Understanding Heart Disease Risks in Women: Menopause’s Impact on Cardiovascular Health

Heart disease symptoms often start during perimenopause, a transitional phase generally occurring in women’s 40s. This stage leads into menopause, marked by significant changes in estrogen levels.

“There are sudden increases in heart disease risks during this transition, right before a woman’s estrogen significantly declines,” says Nanette Santoro, MD, from the University of Colorado School of Medicine. “During menopause, these risks start to slow down, suggesting the transition itself raises these risks.”

This finding is recent. Santoro and the American Heart Association (AHA) stress the need for increased attention to heart disease symptoms at midlife, coinciding with perimenopause. Menstrual cycles also change during this phase.

The timing of this transition varies due to lifestyle and genetic factors. Perimenopause lasts an average of seven years before menopause occurs.

Increased Risks During Perimenopause

Heart disease encompasses a range of issues affecting the heart and blood vessels, leading to heart attacks or strokes. Perimenopause creates physiological stress as estrogen levels fluctuate, bringing symptoms like hot flashes and mood changes. This stress may elevate heart disease risks, though experts are uncertain of the exact mechanisms.

Common increased risks during this period include:

• Higher cholesterol levels
• Increased blood pressure
• Accelerated plaque buildup in carotid arteries
• Rapid weight gain, particularly around the waist
• Worse sleep issues for some women
• Greater risk of depression

While risks may increase during perimenopause, heart disease usually develops years later. “Women generally start to have more heart attacks than men around age 70,” Santoro remarks. “They also experience worse health outcomes.”

Research on preventing heart disease in women is limited. Existing prevention techniques for men may not be as effective for women. Factors such as inflammation, depression, and smaller blood vessels are linked to women’s heart disease, but more studies are required in these areas.

Reducing Heart Disease Risks

Women can significantly lower their heart disease risk through aerobic exercise, with 150 minutes of moderate exercise recommended weekly, such as brisk walking.

“Women begin to surpass men in their heart attack rates around age 70,” – Nanette Santoro, MD

Other important lifestyle changes include weight management and adopting a heart-healthy diet, rich in fruits, vegetables, whole grains, and healthy proteins while limiting sugar, salt, processed foods, and alcohol. Quitting smoking and managing blood pressure and cholesterol are also essential. Adequate sleep is critical, as lack of sleep can contribute to heart disease.

Estrogen replacement therapy’s effect on heart disease risk is still uncertain, as studies have shown mixed results.

Studies on Hormone Therapy and Heart Health

“Women tend to be lighter sleepers, and sleep quality often worsens with age. Less sleep increases the risk of heart disease.” – Nanette Santoro, MD

A national study indicated estrogen therapy may slow plaque build-up leading to arteriosclerosis. However, the Women’s Health Initiative study showed that estrogen therapy did not prevent heart disease in postmenopausal women.

Severe hot flashes might heighten heart disease risk, suggesting women experiencing this may benefit from estrogen. However, experts advise against using estrogen solely for prevention.

New medications are available to alleviate hot flashes without estrogen’s risks. One drug named Veozah (fezolinetant) has received FDA approval and shows efficacy in many women.

Santoro advocates for midlife health assessments for all women. “These issues aren’t obvious at this stage,” she states. “Managing risk factors during perimenopause can prevent heart disease later.”

Guest contributor: Carrie Printz is a Denver-based health sciences writer.