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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