Menopause and cardiovascular risk: everything you need to know

“The cardiovascular system of women during childbearing age is protected by estrogen. These hormones act as a shield for the cardiovascular system and favorably regulate the metabolic structure. Menopause represents a phase of profound change because, with the fall in estrogen levels, the metabolism changes, favoring an increase in blood pressure and body weight. Precisely these factors entail greater risks for the heart, because they increase chances of developing diseases of the cardiovascular system,” explains Dr. De Cesare.

The other risk factors for the female population

In addition to menopause, there are other factors that have a major impact on the onset of cardiovascular diseases, such as:

• diabetes
• obesity
• hypercholesterolemia
• hypertension
• stress
• passive lifestyle
• smoke
• genetic predisposition.

Cardiovascular disease typically occurs in women at least 10 years later than in men, due to the protection given by estrogen until menopause. Furthermore, diagnosis of cardiovascular diseases is more difficult because they occur within less evident clinical picture. In the case of ischemic heart disease (a set of conditions that involve a reduction in blood and oxygen supply to the heart, with clinical manifestations ranging from angina pectoris to myocardial infarction).

“Ischemic heart disease has many common aspects to both sexes, but there are certainly some specific peculiarities in women, whose knowledge is not very widespread. Not much was known about the specificities in women until recently, because in the past there were few studies on the subject and only men were considered.

In 1991 NIH (American government body for medical research) made compulsory the inclusion of women in research, the assessment of existence of differences in risk factors, symptoms and therapeutic procedures in both sexes.

The studies carried out demonstrated that, from an epidemiological point of view, women develop ischemic heart disease (CAD) in an older age than men, especially after menopause. The same is true for the hypertension. There is also an increased chance of death in women who have suffered a myocardial infarction, especially in case of hypertension,” explains Dr. De Cesare.

“The first difference between men and women in ischemic heart disease is the symptoms. Those that are generally considered to be typical for a heart attack (chest pain or burning in the left arm) are actually more frequent in middle-aged men and less for women, especially young. In most cases, however, the symptoms in women are:

• fatigue,
• abdominal pain in the umbilical and suprapubic region,
• faint feeling, etc.

These are disorders common to many other conditions, often underestimated by the doctor, which can lead to an incorrect or late diagnosis,” explains the expert.

“Important differences between the sexes also emerge into diagnosis. The foundation stone of ischemic heart disease diagnostics is the stress test. Traditionally, in premenopausal women, the test can give false positivity (indicate a pathological result, even in the absence of disease) much more frequently than in men. After menopause, this phenomenon is reversed,” continues Dr. De Cesare.

“Finally, in women, there are some particular forms of acute coronary syndrome, which are very rare in men. This is the reversible apical balloning syndrome or Tako_Tsubo syndrome (so called for the particular morphology that the left ventricle assumes, similar to a squid fishing tool used in Japan).

A pathology that in many respects mimics a heart attack, both for the symptoms and for the electrocardiographic alterations and myocardial enzymes (substances that are released into the blood by the myocardial cells due to a too modest supply of oxygen compared to real needs). However, even if coronary angiography generally shows a picture of absolute normality, the ventricle assumes the typical appearance of one affected by a severe heart attack.

This syndrome often occurs as a result of strong psychic or more rarely physical stress (surgery), but on the positive side it is generally followed by almost complete recovery of the left ventricular function. Healing occurs in a very variable amount of time from person per person,” concludes Dr. De Cesare.

“As mentioned earlier, the heart of postmenopausal women is at greater risk. To prevent it, it is essential for women to adopt a healthy lifestyle throughout their life and especially during menopause.

First of all, women should follow a balanced diet and keep their weight under control to avoid the increase in blood pressure and cholesterol, enemies of the heart. In particular, it is good to reduce salt intake (less than 5 grams per day) and prefer foods such as:

• fruits and vegetables,
• legumes,
• foods low in animal fat, such as fish,
• white meat.

Red meats, cheeses and sausages, sweets and sugary drinks should be limited.

In addition, every woman should practice regular physical activity: do sports and also walk for at least 30 minutes a day, and take the stairs instead of using an elevator; also, do not smoke and reduce alcohol consumption.

Finally, to reduce the intensity of hot flashes and palpitations, it is advisable not to exceed the consumption of coffee, spicy foods and to dress in several layers of thin and breathable clothing,” continues Dr. De Cesare.