Cardiovascular Disease in women in menopause, why should think about your heart health!!

04 Apr Cardiovascular Disease in women in menopause, why should think about your heart health!!

Cardiovascular Disease in Perimenopause and Menopause

Cardiovascular disease (CVD) is the leading cause of death in both men and women, yet is frequently underestimated in females and, compared with men, sadly women are less likely to be offered interventions, are less likely to be represented in clinical trials and have a worse prognosis.

How Big a Problem?

CVD is the leading cause of death in women after menopause and more women die from heart disease and stroke than from the next five causes of death combined, including breast cancer. Although many women perceive that one of the leading risks to their health is breast cancer, globally women are nine times more likely to die of CVD than of breast cancer. CVD is traditionally thought of as being a problem of middle-aged men, but CVD affects just as many women when they approach midlife.

This delay is thought to be due to the protective effects of oestrogen that occur in the years before menopause. As oestrogen levels drop, often from the mid-40s onwards, the protective effect is lost, and changes occur that lead to an increased risk of heart disease in the ensuing years. The health risks that women seem to be most concerned about at perimenopause and menopause are physical menopausal symptoms such as hot flashes, mood swings, osteoporosis, and breast cancer amongst others. It is not common for women to know how much the cardiovascular system is silently affected during hormonal transition.

The Role of Menopause

Menopause affects all women and occurs when the ovaries either naturally stop producing oestrogen due to the decline and cessation of oocyte development and ovulation, which is essential for the production of both oestrogen and progesterone or when the ovaries are removed or damaged by other therapies. The average age at natural menopause varies between countries and is affected by factors such as genetics, nutrition, smoking and age of menarche; in Europe, it is around 51 years. As oocyte quality and number decline gradually, changes related to lower levels of oestrogen may commence several years beforehand.

Oestrogen deficiency can lead to early, intermediate, and long-term health problems. There is widespread awareness of the common early menopausal symptoms such as hot flashes, night sweats, insomnia and mood changes. Intermediate symptoms of vaginal dryness, irritation, discomfort and bladder changes are very common and, although discussed less often than hot flushes, are gradually being reported and treated a little more often than in the past. The long-term effect of menopause on the bones, with the lack of oestrogen leading to loss of bone strength (and eventually osteoporosis) with an increased risk of fracture, is fairly well known and frequently addressed. However, there is an incredibly poor appreciation of the important long-term effects of menopause on the cardiovascular system.

The Effect of Menopause on Risk of Cardiovascular Disease

Weight

Being overweight is a significant risk factor for CVD and is an increasing problem in the Western world. Obesity is more common in men than in women before 45 years of age, but after this point, the trend reverses. During menopause, and, starting within the first year of menopause, there is a shift in fat distribution and storage in women from the hips to the waist, more resembling that of the abdominal visceral fat storage in men. These are often referred to as ‘pear’ and ‘apple’ shapes, the apple shape being associated with an increased risk of CVD. Waist circumference reflects this risk: women with a waist circumference >80cm have an increased risk of CVD, with an even greater risk for those whose waist circumference is ≥88cm.The exact mechanism by which oestrogen deficiency leads to weight gain and change in fat distribution is not clear but is thought to be related to a relative excess of androgens (post-menopausal ovaries still produce some androgens) together with changes in leptin and thyroid function.

Blood Pressure

Hypertension is also a major risk factor for CVD, and after 45 years of age, more women than men develop hypertension.

Cholesterol

There is no doubt that raised cholesterol is a significant risk factor for CVD. Menopause is associated with a progressive increase in total cholesterol, with an increase in low-density lipoprotein (LDL), lipoprotein-α and triglycerides and a decrease in high-density lipoprotein (HDL).^7–9 Therefore, menopausal women are exposed to a more atherogenic lipid profile than pre-menopausal women. Total cholesterol levels peak in women at 55–65 years of age – about 10 years later than the peak in men.

Agents that lower cholesterol levels reduce heart disease risk in both men and women, but it is thought that a larger proportion of women than men are at high risk and are not being effectively treated. It was shown in a recent survey that only one in four women associates menopause with high cholesterol, leading to a lack of awareness of the need to consider having cholesterol levels checked around the time of menopause.⁵

There is no doubt that raised cholesterol is a significant risk factor for CVD. Menopause is associated with a progressive increase in total cholesterol, with an increase in low-density lipoprotein (LDL), lipoprotein-α and triglycerides and a decrease in high-density lipoprotein (HDL). Therefore, menopausal women are exposed to a more atherogenic lipid profile than pre-menopausal women. Total cholesterol levels peak in women at 55–65 years of age – about 10 years later than the peak in men

Agents that lower cholesterol levels reduce heart disease risk in both men and women, but it is thought that a larger proportion of women than men are at high risk and are not being effectively treated. It was shown in a recent survey that only one in four women associates menopause with high cholesterol, leading to a lack of awareness of the need to consider having cholesterol levels checked around the time of menopause.

Specific Cholesterol-lowering Dietary Methods

Some interest has been shown in specific dietary methods of reducing cholesterol levels, with a variety of foods containing active ingredients that have been shown to have LDL-cholesterol-lowering properties. Active ingredients include plant sterols/stanols (added to foods such as margarine, milk products and yogurts), and beta-glucan (a soluble fibre found in oats). In the case of beta-glucan, the ingredient in oats-based cereals, the evidence supports cholesterol lowering in the range of 2–5% when 3–5g beta-glucan is consumed daily. Oats are a fantastic food for cholesterol lowering properties.

However, one of the most effective ways to lower LDL cholesterol through dietary changes is by the inclusion of plant sterols or stanols. Plant sterols and stanols lower LDL cholesterol levels by blocking the absorption of cholesterol from food during digestion, and by blocking the re-absorption of cholesterol from the liver. Taking 2–2.5g of plant sterols per day is thought to lower LDL cholesterol by an average of 10% within two to three weeks. When combined with a healthy diet and lifestyle, LDL cholesterol can be further reduced by 5%. Plant sterols and stanols have no effect on HDL cholesterol or triglycerides. The 10% cholesterol lowering of plant sterols is additive to that of a healthy cholesterol-lowering diet.  You can buy supplements of plant sterols which may be an option for you?

Green tea, flaxseed and garlic are excellent for cardiovascular health and have cholesterol-lowering compounds.

Saturated fats and cholesterol

• milk and white chocolate, toffee, cakes, puddings and biscuits
• pastries and pies
• fatty meat, such as lamb chops
• processed meat, such as sausages, burgers, bacon, salami
• butter, lard, ghee, dripping, margarine, goose fat
• coconut and palm oils, coconut cream
• full-fat dairy products such as cream, milk, yoghurt, crème fraiche and cheese, I know you eat cheese but not in excess is good.

Saturated fats are usually hard at room temperature, such as butter, the fat in meat, and coconut. Unsaturated fats are liquid, such as olive oil.

Many foods contain a mixture of saturated and unsaturated fats. Try to choose foods with more unsaturated fat than saturated.

Herbs that can support cardiovascular health in women

Many herbs can be useful, here are a few that could be beneficial to you.

Crataegus (Hawthorn) – tonic for the heart, provides tone. Support the integrity of the blood vessels.

Cynara scolymus (cynarin) has lipid-lowering effect and increases bile

production thereby helping to clear cholesterol from the body.

Curcuma longa reduces total cholesterol and non-HDL cholesterol.

Gymnema sylvestre for blood sugar control and to reduce sugar cravings.