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Does menopause cause heart disease?

Heather Swales, M.D., FACC [February 14 2014]

Menopause is a normal part of life for a woman and marks the end of her menstruation and fertility. It does not cause heart disease. However, the risk of heart disease rises soon after menopause. Some of the increased risk after menopause can be attributed to LDL (bad cholesterol) levels rising and HDL (good cholesterol) levels falling. The body also becomes more glucose intolerant (at higher risk of developing diabetes). Additionally, the inner lining of the blood vessels (endothelium) changes and becomes more susceptible to atherosclerosis (plaque buildup) and clot formation. The reason for these changes is attributed to declining levels of natural estrogen in the body.

Interestingly, taking estrogen supplements (hormone therapy) has not been shown to be protective and, in fact, may contribute to increased risk of cardiovascular disease in postmenopausal women by increasing risk of stroke and heart attack, in addition to other adverse health consequences. Therefore, the U.S. Preventive Services Task Force, the North American Menopause Society, the American Heart Association and other scientific organizations do not recommend using hormone supplementation containing estrogen to prevent heart disease.

There are probably other causes contributing to increased risk of heart disease around the time of menopause besides the fall in estrogen; these include increasing age and previous poor lifestyle habits that start taking a toll. What is clearly understood is that if you lead a healthy lifestyle and all of your risk factors for heart disease are well controlled, your risk of developing heart disease after menopause is much lower. Therefore, as women enter into menopause it is a good opportunity to make sure they are doing everything possible to reduce their risk of heart disease.

Some things, all women (pre and postmenopausal) should be doing to reduce cardiovascular disease risk include:
• stop smoking and exposure to secondhand smoke;
• eat a diet high in fruits and vegetables and low in saturated fats;
• perform a minimum of 150 minutes/week of moderate intensity exercise;
• maintain a healthy weight, with a body mass index (BMI) between 19 and 25 kg/m2;
• keep alcohol use in moderation (no more than one alcoholic drink/day for women); and
• obtain routine screenings for diabetes, blood pressure and cholesterol; keep your numbers in target, perhaps with help from your doctor.

Heather Swales, M.D., FACC, is a member of The Hospital of Central Connecticut (HOCC) medical staff and director of HOCC's Women's Heart Wellness Center, 860-224-5694. For referrals to HOCC physicians, please contact our free Need-A-Physician referral service by phone at 1-800-321-6244 or online, www.thocc.org.