When it comes to menopause and heart disease risk, timing could be everything.
Doctors have long known that women face a greater risk for heart disease after menopause, the cessation of menstrual periods. But reporting in the Journal of the American Heart Association, researchers at the University of Virginia in Charlottesville recently put a new timestamp on the process. The data, which involved 1470 women, shows that key risk factors for heart attack, diabetes, and stroke rise more sharply in the years leading up to menopause than those that follow.
The risk factors they investigated are part of the constellation of criteria known as the metabolic syndrome, including a large waistline, high levels of triglycerides (a particularly dangerous type of blood fat), low “good” HDL cholesterol, high blood pressure, and high fasting blood sugar. An individual’s risk for heart disease, diabetes, and stroke increases with the number of metabolic risk factors they have.
Researchers also found key differences between African American and white women. For instance, the rise in risk factors for metabolic syndrome during perimenopause—the roughly ten years prior to menopause—was especially dramatic among African American women. However, they experienced a slower rate of increase than white women after menopause. And African Americans had a higher rates of metabolic syndrome overall, with more cases of high blood pressure and high blood sugar levels, in particular.
The changes women experience during the transition are linked to dropping levels of estrogen. Among other cardiovascular effects, estrogen decreases LDL cholesterol and dilates blood vessels, allowing blood to flow freely. As estrogen levels fall, these protective effects decline. Dwindling estrogen also leads to the accumulation of fat around the middle, which boosts the risk for heart disease and insulin resistance. Given that the average age of menopause is 54, the danger zone for women’s hearts could begin as early as the mid-40s.
Since these processes are underway well before periods end, the research suggests, symptoms that mark the midlife transition, such as hot flashes, erratic cycles, fatigue, and mood changes, should be a wake-up call for doctors and their female patients—particularly African American women.
Women and their doctors may need to step up the conversation about heart disease and its risk factors and address measures that can help keep problems at bay. Tests that can identify heart disease problems, as well as tests of inflammation, which plays a role in unhealthy metabolic processes, could prove to be beneficial for some.
No matter what a woman’s age or stage, healthy habits—a diet emphasizing fruits and vegetables, lean protein, whole grains, and healthy fats; regular exercise; and good sleep hygiene—can make a significant difference to her health or even save her life.