Menopause Enhances the Risk of Heart Disease

A new statement by The American Heart Association (AHA; Dallas, TX, USA) highlights the transition period into menopause as a key risk factor for coronary heart disease (CHD) in women.

The statement, issued on behalf of AHA Prevention Science Committee of the Council on Epidemiology and Prevention, reiterates that cardiovascular disease (CVD) is the leading cause of death in women, with a notable increase in disease risk following menopause transition (MT). Longitudinal studies have documented distinct patterns of sex hormone changes, adverse alterations in body composition, lipids, and lipoproteins, and measures of vascular health over the MT, which increase the risk of developing CVD post-menopausally.

The AHA stress that the reported findings underline the significance of MT as a time of accelerating CVD risk, emphasizing the importance of monitoring women’s health during midlife. However, as the 2011 AHA guidelines for CVD prevention in women did not include information on the contribution of the MT to increased CVD in women, they determined a crucial need to increase awareness of the significant adverse cardiometabolic health-related changes accompanying midlife and the MT. The AHA statement was published on November 30, 2020, in Circulation.

“Over the past 20 years, our knowledge of how the menopause transition might contribute to CVD has been dramatically evolving,” said Professor Samar El Khoudary, PhD, MPH, chair of the AHA committee. “At the time women begin the transition into menopause, their bodies start producing less estrogen. Studies have shown that this hormone may have cardio-protective effects, and, therefore, its reduction at the transition into menopause may put women at an enhanced risk of cardiovascular disease.”

“Women should be made aware of their risk of CVD, and interventions need to be established to protect those who are most at-risk, such as women transitioning to menopause. There is much work to be done to change the public and clinical perception that CVD is more prominent in men,” concluded Professor El Khoudary. “This misconception often leads to women receiving less aggressive treatment strategies and being underrepresented in clinical trials, which may contribute to their enhanced risk of heart failure following a heart attack.”

Menopause is the permanent cessation of the primary functions of the ovaries, including the end of estradiol and progesterone endocrine hormone production. The MT can be divided into three stages. During pre-menopause, the menstrual cycle becomes irregular, beginning 5-10 years before menopause; perimenopause is the transition period prior to menopause, when the function of the ovaries noticeably fades away, leading to close of menstruation; post-menopause is the time after the last menstruation.

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The American Heart Association