From the Guidelines
Menopause significantly increases the risk of cardiovascular disease in women, and therefore, it is crucial to adopt heart-healthy lifestyle modifications and consider individualized medical interventions to mitigate this risk. During menopause, women experience unfavorable changes in lipid profiles, insulin resistance, weight gain, and elevated blood pressure, contributing to a 2-4 fold increase in cardiovascular disease risk compared to pre-menopausal women 1. To manage these effects, women should engage in regular exercise, such as 150 minutes of moderate activity weekly, and follow a Mediterranean or DASH diet rich in fruits, vegetables, whole grains, and lean proteins. Additionally, smoking cessation and limiting alcohol consumption are essential lifestyle modifications.
Blood pressure should be maintained below 130/80 mmHg, and regular screenings for diabetes, cholesterol, and other cardiovascular risk factors are vital. While hormone replacement therapy (HRT) was once widely prescribed for cardiovascular protection, current recommendations suggest using the lowest effective dose for the shortest duration primarily for menopausal symptom management rather than cardiovascular protection 1. Women with existing cardiovascular risk factors should discuss with their healthcare provider whether medications like statins, aspirin, or antihypertensives might be appropriate for their individual risk profile. The development of hypertension starts in young, premenopausal women, often in association with disorders of reproductive organs, and therefore needs to be managed early in life to prevent future cardiovascular disease 1.
Key considerations for managing cardiovascular risk in menopausal women include:
- Regular exercise and a balanced diet
- Blood pressure control below 130/80 mmHg
- Regular screenings for diabetes, cholesterol, and other cardiovascular risk factors
- Individualized consideration of medications like statins, aspirin, or antihypertensives for women with existing cardiovascular risk factors
- Early management of hypertension in premenopausal women to prevent future cardiovascular disease.
From the Research
Menopause and Cardiovascular Disease
- Menopause is associated with an increased risk of cardiovascular disease (CVD) in women, with declining hormone levels playing a potential role in this transition 2.
- The menopause transition contributes to the increase in coronary heart disease risk, with distinct patterns of sex hormone changes, adverse alterations in body composition, lipids and lipoproteins, and measures of vascular health 3.
- Traditional risk factors for CVD, such as changes in body fat distribution, reduced glucose tolerance, abnormal plasma lipids, increased blood pressure, and endothelial dysfunction, are compounded during menopause 4.
Menopausal Hormone Therapy and Cardiovascular Disease
- Menopausal hormone therapy (MHT) has been proposed as a strategy for reducing CVD risk, but trials have not consistently shown cardiovascular benefit, and several describe significant risks 2.
- The timing of hormone administration seems to play a role in its relative risks and benefits, with some studies suggesting that MHT started soon after menopause may confer cardiovascular benefit 4.
- Different formulations, doses, and routes of delivery of MHT have different effects on cardiometabolic markers and risks of clinical CVD events, with transdermal estrogens posing a lower risk of venous thromboembolism and stroke than oral estrogens 5.
Lifestyle Factors and Cardiovascular Disease Risk
- Changing dietary habits during perimenopause can significantly improve CVD risk factors, with a balanced diet and fluid intake, dietary prevention of cardiovascular diseases, and key preventive nutrients such as vitamin D, calcium, and protein intake playing important roles 6.
- Nutrition counseling and intervention can effectively reduce the risk factors of CVD, insulin resistance, type 2 diabetes mellitus, osteoporosis, and tumors during the perimenopause and menopause periods 6.