cardiovascular health. If you weigh 200 pounds, for example, losing 10 to 20 pounds can help lower your heart disease risk. Work closely with your healthcare provider for the best approach to weight loss.
• Talk with your provider about hormone replacement therapy. For some women, hormone replacement therapy may be an appropriate tool for both managing menopause symptoms and mitigating menopause-related heart disease risk. Talk with your healthcare provider to learn more about this option’s risks and benefits for you.

Work with a PinnacleCare Health Advisor

We realize this is a long list of strategies, including working with multiple specialists in certain cases. Having the support of a PinnacleCare Health Advisor to help you manage your care can make all the difference in living a healthier life. Connect with our team today to learn more.

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PinnacleCare is a member of the Sun Life Financial Inc. (“Sun Life”) family of companies. PinnacleCare and its employees do not diagnose medical conditions, recommend treatment options or provide medical care, and any information or services provided should not be considered medical advice. Any medical decisions should be made only after consultation with and at the direction of your medical provider. Any person or entity who provides health care services following a referral or other service provided does so independently and not as an agent or representative of PinnacleCare.

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