Heart Health And Heart Disease Risk

If you’re going through early menopause, there’s quite a bit that you should be aware of where heart disease is concerned.

Heart disease is the number one killer  of American women — responsible for about 36% of deaths.  And virtually every study of premature and early menopause makes a very bold statement:

Women who experience early menopause or premature ovarian failure (POF) appear to have an increased  risk of heart disease compared to other women their age.

According to one study, women who go through menopause before age 35 may have a two to threefold higher risk of heart disease. Likewise, women who have their ovaries removed before age 35 may have a sevenfold higher risk (1).

If you’re older than 35 but still younger than 40, your risk is a only bit lower — about twice the chance of developing heart disease. In fact, whether you’ve gone through a surgical or natural premature menopause, you’re at a higher risk of heart disease than women who have gone through menopause at the average age.

These are startling figures to say the least — and one of the key reasons it’s so important to take charge of your heart health as soon as possible.

Are You At an Even Higher Risk for Heart Disease?

Heart disease risk factors:

• Family history of heart disease
• An unfavorable cholesterol profile
• Obesity
• High blood pressure
• Being diabetic
• Smoking
• Sedentary lifestyle

As with so many things that affect you when you’re coping with an early menopause or premature ovarian failure (POF), the reason for this increased risk appears to be lower amounts of estrogen. There have been a number of research studies exploring this link between estrogen and heart disease, however the results have not been completely conclusive.

The historically widely reported Women’s Health Initiative Study (WHI) halted the arm of the study in which “normal” menopausal women (women aged 50 to 79) were taking Prempro hormone therapy (conjugated equine estrogen and medroxyprogesterone acetate) due to an increase in heart attack and stroke.

In the above case, it appeared that the progestin (Provera) was particularly problematic where heart problems was concerned, as those women in another arm of the study who were on estrogen alone didn’t show this same marked increase in cardiac events.

Another study (the HERS study) found that post-menopausal women (women of “normal” menopausal age — that is, older women) with a history of heart disease actually increased their risks of having heart problems for the first two years of hormone replacement therapy (HRT), but after this, the risk diminished.

According to a number of studies, it appears that estrogen decreases LDL (low-density lipoprotein — the “bad” cholesterol) and increases HDL (high-density lipoprotein — the “good” cholesterol). This keeps atherosclerotic plaque from sticking to arteries. It also reduces one form of LDL cholesterol called LP(a) , which can cause stroke if high (2).

Estrogen also appears to help keep your homocysteine levels low. Homocysteine is an amino acid that, at elevated levels, affects the arterial linings and appears to be connected with an increase in heart disease and stroke. Finally, it may help to keep your blood vessels elastic, so they can expand when necessary to allow for increased blood flow.

Heart Helpers: What You Can Do To Tackle Heart Disease

If you have premature menopause, it’s important to be proactive in addressing your risks of heart disease through a variety of measures. Here are some considerations to take into account:

Consider replacing the estrogen you’ve lost

When it comes to fighting heart disease, estrogen itself appears to be on your side. Yes, there has been a longstanding debate over the pros and cons of estrogen replacement therapy and some concern over the findings of research. This has made the issue a major source of controversy and contention between different viewpoints.

The official position of the National Institute for Health and Care Excellence (NICE) is that HRT has no effect on the risk of dying from heart disease.

Most women become post-menopausal in their 50s, and the circumstances of a “normal” menopause are entirely different to those faced by women experiencing early menopause or premature ovarian failure (POF).

As with so much of the reporting surrounding menopause and large HRT studies, discussion has been focused around women in their 50s (and beyond) and the risks vs benefits scenario that they face. For those going through early menopause or POF: the guidelines are clear — the benefits of HRT in symptom management and disease-risk reduction outweigh any drawbacks.

In further good news, the results of various studies have  shown a heart-protecting effect for HRT: replacing estrogen may result in a lower risk of heart disease — as much as 50 percent if used for ten years or longer, with smaller improvements observed when used for lesser time periods (3, 4, 5).

Researchers believe that one way in which estrogen protects your heart is by reversing the rise in the “bad” LDL cholesterol after menopause. According to one recent study of women taking estrogen, LDL declined 13.5 percent while HDL (the “good” cholesterol) increased 22.5 percent (6).

Other studies have also shown that estrogen lowers fibrinogen, a blood-clotting factor and helps your blood vessels respond well to overloading through stress or exercise (7).

There is some nuance to the picture, however. According to some research, oral estrogen may increase your level of triglycerides (a type of fat in your blood that may be linked to heart disease), and can increase your risk of blood clots (6).

Keep in mind, younger women taking HRT are “replacing” estrogen up to levels are normal among their nonmenopausal peer group. This is the foremost underlying factor influencing treatment differences between women with early menopause and menopause at a “normal” age.

Useful helpsheets on our site include:

• The Women’s Health Initiative (WHI) HRT Study
• HRT vs. Birth Control Pills: The Ultimate Guide
• Available Forms of HRT (USA)

Diet & Exercise

• Aim for thirty minutes a day of moderate intensity exercise offers significant all-round health benefits.
• Opt for a diet rich in heart-friendly, whole foods. In particular, try to include sources of omega-3 fats, such as those in fatty fishes like salmon.
• Up your fiber intake. It’s a good idea to get about 25 to 35 grams of fiber a day — to help reduce cholesterol, protect against diabetes, and keep blood sugar levels stable.
• Try to cut down on sugar

Here are some more useful tips:

• If you smoke, quit. Smoking is one of the leading causes of heart disease.
• Have your blood pressure and cholesterol checked — and keep track of your levels. If you start HRT, it makes sense to get checked at the very beginning, then three or so months later to see if the HRT is working well for you. Otherwise, you may need to readjust your treatment.
• Cut down on alcohol

There are few health priorities that can be ranked as high in importance as your heart. That’s why it’s vital you take proactive steps to ensure you’re doing all you can to minimize a risk of disease that is known to be higher in women who’ve going through POF or early menopause. As always, work closely with your doctor to plan a course of treatment that works for you.