How does menopause raise the risk of a heart attack?
MetroCreative
Menopause can add to the risk of adverse cardiovascular events for women.
Dr. Jaya Mehta
It’s a rite of passage that women can’t avoid and one that can be filled with many physical changes.
Now, a new article authored by a Pittsburgh doctor casts light on how menopause can increase a woman’s risk of heart attack, coronary artery disease and other cardiovascular issues.
“For all people, risk of adverse cardiovascular events increases as we age,” said Dr. Jaya Mehta, Allegheny Health Network (AHN) primary care internist. “For women, it’s not just the normal aging process that contributes to this increased risk – physiological changes driven by menopausal hormonal fluctuations and ovarian aging also add to the risk.”
Mehta was lead author of the article published in the journal “Nature,” and researched the article along with physicians from AHN and the Harvard Medical School. It focuses on how women experiencing menopause – including premature or surgically induced menopause – have an increased risk of adverse cardiometabolic changes and related cardiovascular events such as heart attacks and coronary artery disease.
Those changes include increased fatty tissue deposits and vascular anatomy changes, such as increased arterial stiffness.
“Over the past decade, a significant amount of data has come out supporting the increased cardiovascular and metabolic risk during this transition,” explained Mehta. “The paper is intended to guide clinicians and patients on lifestyle and pharmacologic agents that can help reduce this risk that all women face.”
How menopause changes our bodies
Studies of women undergoing menopause show they experience increased fat deposition on organs and changes in vascular structures such as stiffening of arteries. These changes can lead to and put women at risk for cardiac events, like heart attacks or coronary heart disease.
While changes in a man’s body composition occur more gradually, modifications in a woman’s body composition occur most rapidly during the two-year period before and after their final menstrual period.
“That change in body composition, fat metabolism, and estrogen levels during menopause is associated with elevated lipid levels, arterial thickening, and other heart health risk factors,” said Mehta.
Cardiovascular disease remains the leading cause of death in women, who tend to develop the disease later in life than men do.
“Menopause is not just about hot flashes and reproductive system changes,” she added. “We want patients to be mindful of the other health risks associated with the menopausal transition, and to take preventive steps – such as prioritizing improved diet and sleep habits – to lessen those risks.”
Research also shows women who experience “premature menopause” – symptoms prior to age 40 – or early menopause (from ages 40-45) also have an increased risk of heart failure or atrial fibrillation compared to those who begin the menopausal transition at a later age.
Focus on heart health
While we can’t avoid menopause, there are steps we can take to get and stay heart healthy ahead of, during and after the transition.
“This data supports continuing with heart healthy behaviors such as increasing cardiovascular exercise, maintaining a healthy weight, stopping smoking or avoiding smoking cigarettes and getting adequate sleep,” said Mehta. “It is helpful to start following these habits prior the transition and continuing them throughout. Following up with a primary care physician regularly to ensure cholesterol levels, diabetes screening, kidney and liver tests are checked is helpful to stay on top of cardiovascular and metabolic risks that arise during this transition.”
Along with sticking to lifestyle modifications, Mehta said there are pharmacologic agents that help mitigate risks.
“Statin and aspirin therapy for those who its recommended are common treatments we use to help mitigate cardiovascular risk,” she said. “Hormone therapy, including estrogen and progesterone, for women who suffer from bothersome vasomotor symptoms or hot flashes have been shown to have some benefit for patients who are younger and closer to menopause.”
Make sure to discuss these options with your doctor. While hormone therapy has been linked to an increase in breast cancer risk in some women, it also has been linked to reducing type 2 diabetes in post-menopausal patients.
“Additionally, women who suffer from severe hot flashes likely have increased cardiometabolic risk so addressing the hot flashes is an important step in mitigating risk,” said Mehta.
She stressed the importance of discussing menopause and its physical changes with your doctor and says you shouldn’t feel uncomfortable having that conversation.
“Menopause is more than just reproductive changes, and more than the common symptoms experienced such as hot flashes and vaginal dryness,” Mehta said. “Women should feel comfortable and empowered to bring up any changes they’re going through with their clinician. For so long, this has been something we have not addressed at doctors’ visits and has been generally taken as ‘natural changes.’ It’s important for a woman to know and understand what changes are occurring in her body so she can approach this transition in a healthy way.”