The No. 1 cause of sickness and death in the menopausal woman is heart disease. In 1993, the number of deaths from heart disease in menopausal women was about double that from all deaths resulting from all cancers, diabetes and accidents combined.
A major fear in maturing women is of getting some form of cancer, particularly breast and ovarian. Cancer is a dreadful disease, no question. In fact, 1 in 8 women will develop breast cancer in her lifetime. However, it is a woman’s risk for cardiovascular disease that plays the greatest role in how healthy she will be in her post-menopausal years. Since a woman today has an average life expectancy of about 80 years, she will probably live about a third of her life in her post-menopausal years. Therefore, it is important to reduce as many risk factors for heart disease as possible.
When does a woman’s risk for heart disease start to increase?
Heart disease is often thought of as a man’s disease, and men do have a greater risk of developing heart disease than do premenopausal women. Unfortunately, a woman’s decreased risk does not remain throughout her lifetime. By age 40, a woman’s risk increases, and by about age 50 (a time of large changes in a woman’s hormonal environment), her risk for heart disease approximates that of a man. In later years, she may have even higher risk rates than do men.
Why do older women have increased risks for heart disease?
Until menopause, it is thought that increased estrogen levels have a protective effect. Therefore, menopause — and its associated decreased estrogen levels — is associated with increased risk. Other risk factors for heart disease that occur more in menopausal women are diabetes, obesity and increased cholesterol levels.
What are major risk factors for heart disease?
smoking
high blood pressure
high total and LDL cholesterol, and low HDL cholesterol (total and LDL cholesterol increase risk while HDL cholesterol is protective)
diabetes mellitus
obesity
How can estrogen replacement therapy reduce heart disease risk?
Estrogen replacement can reduce risk by:
1) Improving the cholesterol profile — It reduces total and LDL cholesterol but increases HDL cholesterol. Therefore there exists more “good” cholesterol, which helps protect against heart disease, and less “bad” cholesterol.
2) Improving circulation — Estrogen replacement increases the decreased blood vessel diameter that occurs in menopause. It also makes blood flow faster through this widened tube; therefore there is less chance for cholesterol to stick to the lining of the blood vessels, which means there is less chance for atherosclerosis or “hardening of the arteries” associated with heart disease and stroke.
Does a woman with heart disease have the same symptoms as does a man?
Not necessarily. A woman with heart disease is more likely to have symptoms other than the crushing chest pain or angina, which often occurs before heart attacks in men.
Her symptoms may include nausea, difficulty breathing and other kinds of vague symptoms of “just not feeling right.”
What can I do to reduce my risk for heart disease?
Stop smoking.
Check blood pressure, and consider treatment if elevated.
Lower cholesterol levels.
Control or lose weight.
Control or reduce risk for diabetes mellitus.
Consider hormone replacement therapy. (Note: Not all women are candidates for hormone replacement therapy.)