Heart Health and Cardiovascular Risk in Menopause

Cardiovascular health during and after Menopause.

As a general rule, women have a lower risk of cardiovascular disease compared to men. This, however, all changes once a woman transitions through Menopause. Keep reading to get the facts on your risk of cardiovascular disease as we age and go through Menopause, why we experience these changes and what you can do to keep your cardiovascular system healthy!

What is the risk?

It is widely recognised that premenopausal women have a lower risk of heart disease compared to their age-matched male counterparts. While all of the reasons for these differences are unclear, it is thought that women’s lower fasting blood glucose levels (blood sugar levels) and better lipid (cholesterol) profile may play a role. This may be part, due to the higher levels of Estrogen in women. Estrogen is cardioprotective, meaning it plays a role in maintaining the health of our cardiovascular system. We’ll delve a little deeper into what this means below.

As you transition through Perimenopause to Post Menopause, your risk of heart disease increases. In Australia, over 500 million women are living with some form of heart disease or have had a stroke, with the majority being older women. Statistics also show that cardiovascular death rates increase with age.

Why does our risk go up after menopause?

As we learnt in one of the previous She Community blogs, blood glucose levels are affected as we transition into Menopause. Due to the lowering levels of Estrogen and increase in abdominal fat we are more likely to become insulin resistant. This in turn causes our blood glucose levels to rise. When our glucose levels are high for prolonged periods, the vessels and nerves that control our heart become damage, therefore increasing your risk of cardiovascular disease.

The same can be said for our cholesterol levels. Again, the decline in estrogen causes an increase in our LDL cholesterol (the ‘bad’ cholesterol) and a decrease in HDL (the ‘good’ cholesterol). Increases in cholesterol can contribute to a build up of fatty deposits in our arteries, which can affect the flow of blood. These fatty deposits can also break off and travel through your arteries in the form of a clot. Clots can lead to a heart attack or a stroke.

Another factor to consider is our muscle mass. As we age, our muscle mass naturally declines. This is further exacerbated by, you guessed it, the decline in Estrogen associated with Menopause! Lower muscle mass can mean an increase in blood glucose levels, increased cholesterol, increased inflammation and arterial stiffness. All of these things increase your risk of cardiovasular disease.

What can you do to keep your cardiovascular system healthy?

One of the most important things that you can do to protect your cardiovascular health is to do regular exercise! Aerobic exercise (the type of exercise that gets your heart rate and breathing rate up) has been repeatedly shown to improve our cardiorespiratory fitness. The better your cardiorespiratory fitness, the lower your risk of developing a whole range of chronic health conditions, including cardiovascular disease.

This is because aerobic exercise improves your glucose levels, cholesterol levels, helps to manage blood pressure and helps in the maintenance of a healthy body weight, all things that lower your overall risk of cardiovascular disease and become increasingly important as our levels of Estrogen reduce throughout menopause.

The other really important type of exercise that needs to be included is strength exercises. Also known as resistance exercise, this type of exercise helps to strengthen our muscles and bones. Not only does strength exercises help to increase our muscle mass, it contributes to lowering blood glucose levels and improves your blood lipid profile. Strength exercise is also really important for maintaining our bone density as we age.

Recommendations

Ideally, you should be completing both aerobic and strength exercise regularly. The combination of both types of exercise are more effective than one type alone, particularly for lowering your risk of cardiovascular disease.

Aerobic Exercise – Aim to do some type of aerobic exercise that increases your heart and breathing rate most days. This can include brisk walking, running, swimming, cycling, dancing or paddling. While 30 minute is an ideal amount to aim for each day, start with smaller bout of 10 minutes if you are new to exercising.

Strength Exercise – Aim to do exercise that aims to strengthen your muscles 2 to 3 times a week. These are typically exercises that are repetitive in nature and make your muscles work against resistance. You can use your own body weight as well as weights or resistance bands. Aim to include all the major muscle groups in your body including your arms, legs, back and abdominals.

“Aerobic AND strength exercise is the best way to keep you healthy as you transition through menopause.”

If you are unsure where to start or have any pre-exiting conditions or injuries, it is an excellent idea to speak to an exercise professional, such as an Exercise Physiologist. Exercise Physiologists are the experts in exercise, with an in-depth knowledge of how to prescribe the best type of exercise for you and your situation. Click here to find an Exercise Physiologist near you.

References

1. Fappi, A., & Mittendorfer, B. (2020). Different physiological mechanisms underlie an adverse cardiovascular disease risk profile in men and women. Proceedings of the Nutrition Society, 79(2), 210-218.

2. Australian Institute of Health and Welfare. (2019). Cardiovascular disease in women. Canberra: AIHW.

3. Nair, A. R., Pillai, A. J., & Nair, N. (2021). Cardiovascular changes in menopause. Current cardiology reviews, 17(4).

4. Xiang, D., Liu, Y., Zhou, S., Zhou, E., & Wang, Y. (2021). Protective effects of estrogen on cardiovascular disease mediated by oxidative stress. Oxidative medicine and cellular

longevity, 2021, 1-15.

5. Srikanthan, P., Horwich, T. B., & Tseng, C. H. (2016). Relation of muscle mass and fat mass to cardiovascular disease mortality. The American journal of cardiology, 117(8), 1355-1360.

6. Damluji, A. A., Alfaraidhy, M., AlHajri, N., Rohant, N. N., Kumar, M., Al Malouf, C., ... & Goyal, P. (2023). Sarcopenia and cardiovascular diseases. Circulation, 147(20), 1534-1553.

7. https://pubmed.ncbi.nlm.nih.gov/36928171/

8. Damigou, E., Kouvari, M., & Panagiotakos, D. (2023). The role of skeletal muscle mass on cardiovascular disease risk: An emerging role on modulating lipid profile. Current Opinion in Cardiology, 38(4), 352-357.

9. Liang, M., Pan, Y., Zhong, T., Zeng, Y., & Cheng, A. S. (2021). Effects of aerobic, resistance, and combined exercise on metabolic syndrome parameters and cardiovascular risk factors: a systematic review and network meta-analysis. Reviews in cardiovascular medicine, 22(4), 1523-1533.