Pop quiz, ladies! What’s the number one killer of women? Breast cancer? Ovarian cancer? Stroke?
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
Wrong. It’s heart disease. Commonly viewed as a “man’s disease,” heart disease causes about 25 percent of women’s deaths each year in the United States. And the older you are, the more likely you are to get it.
After menopause, your risk for heart disease increases dramatically. That’s because your heart becomes quite vulnerable when your ovaries stop making estrogen, especially if you have other heart disease risk factors, such as diabetes, smoking and obesity.
Estrogen: Keeper of your heart
Estrogen does a lot of good for your cardiovascular system. It can:
- Decrease LDL (bad) cholesterol
- Increase HDL (good) cholesterol
- Dilate blood vessels
- Protect against blood vessel injury
- Prevent plaque from building up in arteries
- Aid the formation of new blood vessels
Evidence shows that estrogen may play a protective role in young women. Premenopausal women rarely develop coronary artery disease.
So, it makes sense that when estrogen levels drop during menopause, your heart loses a big supporter. The main question in recent years — and a major cause of confusion and controversy — has been whether hormone therapy can serve as a substitute.
Hormone therapy might help
In a nutshell: quite possibly.
For the last decade, the Women’s Health Initiative (WHI) trial and its researchers dominated the news on women’s hormonal health and cast research results in a negative and limiting way. Based on data from the WHI, the U.S. Preventive Services Task Force discouraged using hormone replacement therapy (HRT) for heart protection. The American Heart Association agreed, saying HRT should not be used to prevent or treat heart disease.
But last October, the results of a significant, long-term study from Denmark turned the tables. The study included 1,000 healthy women, ages 45 to 58. Some received HRT and some didn’t. Over 10 years, those who received HRT had the following positive results:
- Half the death rate compared to women not on HRT
- Fewer heart attacks
- Less heart failure
And the really big news: They had no increased risk of cancer, stroke or blood clot.
That study has been a game-changer. HRT is the only agent shown to reduce the rate of heart attack, death and heart failure in healthy, midlife women. Not even aspirin or cholesterol-lowering statins have done that.
So instead of continuing to prescribe the least amount of HRT for purely menopausal symptoms, we now can start considering HRT for its preventive health benefits.
Your best bet is a healthy lifestyle
We’ll continue to study the role of HRT in midlife women’s overall health. In the meantime, there are some sure ways to reduce your risk of heart disease during and after menopause. They’ll sound familiar because they apply to everyone at any age.
- Don’t smoke. Smokers have more than twice the risk of a heart attack than nonsmokers. Even one to two cigarettes a day greatly increase the risk of heart attack, stroke and other cardiovascular conditions. Nonsmokers who are constantly exposed to secondhand smoke also have an increased risk.
- Treat medical conditions. If you have diabetes, high cholesterol or high blood pressure, you are at a higher risk for heart disease. Work with your doctor to keep these conditions under control.
- Maintain a healthy body weight. The more you weigh, the harder your heart has to work to give your body nutrients. Research has shown that being overweight contributes to the onset of heart disease.
- Exercise throughout the week. The heart is like any other muscle — it needs a workout to stay strong. Exercising helps improve how well the heart pumps blood through your body. Try to do at least moderate exercise for at least 30 minutes a day, on most days.
- Eat a heart-healthy diet. Enjoy plenty of plant-based foods, such as fruit, vegetables, nuts and whole grains. Limit sodium, saturated fat, cholesterol, trans fat (partially hydrogenated fats) and refined sugar. Omega-3 fatty acids are good fats and come from tuna, salmon, flaxseed, almonds and walnuts. Monounsaturated fats also are good for you and are found in olive and peanut oils.
Midlife is the time to plan for your “second adulthood.” Don’t let menopause and dwindling estrogen get in the way. Ensure your own good health and vitality, starting with your powerhouse, your heart.
Speaking of Women’s Health