Protect Your Postmenopausal Heart

A woman's risk of heart disease increases after menopause. Here's how to keep your ticker in tip-top shape.

By The North American Menopause Society
hands holding heart disease menopause picture
Photograph: Marcela Barsse

Many women think of heart disease as a man’s disease. In reality, cardiovascular disease (CVD) remains the leading cause of death for women age 65 and older and the second leading cause of death among women ages 45 to 64 in the United States and Canada. It includes many conditions, such as myocardial infarction, congestive heart failure, hypertension, stroke and valvular heart disease. More women than men die from heart disease. This may be because it is detected at later stages in women than in men as women’s symptoms can be different than men’s.

Menopause and CVD risk

After menopause, however, a woman’s risk increases, leading some to suggest that estrogen provides cardioprotective benefits. The extent to which lowered estrogen levels may lead to an increase in CVD risk is not clear, but research continues, including investigations into whether hot flashes are related to a woman’s CVD risk.

Risk factors

Major risk factors associated with CVD in women include:

  • Age 55 or older
  • Cigarette smoking
  • Sedentary lifestyle
  • Hypertension
  • Diabetes
  • African-American heritage
  • High cholesterol
  • Poor diet, obesity, metabolic syndrome
  • Family history of CVD
  • Stress
  • Premature menopause, especially if reached before age 35



Your clinician may use the Framingham Risk Score to estimate your 10-year risk for developing CVD events. Points are assigned to various levels of risk, which are then translated into the 10-year estimated risk for CVD events. Risk factors included are age, cholesterol levels, blood pressure, ongoing treatment for hypertension and cigarette smoking.

Maintaining heart health

Women with risk factors for CVD should initiate lifestyle changes to decrease their overall risk:

Don’t smoke. Smokers are considerably more likely to have a heart attack than nonsmokers. But there’s good news. When a woman stops smoking, no matter how long or how much she smoked, her risk of heart disease drops rapidly. There are many other good reasons not to smoke. These include increased vitality, improved appearance, and decreased risk of osteoporosis and cancer of the cervix, lungs, mouth and throat. There are numerous programs and aids available to help women quit smoking. A good place to start is

Control blood pressure. Hypertension (high blood pressure) is defined as an arm cuff reading greater than 140/90 mm Hg. It is preferable to keep blood pressure below 120/80.Even mild elevations can double the risk of stroke or heart attack. High blood pressure becomes more common as women age. In fact, more than 50 percent of all women over age 55 are affected. Black women are especially susceptible. Regular blood pressure testing is important because high blood pressure rarely causes symptoms. High blood pressure can be controlled by eating a healthy diet, limiting salt and alcohol, exercising on a regular basis and reducing stress.

Control cholesterol. Bringing cholesterol levels to within normal limits has a significant impact on heart disease risk. Total cholesterol should be less than 200 mg/dL. Other goals include maintaining high levels of high-density lipoprotein cholesterol (HDL, the “good cholesterol”) and low levels of low-density lipoprotein cholesterol (LDL, the “bad cholesterol”). Target levels for HDL are at least 50 mg/dL; for LDL, optimal levels are less than 100 mg/dL, even lower for women with heart disease risks. To lower your cholesterol, be sure to maintain a healthy weight, exercise, and make HDL fats and fiber part of your diet.

Exercise regularly. A sedentary lifestyle is almost as great a risk factor for heart disease as smoking because of diminished circulation and weight gain. Regular physical activity promotes heart health and has been shown to reduce the risk of heart attacks in women. For heart health, all women should aim for at least 30 to 60 minutes of moderate intensity aerobic exercise (brisk walking, for example) most days—provided that this amount is first approved by their healthcare provider.

Improve nutrition. Choose a diet that includes:

  • A variety of fruits and vegetables
  • Whole grains
  • Low- or nonfat dairy products, soy food products
  • Fish
  • Legumes
  • Sources of protein low in saturated and trans fat (such as poultry, lean meats, and plant sources like beans, seeds and nuts)


Avoid foods that have:

  • A high amount of cholesterol
  • A high amount of saturated and trans fat
  • A high amount of salt (limiting salt may help control high blood pressure)

Additionally, alcohol consumption should not exceed one or two drinks a day, and no more than seven per week.

Don’t use hormone therapy to prevent heart disease.Previously, hormone therapy (HT) was thought to reduce the risk of heart disease, primarily because of its beneficial effects on cholesterol. However, more recent studies have shown that some types of HT increase the risk of heart disease, blood clots, and stroke. Recently, there has been debate on whether the age at which a woman begins HT makes a difference, as some studies show heart benefits when starting HT closer to menopause. It appears in some studies that only when a woman with a risk of heart disease starts HT after menopause that problems could arise. Current government recommendations are cautious, stating that estrogen should not be used to prevent heart disease. Also, a woman with heart disease should not begin HT without careful consideration of the risks.

For more tips on how to transform the menopause experience into a positive one, visit the NAMS website.

Next: Make Yourself Immune to Menopausal Stress

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First Published Wed, 2011-08-03 16:51

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