How does menopause affect cardiovascular health?

In one of her latest medical articles here, distinguished menopause specialist, Dr Theodora Kalentzi, discusses the relationship between cardiovascular disease and menopause. 

In what ways can menopause affect cardiovascular health?

Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality worldwide, and its relationship with menopause is of particular concern for women's health. Menopause, typically occurring between the ages of 45 and 55, marks the end of a woman's reproductive years and is characterised by the cessation of menstrual cycles and a significant decline in oestrogen levels. This hormonal shift has profound effects on cardiovascular health.

Oestrogen is known for its cardioprotective properties. It helps maintain flexible blood vessels and supports favorable cholesterol levels by increasing high-density lipoprotein (HDL) and reducing low-density lipoprotein (LDL). With the onset of menopause, the decrease in oestrogen levels disrupts this balance, leading to an increased risk of CVD. Postmenopausal women often experience elevated LDL cholesterol and triglyceride levels, contributing to atherosclerosis—the buildup of fatty deposits in the arteries—which can lead to heart attacks and strokes.

Moreover, menopause is associated with changes in body fat distribution, with an increase in central adiposity (abdominal fat), which is a risk factor for insulin resistance and type 2 diabetes—both significant contributors to cardiovascular disease. Additionally, blood pressure tends to rise after menopause, further elevating the risk of CVD.

Hormone replacement therapy (HRT) has been a topic of extensive research and debate concerning its role in mitigating CVD risk post-menopause. While HRT can alleviate menopausal symptoms and improve quality of life, its impact on cardiovascular health is complex and not uniformly beneficial. Some studies suggest that HRT may lower the risk of CVD if started soon after menopause, but other research indicates potential risks, particularly when initiated later. Therefore, the decision to use HRT must be individualised and made in consultation with a healthcare provider, considering the woman’s overall health, risk factors, and personal preferences.

To mitigate the increased risk of cardiovascular disease post-menopause, lifestyle modifications are crucial. These include maintaining a healthy diet rich in fruits, vegetables, whole grains, and lean proteins; engaging in regular physical activity; avoiding smoking; moderating alcohol intake; and managing stress. Regular medical check-ups are also essential to monitor and manage blood pressure, cholesterol levels, and other cardiovascular risk factors.