Cardiovascular disease (heart attacks and strokes)
What is cardiovascular disease?
Cardiovascular disease (CVD) refers to conditions that affect the heart and blood vessels, i.e. the cardiovascular system. It is the leading cause of death in women in Europe and worldwide, and women are twice as likely to die of a heart attack as they are to die of breast cancer. Each year, more than 30,000 women are admitted to hospital in the UK due to a heart attack.
CVD comprises coronary heart disease, strokes, peripheral arterial disease and aortic disease and is typically caused by the build-up of fatty deposits in the blood vessels (atherosclerosis).
Risk factors for CVD include high blood pressure, smoking, raised cholesterol and diabetes. A sedentary lifestyle (little exercise) and being overweight/obese are further significant risk factors, as is a family history of CVD.
Among middle-aged people, CVD is 2-5 times more common in men than women. However, following menopause, rates of CVD in women are increased to levels as high as, or higher than in men, and women have worse outcomes and are more likely do die of heart disease than men. It is important to understand the reasons for this, and what interventions (treatment and/or lifestyle changes) should be considered to minimise the risk.
Why is cardiovascular disease risk increased after menopause?
Before menopause, women’s ovaries produce estrogen which protects against CVD by its anti-inflammatory properties, increasing good cholesterol (HDL) and decreasing bad cholesterol (LDL), as well as its beneficial effects on blood vessels. However after menopause, as estrogen levels decline, rates of CVD increase. Prior to menopause, women are also protected from conditions such as osteoporosis and Alzheimer’s disease.
A major driver of CVD and other chronic disease risks after menopause is metabolic syndrome, a condition characterised by an increase in abdominal fat, high blood pressure, reduced insulin sensitivity and abnormal blood fats (cholesterol and triglycerides). Estrogen loss in the menopausal transition is associated with an increased risk of metabolic syndome, and although some women gain weight overall as they get older, many who don’t notice an increase in fat deposition round their middle.
Clinical studies show that estrogen given as hormone replacement therapy (HRT) to women under the age of 60 or within 10 years of menopause onset reduces the risk of CVD.
What are the symptoms of CVD?
Although many people with CVD have no symptoms at all, these may include:-
- Pain in the chest, back, left arm, or jaw
- Breathlessness
- Very fast or slow heartbeat, or palpitations
- Feeling dizzy, lightheaded, or faint
- fatigue
- Swollen feet or legs
How can CVD be prevented?
Various medical and lifestyle modifications, including the following, have been shown to reduce the risk of CVD:
- Effective treatment of high blood pressure and diabetes
- Stopping smoking; even one cigarette per day is associated with a major increase in CVD
- Maintaining a healthy weight
- exercising and keeping fit and active
- Reducing alcohol consumption
- attention to diet
- Reducing stress
- Addressing sleep quality/quantity
Can HRT be given to prevent CVD?
As discussed above, research shows that HRT reduces the risk of CVD in the earlier stages of menopause, likely as a result of a combination of its beneficial effects on blood vessels and blood fats, as well as its modulating effects on the risk of metabolic syndrome. Studies show that HRT reduces menopause-related central body fat deposition.
Observational studies have shown that post-menopausal HRT use is associated with a 40–50% reduction in CVD outcomes, including death from CVD, and the WHI study, the largest randomised clinical trial comparing HRT with placebo in over 16,000 women, showed a significant reduction in coronary heart disease outcomes in women starting estrogen treatment below age 60 years compared with placebo. Other studies have shown similar results.
However, despite this, HRT is only generally recommended for prevention and treatment of vasomotor symptoms (hot flushes and sweats) and osteoporosis, and not for the prevention of CVD. This is mainly because some of the early studies of HRT suggested that it might increase CVD in some groups of women. However, more recently, the data from these studies have been re-analysed and the risks and benefits set out more clearly, showing that in women starting HRT between the ages of 50-69, or within 10 years of menopause onset:
- HRT does not increase cardiovascular disease risk
- HRT does not affect the risk of dying from cardiovascular disease
- HRT with estrogen alone is associated with no, or reduced, risk of coronary heart disease
- cardiovascular risk factors are not a contraindication to HRT use providing they are appropriately managed
Additionally, for women starting HRT over the age of 60 or more than 10 years after menopause onset, HRT does not appear to increase the risk of cardiovascular events, or deaths from cardiovascular or other causes.
How NewWoman Health can help
At NewWomen Health we have a commitment to educating, advising, treating and supporting women approaching, during, and following menopause. Our wide range of medical and lifestyle interventions helps women to manage or minimise their menopause symptoms and improve their quality (and potential longevity) of life in an aspirational and uplifting way.
If you’re concerned about cardiovascular disease or other menopause-related problems, we can support you with our personalised medical consultations with menopause specialists. Take the next step in ensuring your long-term health and quality of life by booking a consultation with us today.
