Menopause Transition Associated With Higher Cardiovascular Risks

Samar R. El Khoudary, Ph.D, M.P.H.

The years leading up to menopause — or menopause transition — is a time of increasing heart disease risk for women, according to a new Scientific Statement from the American Heart Association (AHA).

Monitoring women’s health and lifestyle while integrating early intervention strategies for good cardiovascular health are important, especially during midlife and menopause to help prevent heart disease, according to the statement, “Menopause Transition and Cardiovascular Disease Risk: Implications for Timing for Early Prevention,” published in AHA’s journal, Circulation.

Hormone therapy during the menopause transition period may also help reduce heart disease risks, according to AHA.

“Over the past 20 years, our knowledge of how the menopause transition might contribute to cardiovascular disease has been dramatically evolving. We have accumulated data consistently pointing to the menopause transition as a time of change in cardiovascular health,” Samar R. El Khoudary, Ph.D., M.P.H., chair of the statement writing committee and associate professor of epidemiology at the University of Pittsburgh’s Graduate School of Public Health and the Clinical and Translational Science Institute, said in a news release.

Physiological changes during menopause, such as increased abdominal fat and visceral fat (body fat around the organs), are associated with a heightened risk of all-cause, cardiovascular disease and cancer mortality — even among those with normal body mass index levels, AHA said.

In addition, cholesterol levels, metabolic syndrome risk and vascular vulnerability appear to increase with menopause beyond the effects of normal aging.

For many women, the menopause transition begins when they are in their late 40s to mid-50s. Before this transition, women produce estrogen, which may also have cardio-protective effects. When women go through the natural menopause transition, their ovaries stop producing as much estrogen, AHA said. The changes can also occur through surgical menopause (a partial or full hysterectomy, which includes removal of one or both ovaries).

Since the increase in heart disease risk during menopause is associated with a decrease in estrogen production, healthcare professionals and scientists have studied if hormone therapy might help reduce cardiovascular risk.

“There is research indicating potential cardiovascular benefits of certain combinations of hormone therapy when initiated in early but not late menopause,” AHA said. “Further research is needed to evaluate the role of other hormone therapies, and how long these interventions impact cardio-metabolic health.”

In addition, some studies show the benefits of hormone therapy — including a decreased risk of type 2 diabetes and protection from bone loss — seem to outweigh the risks for most women in early menopause.

“Current recommendations from leading professional medical societies endorse the use of hormone therapy for women who have recently begun the menopause transition, with appropriate indications,” AHA said.

Healthcare professionals should also consider an aggressive, prevention-based approach for women during the menopause transition to decrease the probability of a future cardiovascular disease occurrence, such as heart attack or stroke, El Khoudary said.