Are you going through the “cardiovascular change”?

Menopause is a time of distress due to the symptoms it brings. But few realize how much a woman’s risk for heart disease increases during this change. That’s because menopause isn’t just “the change” that marks the end of your menstrual cycle. It’s the time of life that also signals a change in cardiovascular health.

That change is probably a big part of the reason why heart disease is the number one killer of women — and researchers are finally putting two and two together…

“Over the past 20 years, our knowledge of how the menopause transition might contribute to cardiovascular disease has been dramatically evolving,” said Samar R. El Khoudary, Ph.D., M.P.H., FAHA, chair of the statement writing committee and associate professor of epidemiology at the University of Pittsburgh’s Graduate School of Public Health and the Clinical and Translational Science Institute. “We have accumulated data consistently pointing to the menopause transition as a time of change in cardiovascular health.”

And they have a warning for us…

Monitoring women’s health and lifestyle — while integrating early intervention strategies for good cardiovascular health — are important, especially during midlife and during menopause to help prevent heart disease, according to a new Scientific Statement from the American Heart Association (AHA) recently published in its flagship journal, Circulation.

Time to get serious about this change

The Scientific Statement from the AHA, titled “Menopause Transition and Cardiovascular Disease Risk: Implications for Timing for Early Prevention” summarizes research focused on the use of hormone therapy provides an overview of risks related to the stages of menopause, age at menopause and lifestyle factors that affect women’s risk during this time.

Key takeaways in the statement include the following:

• Some of the common symptoms felt with menopause correlate with cardiovascular disease. Hot flashes and night sweats are associated with worse cardiovascular disease risk factor levels. Depression and sleep disturbances, linked in some studies to an increased risk of heart disease, are also common among women during this time. 
• Physiological changes during menopause, such as increased abdominal fat and visceral fat (body fat around the organs), are associated with a heightened risk of all-cause, cardiovascular disease and cancer mortality, even among those with normal body mass index levels.
• Cholesterol levels, metabolic syndrome risk and vascular vulnerability appear to increase with menopause beyond the effects of normal aging. Metabolic syndrome is diagnosed when a person has three or more of the following measurements: abdominal obesity, high triglycerides, low HDL cholesterol (the good cholesterol), high blood pressure and/or high blood glucose levels (blood sugar).
• Novel data show a reversal in the associations of HDL cholesterol (the good cholesterol) with heart disease risk over the menopause transition, suggesting higher good cholesterol levels may not consistently reflect good heart health in all stages of life in women.
• Data about the use of cholesterol-lowering medications remains limited for women going through the menopause transition and requires further study to develop evidence-based recommendations.
• Women who experience menopause at an earlier age have a higher risk of heart disease. A woman’s age at menopause can be influenced by factors such as length of menstrual cycle, poor cardiovascular risk profile during reproductive years and socioeconomic factors. Race and ethnicity also play a role, with many Hispanic and Black women experiencing menopause at younger ages.
• Physical activity and nutrition may play a role in the timing of menopause for all women. Women who drink little to moderate amounts of alcohol may have later onset of menopause, and those who smoke cigarettes are likely to start menopause about a year earlier than non-smokers.
• There is, however, limited information on what is ideal in terms of lifestyle changes (such as the AHA’s Life’s Simple 7) for women during menopause. Data does indicate that only 7.2 percent of women in menopause meet physical activity guidelines, and fewer than 20 percent of them consistently maintain a healthy diet.

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Make changes now to avoid cardiovascular health changes

“Lifestyle and behavioral interventions are critical to maintaining cardiovascular health and reduce heart disease,” said Matthew A. Allison, M.D., M.P.H., FAHA, vice-chair of the statement writing committee and professor and chief of the Division of Preventive Medicine in the Department of Family Medicine and Public Health at the University of California San Diego.

However, most of the randomized clinical trials testing the lifestyle factors and behaviors we know to be heart-healthy were not tested specifically on women during menopause.

I don’t know about you, but until that research is underway, there certainly is no harm in working toward better heart health using what we do know to be generally helpful, starting with these…

Eat the ultimate heart-healthy diet: The traditional Mediterranean diet has been endorsed as the 2019 American College of Cardiology/American Heart Association (ACC/AHA) Guideline on the Primary Prevention of Cardiovascular Disease.

But A group of researchers from the U.S. and Spain has declared that the best diet for omnivores looking to prevent heart disease is a Pesco-Mediterranean diet with a dash of intermittent fasting thrown in for good measure.

Walk: Researchers analyzed data from the Women’s Health Initiative, a 14-year study that included women between 50 and 79 years old at the start.

They specifically looked at women’s walking habits, including how frequently they walked, how long they walked and how fast they walked. And here’s what they found:

• Women who walked at least twice per week reduced their heart failure risk by 20-25 percent compared to women who walked less frequently.
• Women who walked for 40 minutes or more at a time reduced their heart failure risk by 21-25 percent compared to women who walked for shorter periods.
• Women who walked at an average or fast pace reduced their heart failure risk by 26 to 38 percent.

Talk to your doctor about Hormone Replacement Therapy (HRT): The primary purpose of HRT is to ease symptoms during this transition, minimize the risk of developing osteoporosis, and decrease type 2 diabetes risk. And experts do agree that most healthy, recently menopausal women can safely choose to use HRT to relieve symptoms and protect their heart health.

A study confirmed that HRT with estradiol, a form of estrogen, can slow the progression of atherosclerosis. The study was based on data from the Early Versus Late Intervention Trial With Estradiol (ELITE), which compared estradiol with placebo in postmenopausal women.

Sources:

Heart disease risk in women increases leading up to menopause; early intervention is key — EurekAlert!

Leading causes of death – females  — CDC

Menopause and Heart disease — American Heart Association