Menopause: a risk factor for cardiovascular disease
By Barbara Broggelwirth MS, RDN, CDN
Cardiovascular disease (CVD) is the leading cause of death worldwide for men and women. One in three U.S. women will die of heart disease, and more women will die of CVD than men. The risk increases with age in both populations, but the increase starts later for women. While there are several modifiable diet and lifestyle risk factors associated with CVD, some risk factors cannot be changed. Menopause is one of them.
Menopause is a normal, natural event, defined as the final menstrual period, confirmed after one year of no menstrual bleeding. Menopause is all about changing levels or hormones, which are messenger compounds that travel through the bloodstream and direct specific tissues to behave in certain ways. The hormone shift most associated with menopause is estrogen. Nearly every tissue in the body, including the heart, brain, bone, breast, and colon has estrogen receptors. This is the reason physical and psychological changes occur when estrogen levels fluctuate, then drop. Estrogen effects many organ systems that contribute to cardiovascular risk vs. protection, including regulation of fat metabolism and cholesterol levels in the liver. Estrogen also affects the vasodilatation of blood vessels and improves blood flow in the coronary arteries. Dropping levels of estrogen result in changes in the walls of the blood vessels, making it more likely for plaque and blood clots to form.
Declining estrogen levels also impact our cholesterol levels. LDL cholesterol (the harmful kind) increase, and HDL cholesterol (the positive kind) decrease, leading to the build-up of fat and cholesterol in the arteries that contributes to heart attack and stroke. High levels of cholesterol, especially high levels LDL in the blood can cause a buildup of plaque on the inner walls of arteries. Plaque slows blood flow or blocks it entirely. If a blood vessel in the heart becomes blocked, a heart attack can occur. If this blockage happens in a blood vessel in the brain, a stroke can occur.
While menopause may be a non-modifiable risk factor that is outside of our control, there are lifestyle factors that are within our control. Maintaining a healthy weight is important for cardiovascular health. In fact, women who are overweight can reduce health risks greatly by losing just 10 percent of their excess weight. Cardiovascular physical activities (anything that raises your heart rate) can improve blood circulation, strengthen the heart and increase levels of HDL cholesterol (the good kind). Women who need to lose weight or sustain prior weight loss are recommended to get at least 60 to 90 minutes of moderate physical activity on most or all days of the week.
Nutrition plays a significant role in lifestyle strategies for cardiovascular disease prevention. Unhealthy dietary patterns that include hyperpalatable (food is one that is so tempting it can override your ability to control the amount you eat), ultra-processed foods that are typically very high in salt, sugar, and saturated fat can lead to atherosclerosis, an inflammatory disease that contributes to major incidence and mortality of CVD. Foods that are heart healthy include:
- A variety of fruits and vegetables (more than 4.5 cups per day)
- Whole grains and high fiber
- Fish, especially oily fish (at least twice a week)
- Sources of protein that are low in saturated fat and cholesterol, avoiding trans fatty acids
- Limited sodium (less than 1500 milligrams per day)
- Limited alcohol consumption (no more than 1 drink per day)
Exercise also is an excellent way to modify or control risk factors. A regular exercise routine can help:
- Lower blood pressure
- Lessen risk of developing type 2 diabetes
- Maintain a healthy body weight
- Reduce inflammation throughout the body.
American Heart Association, based upon the physical activity guidelines for Americans published by the U.S. Department of Health and Human Services, recommends:
- Getting at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity, or a combination of both, preferably spread throughout the week.
- Adding moderate- to high-intensity muscle-strengthening activity (such as resistance or weights) on at least two days per week.
- Spending less time sitting. Even light-intensity activity can offset some of the risks of being sedentary.
- Gaining even more benefits by being active at least 300 minutes (five hours) per week.
- Increasing the amount and intensity of exercise gradually over time.
If these suggestions seem daunting to you, think progress, not perfection. Any step toward building healthier habits will help to keep your heart and cardiovascular system healthy.
Keeping your heart healthy at Menopause. Cardiovascular Health & Menopause, Menopause Information & Articles | The North American Menopause Society, NAMS. (n.d.). Retrieved February 7, 2023, from https://www.menopause.org/for-women/menopauseflashes/bone-health-and-heart-health/keeping-your-heart-healthy-at-menopause
American Heart Association recommendations for physical activity in adults and kids. www.heart.org. (2022, July 28). Retrieved February 13, 2023, from https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-adults
Barbara Broggelwirth MS, RDN, CDN is a registered dietitian nutritionist who works with Bariatric and Medical Weight Management patients to help them achieve their health and weight loss goals.