Estrogen and the heart
Estrogen plays an important role in the prevention of coronary heart disease in women.
Coronary heart disease refers to disease of the arteries of the heart and is the leading cause of death in women worldwide. In the UK, twice as many women die from coronary heart disease as breast cancer and yet heart disease is considered to be a man’s disease.
Before the menopause, estrogen protects women from heart disease as it has a beneficial effect on the functioning of arteries. It also helps control cholesterol levels and so reduces the build-up of fatty plaques in the arteries. After menopause, as estrogen levels fall, the risk of coronary heart disease increases, and by age 65 equals that of men.
A person’s individual risk of developing heart disease depends on their personal and family medical history, and lifestyle. Risk factors for coronary heart disease include high blood pressure, smoking, being overweight, lack of exercise, raised cholesterol and diabetes.
In addition, women have specific risk factors for coronary heart disease including menopause and some pregnancy complications such as high blood pressure and diabetes during pregnancy. Emotional stress and depression have also been recognised as risk factors for heart disease in women.
Research suggests that women who have hot flushes may be at a higher risk of developing heart problems than women who don’t have them.
So how does heart disease present in women?
Heart disease in women is different from heart disease in men where it’s usually caused by blockages in the larger coronary arteries and often leads to episodes of chest pain called angina, and, in some people, eventually a heart attack.
In women, it’s harder to diagnose.
Although women may develop plaque build-up in the coronary arteries in the same way that men do, it’s usually the smaller blood vessels that come off the large arteries that are the problem. This type of heart disease is called microvascular coronary disease and occurs because of spasm of the blood vessels that reduces the blood flow, rather than plaque build-up. This means that symptoms in women are often different to men’s and may include pain in the back or jaw, or nausea and shortness of breath rather than chest pain. Someone experience pain while having hot flushes, and replacing estrogen by giving hormone replacement therapy or HRT may help this.
HRT has been shown to reduce the risk of heart disease when taken within 10 years of the menopause and because women with early menopause, that is menopause before age 45, and premature menopause before age 40 are at higher risk of premature heart disease, they’re advised to take HRT to protect their hearts at least until the natural age of menopause, around age 51, although there is no requirement to stop taking it at this time.
What can you do to reduce your risk of heart disease?
It’s important to eat a healthy diet rich in coloured fruits and vegetables, whole grains and oily fish and to avoid highly processed foods that are high in sugar and saturated fats. Weight control is also important.
Regular aerobic and weight bearing exercises are important for muscle, bone and heart health, and exercise is also great for mental well-being.
If you have high blood pressure it’s vital that this is controlled, and if you smoke, you should try to stop.
