Heart Disease: Women and Heart Disease

The risk of heart disease in women increases with age. Heart disease is the leading cause of death in women over 40 years old, especially after menopause. Every year, more than 500,000 U.S. women die of heart disease. This translates to approximately one death every minute.

Why Are Women at Increased Risk of Heart Disease as They Age?

Menopause is a normal stage in a woman's life; it comprises any of the changes a woman experiences either before or after she stops menstruating. As menopause nears, the ovaries gradually produce less estrogen (a female hormone), causing changes in the menstrual cycle and other physical changes.

The most common symptoms of menopause are hot flashes, night sweats, emotional changes and changes in the vagina (such as dryness).

Menopause usually occurs naturally in women between ages 45 and 55. However, loss of estrogen can also occur if the ovaries are removed during surgery (such as during a total hysterectomy) or if a woman goes through early menopause.

Why Is Heart Disease Associated With Menopause?

The loss of natural estrogen as women age may contribute to the higher risks seen after menopause. Other factors that may play a role in postmenopausal risks include:

• Changes in the walls of the blood vessels, making it more likely for plaque and blood clots to form.
• Changes in the level of fats in the blood (LDL, or "bad" cholesterol increases and HDL, or "good" cholesterol decreases).
• Increases in fibrinogen levels (a substance in the blood that helps the blood to clot). Increased levels of blood fibrinogen are related to heart disease and stroke since it makes it more likely for blood clots to form, narrowing the arteries and reducing blood flow to the heart.

How Can Menopausal Women Reduce Their Risk for Heart Disease?

First and foremost, "traditional" risk factors should be addressed. Women with the lowest risk of heart disease are those who:

• Avoid or quit smoking.
• Lose weight and/or maintain their ideal body weight.
• Exercise for 30-40 minutes three to five times per week.
• Follow a diet low in saturated fat (<7% daily amount); low in trans-fat (partially hydrogenated fats such as margarine or shortening); and high in: fiber, whole grains, legumes (such as beans and peas), fruits, vegetables, fish and folate-rich foods.
• Treat and control medical conditions such as diabetes, high cholesterol and high blood pressure that are known risk factors for heart disease.

Can Hormone Replacement Reduce My Risk of Heart Disease?

For many years, research  was thought to show that hormone replacement therapy (HRT) could possibly reduce the risk of heart disease in women by replacing the estrogen lost during menopause.

More recent studies of women with existing heart disease have not shown benefits after 4 years of HRT use. In fact, data are showing that some forms of HRT may be harmful in these women.

Experts no longer recommend HRT to protect postmenopausal women against heart disease.

Reviewed by the doctors at The Cleveland Clinic Heart Center.