Here’s what doctors know about heart disease and menopause: Women tend to have heart attacks and heart problems about a decade later than men, on average, and experts have attributed that buffer period to the presence of estrogen. Once estrogen levels drop after menopause, heart disease rates start to climb. But in the latest research published in the Journal of the American Heart Association, researchers say that risk for heart disease actually starts to peak in the years before menopause, and the risk is especially great for African-American women.
“As much as conventional wisdom has been that it’s menopause itself, and being post-menopausal, that increases heart disease risk, it appears that the time leading up to menopause is associated with more rapid change in heart risk factors,” says Dr. Mark DeBoer, associate professor pediatrics at University of Virginia, who, with his colleagues, studied 1,470 women over 12 years. “Once menopause is in place, there is a slower chance in these factors.”
So, the findings clearly showed that women experienced rapid increases in metabolic syndrome severity during the last years of pre-menopause and the transition years to menopause, known as perimenopause.
The risk factors, together known as metabolic syndrome, include a large waistline, high triglyceride (a blood fat) levels, low high-density lipoprotein -- the "good" cholesterol -- levels, high blood pressure and high blood sugar when fasting.
Participants were selected based on whether they went through menopausal changes over a 10-year period.
Among African American women, these risk factors steadily increased in the years prior to menopause at a greater rate than for white women, suggesting that African-American women may be more vulnerable to the changes occurring prior to menopause.
Nearly 45 percent of black women in the study had hypertension compared to 15 percent of white women. Almost 10 percent of black women had high glucose compared to 8 percent of white women. Black women had a slower rate of metabolic syndrome increase after menopause compared to white women, however.
Although nearly 14 percent of white women used hormone replacement therapy in contrast to almost 7 percent of black women, that didn't explain the racial differences. DeBoer observed that the women in the study had a much higher use of hormone replacement therapy than what is currently the norm.
Doctors had thought that replacing declining levels of estrogen with supplemental hormone therapy would protect women’s hearts but a large trial in 2002 showed that the therapy increased risk of breast cancer and did not lower heart disease rates. Current guidelines suggest that women only take hormone therapy for a short period around menopause to alleviate symptoms of hot flashes and night sweats. The latest findings, however, leave open the question of what role, if any, estrogen is playing in the constellation of changing occurring during menopause and how that could affect risk factors for heart disease.
JoAnn Pinkerton, an OBGYN and executive director of the North American Menopause Society, said she was struck by the rapid progression of metabolic syndrome during the transition to menopause, or perimenopause. Pinkerton noted that it is the most difficult phase of menopause, saying that women can gain five to 10 pounds per year in the time leading up to actual menopause, and fibroid tumor growth is possible due to changes in estrogen and progesterone.
“Women who approach the perimenopause need to be really careful about keeping their exercise going and decreasing their portion sizes,” she said.
What the results do stress, and in strongest terms, is that this period is an important time for women to make lifestyle changes to lower their risk of metabolic syndrome effects — such as maintaining a healthy weight, and keeping cholesterol levels and blood pressure in check. “These data suggest that heart disease risk accelerates in the years just leading to perimenopause and menopause,” says DeBoer. “Knowing that there may be a more rapid increase in heart-related risk factors, women may be able to increase their level of exercise and the quality of their diet to in theory counteract some of this natural rise in heart disease risk.”
"The years transitioning to menopause may represent a 'teachable moment', when patients are especially receptive to learning and putting into practice healthy habits that can make a difference in their cardiovascular disease risk," DeBoer noted.
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