THE SILENT SHIFT: Menopause Increases Heart Disease Risk, Experts Warn

By Mariela Angella Oladive

Before menopause, the ratio of women to men experiencing heart attacks was about 1:40, meaning that for every woman who suffered a heart attack, 40 men did.

However, this drastically changes during menopause, narrowing the ratio to 1:3, Dr. Lourdes Ella Santos, a preventive cardiologist, said during the Philippine Heart Association – Philippine College of Cardiology (PHA-PCC) midyear convention at the Iloilo Convention Center on February 1.

Women are urged to take their heart health seriously, especially as they approach midlife.

UNDERSTANDING THE RISK

Menopause, which typically occurs between ages 45 and 55, marks the end of a woman’s reproductive years and is characterized by a decline in estrogen and progesterone levels.

While it is often associated with symptoms like hot flashes and mood swings, Dr. Santos stressed that a more pressing concern is the rising risk of cardiovascular disease (CVD), particularly coronary heart disease (CHD).

“By the time women reach menopause, the risk of heart disease peaks, and the gap between men and women begins to close,” she said.

“This means something is happening in this age group that predisposes women to developing CVDs. This is the stage where women undergo hormonal fluctuations.”

Studies have shown that female hormones, especially estrogen, offer cardioprotective benefits.

The decline in estrogen levels during menopause diminishes these protective effects, leading to adverse changes in cardiovascular risk factors.

Dr. Santos highlighted that heart disease risk does not begin at menopause but starts increasing five to 10 years earlier, during the transition phase when menstrual cycles become irregular.

She cited findings from the Study of Women’s Health Across the Nation (SWAN), which revealed that arterial stiffness, a key indicator of cardiovascular risk, rises by about 0.9% one year before the final menstrual period and surges by 7.5% in the following year.

Another critical measure, carotid intima-media thickness (CIMT), which assesses plaque buildup in arteries, was found to be significantly higher in postmenopausal women compared to premenopausal women.

EARLY SCREENING AND PREVENTION

Dr. Santos emphasized the importance of early screening, urging women to take proactive steps before reaching menopause.

She stressed that as early as age 40, doctors should assess risk factors such as hypertension or diabetes during pregnancy, as these conditions contribute to increased cardiovascular risk later in life.

To help identify at-risk individuals, she presented a framework for assessing atherosclerotic cardiovascular disease (ASCVD) risk in women.

The assessment includes evaluating medical history, pregnancy complications, family history, biomarkers, and lifestyle factors.

She also underscored the need for preventive strategies, recommending lifestyle modifications that can significantly lower cardiovascular risks.

These include adopting a heart-healthy diet, such as the Mediterranean diet, engaging in regular physical activity, and monitoring key biomarkers like blood pressure, cholesterol, blood sugar, and body mass index to detect early warning signs.

She urged women to view midlife as a “critical window” for reducing cardiovascular risks.

“This is the time to act,” she said.

“By addressing risks early, we can significantly lower the chances of heart attacks and strokes in postmenopausal women.”