How does menopause impact CVD Risk?

Before menopause, women tend to have a lower risk of cardiovascular disease (CVD) compared to men, largely due to the protective effects of estrogen. So as estrogen levels decline during perimenopause, this protection decreases which can lead to an increased risk of CVD. 

One of the responses that increases risk of CVD is changes in lipid profile. Estrogen positively influences lipid metabolism by increasing levels of HDL cholesterol (‘good’ cholesterol) and decreasing levels of total  cholesterol and LDL cholesterol (often called “bad” cholesterol because it’s the main source of cholesterol buildup and blockage in the arteries). Research has shown that total cholesterol and LDL cholesterol increase during menopause, which may contribute to increased risk of atherosclerosis.

Estrogen is a vasodilator and keeps your blood vessels open. When estrogen falls there is increased stiffness of the blood vessels which leads to increased risk of CVD.  This is partially as stiffer blood vessels can lead to hypertension (high blood pressure), which becomes more common as women go through perimenopause. Hypertension is a significant risk factor for CVD. 

Women can experience metabolic changes during menopause. For example, menopause is related to a changing distribution of body fat with a tendency towards central obesity which is a risk factor for CVD. It can also lead to increased risk of insulin resistance which can increase risk of CVD. 

Heart rate variability (HRV) is a measure of the balance of activity between two components of the autonomic nervous system; the sympathetic and parasympathetic pathways. HRV tends to reduce during menopause, and a low HRV has been linked to increased risk of CVD.

How can you optimize CVD risk during menopause?

The most important thing to do is to develop a clear understanding of your individual risks and to develop a personalized plan to help you manage your overall health during a time when your physiology and cardiovascular risk profile is changing. 

One factor is understanding the timing of perimenopause. This is because women who start perimenopause earlier have slightly different long-term CVD risk profiles than those who start later, and this means they may need different recommendations on how best to manage risk and symptoms. Depending on age, perimenopause may be diagnosed through symptoms alone or with the help of a blood test to look at hormone levels under the advice of a medical team. 

Another important element is understanding your individual risk profile in relation to cardiovascular health, metabolic risks, and body composition. This can help identify potential issues early and guide management that can significantly impact your future health and wellbeing. As hormone levels fluctuate, risks can evolve. Ensuring there is a good baseline picture of your overall health can help monitor for any changes as they arise. 

The most important cardiovascular disease risk factors are smoking, being physically inactive and poor control of conditions such as Type 2 Diabetes, lipid disorders or hypertension. There are a number of lifestyle improvements that can help optimize health during this time including changes to exercise routines, diet and supplementation. Making these changes early and monitoring the effects can have a significant impact on managing overall health. 

Hormone replacement therapy has also been shown to be effective in reducing cardiovascular risk, with some estimates showing that it can reduce the risk of dying from CVD by about 30%. There is increasing evidence that the timing of introducing this therapy plays a significant role in long term outcomes, with a “window of opportunity” to alter cardiovascular risk if started earlier rather than later. It may not be suitable for everyone, however, and should be discussed with your doctor. 

CVD is the leading cause of death in post-menopausal women but there are a number of steps that can be taken to ensure this is reduced as much as possible. Staying on top of your health during perimenopause is crucial to ensure your cardiovascular risk is optimized. To understand how we at NIA use a range of markers to make personalised recommendations that can help improve long term risk profiles, have a look at our sample dashboard here. 

Sources

• National Institute on Aging: https://www.nia.nih.gov/news/research-explores-impact-menopause-womens-health-and-aging
• American Heart Association: https://www.heart.org/en/news/2023/02/20/the-connection-between-menopause-and-cardiovascular-disease-risks
• Bittner V. (2009). Menopause, age, and cardiovascular risk: a complex relationship. Journal of the American College of Cardiology, 54(25), 2374–2375. https://doi.org/10.1016/j.jacc.2009.10.008
• Matthews, K. A., Crawford, S. L., Chae, C. U., Everson-Rose, S. A., Sowers, M. F., Sternfeld, B., & Sutton-Tyrrell, K. (2009). Are changes in cardiovascular disease risk factors in midlife women due to chronological aging or to the menopausal transition?. Journal of the American College of Cardiology, 54(25), 2366–2373. https://doi.org/10.1016/j.jacc.2009.10.009
• Genazzani A.,Petrillo T.,Semprini E.,Aio C.,Foschi M.,Ambrosetti F.,et al. (2024). Metabolic syndrome, insulin resistance and menopause: the changes in body structure and the therapeutic approach, GREM Gynecological and Reproductive Endocrinology & Metabolism, 02-03/2023:086-091 doi: 10.53260/grem.234026
• Boardman, H. M., Hartley, L., Eisinga, A., Main, C., Roqué i Figuls, M., Bonfill Cosp, X., Gabriel Sanchez, R., & Knight, B. (2015). Hormone therapy for preventing cardiovascular disease in post-menopausal women. The Cochrane database of systematic reviews, 2015(3), CD002229. https://doi.org/10.1002/14651858.CD002229.pub4‍
• Liao, D., Cai, J., Rosamond, W. D., Barnes, R. W., Hutchinson, R. G., Whitsel, E. A., ... & Heiss, G. (1997). Cardiac autonomic function and incident coronary heart disease: a population-based case-cohort study: the ARIC Study. American journal of epidemiology, 145(8), 696-706.

All the views expressed here are based on careful research conducted by the research team at Niahealth. However, in some places we have omitted certain details for the sake of clarity and simplicity. If you have any questions about our research or the content of this blog email our head of research Dr Robin Brown at: robin@niahealth.co