Menopause and heart disease: What women should know

Menopause in itself doesn’t cause heart disease, but women may become more vulnerable to it post menopause as they undergo complex hormonal changes, say doctors. According to the American Heart Association (AHA), a decline in estrogen production may be a reason for an increase in heart disease in post-menopausal women.

“Estrogen is believed to have a positive effect on the inner layer of artery wall, helping to keep blood vessels flexible. That means they can relax and expand to accommodate blood flow,” says the AHA.

Cardiovascular disease is the biggest threat to women’s health, and every year more women succumb to heart disease compared to men. Studies on the health-related quality of life have found that women with cardiovascular disease suffer more physically and psychosocially as compared to men.

“Estrogen lends a protective cover to a woman. When estrogen levels are at their peak in the child bearing age, you see very little incidence of heart problems in women, which unfortunately can be negated by smoking,” says New Delhi-based cardiologist Dr. Sunil Kumar Maheshwari.

Heart disease is also often overlooked in women. Research says that traditionally, women weren’t a part of clinical trials, which led to a lower risk assessment in women. Studies identify menopause, hypertensive disease of pregnancy, and depression, as some of the additional risks for heart disease in women. 

Here’s what women should know about the risk of heart disease post menopause and its prevention.

Early menopause and heart disease

If women undergo early menopause (between 40-45 years of age) or premature menopause (between 35-40), it can make them more prone to heart disease. Early and premature menopause also puts women at a higher risk of osteoporosis and cognitive impairment. According to gynaecologist Dr. Anuradha Sharma, some of the risk factors for early menopause include — Turner syndrome (a condition when one of the X chromosomes is missing or partially missing in women), chemotherapy, cancer treatment, autoimmune causes like thyroid; arthritis; and, even sometimes infections like mumps.

“Women under 40 who experience premature menopause were nearly twice as likely to have a non-fatal cardiovascular event before the age of 60. This is compared to women who reach menopause between the ages of 50 or 51, during what is considered the standard developmental period,” according to Professor Gita Mishra, School of public Health, The University of Queensland (UQ).

Women aged 40 and 44 experiencing menopause had a 40% higher chance of suffering from a cardiovascular condition. These insights were gathered in a study, led by UQ School of Public Health PhD scholar Dongshan Zhu, that analysed data from more than 300,000 women in 15 studies.

Managing stress

Thanks to evolution, our bodies have a “fight or flight” response when they are presented with life-threatening stress. In stressful situations, our body immediately releases hormones which increase our blood pressure, makes our breathing faster, and up the sugar supply to the muscles, all these meant to help us fight danger. However, we are unable to differentiate between life-threatening danger and other stressors which may be related to work, an exam, or money. When people have chronic stress, their body is always on a “fight or flight” mode; this may aggravate cardiac problems.

“Stress releases cortisone, epinephrine, norepinephrine, which cause spasms of the blood vessels. They also cause the platelets to be sticky, and all of these reduce the blood supply. If you already have predisposition and risk factors, or you already have some type of heart disease, it’s going to precipitate. Stress is very damaging,” says cardiologist Dr. Shashibala Soni, Fortis Hospital, Kalyan. Chronic stress may lead to high blood pressure, headaches, depression, anxiety, and heart disease.

“Stress releases cortisone, epinephrine, norepinephrine, which cause spasms of the blood vessels. They also cause the platelets to be sticky, and all of these reduce the blood supply. If you already have predisposition and risk factors, or you already have some type of heart disease, it’s going to precipitate. Stress is very damaging.”

Here are ways to reduce stress from the AHA. However if the stress lasts for 2-3 weeks, doctors advise professional help.

Eating, working out, and healthy living

For a healthy heart, following a healthy lifestyle, healthy eating habits, regular check ups, following a workout regime, and staying active are key. If you are following a healthy lifestyle, it is important to continue to do so post menopause.

Here are some lifestyle habits that can help women have a healthy heart:

• Quit smoking

According to the AHA, smoking may contribute to early menopause, decrease the flexibility of arteries, as well as lower high-density lipoprotein (HDL) or ‘good’ cholesterol.

• Include fresh fruits, vegetables, whole grains, low-fat dairy products, poultry, nuts, and fish in your diet.
• Lower the consumption of sugar and red meat.
• Aim for a minimum of 150 minutes of physical activity each week.

The AHA says 300 minutes or more of physical activity each week can help reduce weight. Walking, cycling, swimming, dancing or aerobics are all good physical activities to follow.

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Hypertension/High blood pressure (BP)

It is one of the biggest health risks for both men and women. According to the Indian Council of Medical Research (ICMR), about 10.8% of deaths in India can be attributed to hypertension. It is also one of the major risk factors for cardiovascular disease and is responsible for premature deaths globally. Post menopause, women should have their blood pressure checked at least once in two years or at any time that they notice symptoms like — severe headaches, fatigue, chest pain, breathlessness, nosebleeds etc.

Women, who have diabetes, heart or kidney problems, need to get their BP checked more frequently or as advised by the doctor. Healthcare practitioners recommend maintaining a healthy BMI, cutting down the intake of salt, sodium, and eating more fruits, vegetables, and grains are all helpful in lowering blood pressure.

Diabetes

Diabetes raises the risk of heart disease as well. According to the Centre for Disease Control and Prevention (CDC), prediabetes, being overweight, family history, and physical inactivity are all risk factors for diabetes. Doctors recommend a fasting blood sugar test once every three years, unless you notice symptoms of diabetes like — extreme fatigue, blurry vision, frequent urination, dry skin, slow healing sores, and feeling hungry and thirsty often. “Women with a history of hypertension during pregnancy, prediabetes, preeclampsia (condition marked by high blood pressure during pregnancy), all of them are at a greater risk of heart disease later in life,” says Dr. Soni. Women with a history of these conditions have to be particularly careful postmenopause. Pregnant women with preeclampsia, for example, are far more likely to develop heart failure later in life, according to research.

“Women with a history of hypertension during pregnancy, prediabetes, preeclampsia (condition marked by high blood pressure during pregnancy), all of them are at a greater risk of heart disease later in life,” says Dr. Soni.

Blood cholesterol

Women post menopause, or any woman in their 40s, 50s, or above should have a blood cholesterol test at least every five years or as per their doctor’s instructions. The blood cholesterol test is for checking the amount of each type of cholesterol and fats in the blood. However, if you notice symptoms like weight gain, or have heart and kidney problems, diabetes, a blood cholesterol test is recommended more frequently.

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