Menopause, Cholesterol, And Cardiovascular Disease
Cardiovascular disease (CVD) is a leading cause of death in both men and women, but the severity of the problem in women is often underestimated, less likely than men and women to benefit from interventions, less likely to participate in clinical trials, and poorer outcomes. The purpose of this paper is to explore the severity of CVD problems in women, summarize the physiology and influence of menopause, discuss the relationship between menopause and CVD risk factors, and provide suggestions for reducing the risk of CVD in postmenopausal women.
The impact of menopause on CVD (Cardiovascular Disease)
Being overweight is a major risk factor for cardiovascular disease and is a growing problem in Western countries. Until the age of 45, men are more likely to be obese than women, but after that the trend is reversed. During menopause, and even after the first year after menopause, the distribution and storage of fat in women shifts from the hips to the waist, a trend more similar to the change in visceral fat storage in men’s abdomens. These patterns are often referred to as the “pear” or “apple” pattern, and the apple pattern is associated with increased risk. The exact mechanism by which CVD.5 deficiency leads to changes in body weight and fat distribution is not known, but relative excess androgens (androgens are still produced by the ovaries after menopause). Changes in leptin and thyroid function are thought to be involved.
There is no doubt that increased cholesterol is a major risk factor for cardiovascular disease. Menopause is associated with a progressive increase in total cholesterol, including increases in low-density lipoprotein (LDL), lipoprotein-α, and triglycerides, as well as a decrease in high-density lipoprotein (HDL).7-9 Total cholesterol levels in women peak between the ages of 55 and 65 years, approximately 10 years later than the observed peak in men.
Cholesterol-lowering medications reduce the risk of heart disease in both men and women, but women are thought to be at higher risk than men and a higher percentage of women are not effectively treated. A recent survey showed that only a quarter of women associated menopause with high cholesterol levels, indicating a lack of awareness of the need to consider cholesterol control during menopause.
Smoking is one of the major risk factors for cardiovascular disease in both men and women, but the risks associated with smoking are systematically higher in women than in men. Although smoking rates are generally higher in men than in women, significant and encouraging declines in smoking rates in men are uncommon in women, but there is an increasing trend in smoking rates in younger women.
Diabetes is increasing in both men and women, with changes in insulin secretion and insulin sensitivity after menopause accounting for the increase in women. Women have a higher risk of dying from diabetes-related cardiovascular disease than men: in the 20-year Framingham Study, the risk of dying from cardiovascular disease was 3.3 times higher in women with diabetes than in women without diabetes, but only 1.7 times higher in men without diabetes.
An increase in these risk factors can lead to a 4-fold increase in a woman’s risk of cardiovascular disease in the first 10 years after menopause.
Managing the risk of cardiovascular disease during menopause
As menopausal symptoms develop, women and their doctors and nurses need to take a long-term view and consider risk factors for bone and heart health, not just symptoms. The World Health Organization (WHO) estimates that 80% of cardiovascular diseases can be prevented through changes in diet and lifestyle. In fact, in a recent European survey, 73 percent of people said they would be willing to treat menopausal symptoms through proper diet and lifestyle.
However, for women experiencing troublesome menopausal symptoms, it may be necessary to monitor symptoms before making major dietary and lifestyle changes; however, this discussion needs to take place sooner rather than later, and the fact is that changes such as losing weight, quitting smoking and increasing physical activity can actually reduce symptoms while possibly helping to provide long-term health benefits. Women should eat a healthy diet (five portions of fruit and vegetables every day, with whole grains and high-fiber foods, reduce saturated fat, increase the monounsaturated and polyunsaturated fats, and to reduce salt), increased physical activity, get at least 30 minutes of moderate exercise five days a week (fast walking and strenuous exercise has the same effect.) It should be a goal that encourages you to maintain a healthy weight.
Quitting smoking is an important consideration for postmenopausal women, as quitting not only improves heart health, but also bone health. A blood pressure check is often part of an assessment for menopause and is also part of a test for women taking hormone replacement therapy. Increased exercise and weight loss can help lower blood pressure, but medication is usually required. Since cholesterol levels rise with menopause, cholesterol control should also be considered as part of menopause evaluation; a 10 percent reduction in LDL cholesterol has been shown to reduce the risk of cardiovascular disease by 20 percent.
Specific dietary approaches to lowering cholesterol
There is a lot of interest in specific diets that lower cholesterol levels, and there are a number of foods with active ingredients that have been shown to lower LDL cholesterol. Active ingredients include phytosterols (added to foods such as margarine, dairy products and yogurt), beta-glucan (a soluble fiber found in oats), and soy protein (found in soy products). Take the beta-glucan found in oat grains, for example. Available data suggest that 3 to 5 grams of beta-glucan per day can reduce cholesterol by 2 to 5%. In addition, eating 25 grams of soy protein a day as part of a low-fat diet can lower cholesterol by 3-5%.
Remember, Cholesterol-lowering drugs reduce the risk of heart disease in both men and women, but women are considered at higher risk than men, and a higher proportion of women are not effectively treated. A recent survey showed that only a quarter of women go through menopause with high cholesterol, suggesting a lack of awareness of how to control cholesterol during menopause.