Heart disease remains the leading killer of women yet only half of women know this fact. Heart disease and stroke kill more women each year than all cancers combined. Ninety percent of women have at least one risk factor for heart disease.
So, what are the risk factors, symptoms, guidelines, treatment recommendations and menopause facts related to heart disease?
Let’s start with risk factors. There are more traditional risk factors but also less commonly talked about risk factors are just as important. Traditional risk factors include obesity, high blood pressure, family history of heart disease, smoking, poor physical activity, diabetes, high LDL cholesterol, low HDL cholesterol and high triglycerides. Please note that high blood pressure is considered 130 systolic (top number) over 80 diastolic (bottom number). This is lower than previous cited 140/90. Other less traditionally discussed risk factors that patients need to be aware of are:
- Rheumatoid arthritis: this increases risk of heart disease as much as diabetes.
- History of gestational diabetes
- History of high blood pressure or preeclampsia in pregnancy
- Early menopause
- Depression (doubles the risk of ischemic heart disease).
- Menopause can increase blood pressure due to lowered estrogen. Estrogen in younger women acts as a vasodilator (opening blood vessels). When estrogen levels go down with menopause, blood vessels constrict which can result in higher blood pressure.
Symptoms of heart disease in women can be milder than those of men. Women with heart disease commonly present with more symptoms than men, but can be atypical presentations such as indigestion, shoulder/arm/back pain, shortness of breath, nausea, vomiting, sweating, and fatigue to name a few.
What can you do? In short, know your risk factors including your history and family history if possible, establish care with a primary clinician to have proper screening, and follow through on an action plan. The American College of Cardiology has a risk calculator that your primary care clinician may use to calculate your individual score of coronary disease. This includes information about your race, blood pressure, cholesterol results, medical history, and smoking status to calculate your ten-year risk of coronary disease. A lifestyle plan that minimizes a person’s heart disease risk is the fundamental key to success whether that be a weight loss plan, smoking cessation, diabetes control, instituting a low sodium (DASH) diet, starting blood pressure and/or cholesterol reducing medications, and for some high-risk patients - starting a daily low dose aspirin. Please note that according to 2019 American Heart Association recommendations, daily low dose aspirin use is not for everyone- this is for high risk patients. The recommendation to be on daily low dose aspirin needs to be decided by your clinician.
Now a word about menopause as it relates to coronary heart disease. The Women’s Health Initiative study (WHI) is a large -over 161,000 women ages 50-79, national, ongoing study started in 1993 that focuses on heart disease prevention and certain cancer prevention. The 2019 findings are that hormone replacement therapy can be helpful in reducing coronary heart disease in women less than 60 years old and/or less that ten years out from time of menopause. This is the conclusion as well from 23 large randomized controlled trials of over 191,000 women. This is NOT true for women over the age of 60 and/or greater than 10 years out from menopause onset. In short, it is about the timing of starting hormones that determines in large part if this is heart beneficial or harmful. For younger menopausal women who do not have contraindications to hormone replacement therapy such as history of blood clot or personal history of breast cancer, hormone replacement therapy can reduce coronary heart disease. This is further discussed in the 2017 Hormone Therapy Position Statement of The North American Menopause Society. For most women, this contrasts with what they see in the media, headlines, and represents a large shift from the talking points of misinformation in recent years.
Being a proactive part of your personal care in collaboration with your clinician is the goal. Self-education using correct resources - some of which have been cited in this column - can be empowering and helpful!
