Heart Disease Risk Increases Before Menopause

Don’t assume women don’t need to worry about heart attacks until menopause or later. Research shows women’s heart disease risk increases before menopause.

There are two common assumptions about women’s health and heart disease risk, both of them just plain wrong.

First, breast cancer is certainly a disease women should be concerned about — it is the most common type of cancer in women (other than skin cancer). But it is not the biggest threat to women’s lives, as is often assumed. Although, according to the American Cancer Society, breast cancer is the cause of death for about 42,000 American women a year, heart disease kills far more. In fact, heart disease is the number one cause of death for all adults in the U.S., taking the lives of about 400,000 women every year, the Centers for Disease Control and Prevention (CDC) reports.

Even if you are well aware of the risk heart disease poses to women in general, many people, including doctors, have long assumed women were relatively protected from cardiovascular disease until they reached menopause (signaled by 12 months since a woman’s last menstruation) and beyond. But researchers now know that can be a dangerous assumption, too.

It turns out, heart disease risk increases before menopause. And that’s why getting the facts about lowering heart disease risks during the years preceding menopause can be crucially important for healthy aging and reducing the risk of heart attack and stroke.

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Heart disease risks rise during perimenopause

Unless menopause occurs abruptly through surgical menopause (a hysterectomy, which removes one or both ovaries), the shift into menopause is gradual. It usually begins with changes in menstruation until periods finally cease, usually when a woman reaches her late 40s to mid-50s.

This period is often called perimenopause, which means “around menopause.” It describes the years during which a woman’s body is going through hormonal shifts as the reproductive time of her life is coming to an end.

During these transition years, the female sex hormone estrogen — which appears to help protect cardiovascular health — is already decreasing and heart disease risks may be rising.

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

Based on new information about women and heart health complied by researchers over recent years, El Khoudary chaired a committee of heart experts to produce the American Heart Association’s updated scientific statement, “Menopause Transition and Cardiovascular Disease Risk: Implications for Timing for Early Prevention,” published in the journal, Circulation.

How to lower risks as you reach your middle years

Because the increase in heart disease risk during perimenopause and beyond is associated with a decline in the hormone estrogen, there is renewed interest from doctors and researchers in the potential cardiovascular benefits of prescribing combinations of hormone therapy early in this transition, but not in late menopause. In addition, some studies show hormone therapy may not only help protect heart health but may lower the risk of type 2 diabetes and protect from bone loss, too.

For most women, the benefits of hormone therapy early in the menopause transition appear to outweigh any risks, according to El Khoudary. Women should discuss hormone therapy in perimenopause with their doctors to see if it might be appropriate for them, based on their individual health risks and family history.

Your lifestyle can reduce cardiovascular risk at perimenopause and beyond

“This scientific statement aims to raise awareness for both healthcare professionals and women about the significant adverse cardiovascular health changes accompanying midlife and the menopause transition and point out the importance of adopting prevention strategies early during this stage,” El Khoudary explained. “As such, it emphasizes the importance of monitoring women’s health during midlife and targeting this stage as a critical window for applying early intervention strategies that aim to maintain a heathy heart and reduce the risk of heart disease.”

Those approaches can involve medications, when needed. But a healthy lifestyle can also go far to lower heart disease risk during the menopause transition and beyond.

The American Heart Association urges women to pay attention to these tips, dubbed Life’s Simple 7, to improve and protect their heart health:

1. Get and keep weight under control. Transitioning into menopause doesn’t mean you should accept extra pounds. Excess weight increases your risk of high blood pressure and other heart risks.
2. Know your blood pressure numbers. If they are too high, work with your doctor to lower your blood pressure with diet, exercise and, if needed, medication.
3. Control cholesterol. Find out if our cholesterol is too high, placing you at risk for arteries clogged with plaque. Exercise and eating a healthy diet, along with statins if indicated, can go far to lower elevated cholesterol.
4. Manage your blood sugar levels. The risk for metabolic syndrome and type 2 diabetes increases around the menopause transition — and that means blood sugar may become higher than normal, raising the risk of damage to your heart. Exercise and weight loss can improve and sometimes reverse type 2 diabetes and metabolic syndrome. Talk to you doctor and stick to any treatment plan for the condition.
5. Get moving. Regular physical activity benefits cardiovascular health. Research, however, shows only about 7 percent of women around menopause meet guidelines for minimal daily exercise. Find something you enjoy — even simply walking every day — and stick to it.
6. Eat a healthy diet. Forgo high-fat, processed fast foods and commit to eating more fruits, veggies, and whole grains. A healthy, nutritious diet is one of the best weapons for fighting cardiovascular disease, according to the American Heart Association.
7. Stop smoking. Cigarette smokers have a higher risk of cardiovascular disease. If you need help to quit, talk to your doctor.

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