Health Conditions

Protect Your Heart Before Menopause

What’s the number one cause of death in American women? If you guessed cancer, try again. Contrary to popular opinion, cardiovascular disease kills more women than all cancers combined. What’s even scarier is that the majority of cardiovascular events occur after menopause, because that’s when a woman’s risk rapidly increases. But you can take preventative measures to protect your heart. In fact, 80 percent of cardiac events can be prevented with education and lifestyle changes, according to the American Heart Association.

Women vs. Men

Men and women have different symptoms of heart disease, and once women exhibit heart disease, the process and outcome tend to be worse than those of men, says Dr. Howard Hodis, Director, Atherosclerosis Research Unit at Keck School of Medicine at the University of Southern California. He is also a board member for the North American Menopause Society (NAMS), which recently had its annual meeting at which he presented “new updates” during the plenary session on cardiovascular disease in women.

Dr. Hodis explains the differences are due in part to a sex-biased approach, resulting in delayed or missed diagnosis and delayed treatment. “There is also a clear sex-specific response to therapies, of which many health-care providers and women are unaware,” he adds.

Comparisons between men and women strongly suggest that an increased risk of heart disease after menopause is due to loss of ovarian function and the major hormone that the ovaries produce, estrogen. “With a reduction in estrogen and other hormones like testosterone,” says Dr. Hodis, “there are all kinds of downstream effects resulting from the lack of these hormones that increase a woman’s risk for cardiovascular disease.”

Dr. Hodis shared some key statistics during his presentation, such as 63 percent of women who die suddenly of coronary heart disease had no previous symptoms. Forty-four percent of women will die within a year after having a heart attack. The American Heart Association (AHA) says that 90 percent of women have one or more risk factors for heart disease or stroke, and heart disease affects women of all ethnicities.

Why Menopause?

The decline of estrogen after menopause is key. Estrogen protects the artery lining, so without it, the arteries are more susceptible to damage, says Dr. Suzanne Steinbaum, spokesperson for Go Red for Women, the AHA’s national movement to end heart disease and stroke in women. “As a woman ages and loses this estrogen, the arteries get stiffer and there is an increase in blood pressure,” she says. “Also, the LDL (‘bad’) cholesterol goes up and the HDL (‘good’) cholesterol goes down. These factors all can increase the risk.”

Not only do postmenopausal women have a greater risk of heart disease, but especially so 10 years after menopause.

Risk Factors

Of course bad habits like smoking speed up the process, and maintaining normal blood pressure slows it down. As Dr. Steinbaum reminds all women, “It is possible to train for menopause like you are training for a marathon!” Because the average age of menopause is 51 but can be as early as 35 or as late as 60, it’s never too early to protect the heart, says Dr. Mary Jane Minkin of Yale, who is an active member of NAMS and is a certified menopause clinician.

One of the first steps is to schedule a well visit with your primary care provider to determine and understand your risks, and make an appropriate plan. Make sure this health-care provider is seen regularly and is educated on the topic and savvy to all the preventative measures currently available, says Dr. Hodis.

Protect Your Heart Before Menopause2


A diet that is filled with fruits and vegetables, legumes, nuts, whole grains, low-fat dairy, and lean meats with minimal sugar is the healthiest way to eat, says Dr. Steinbaum. This Mediterranean-style diet also includes oil and fish, with limited meat, cheese, and sweets.

If you have high blood pressure, lower your salt intake such as in the DASH (Dietary Approaches to Stop Hypertension) diet, recommends Dr. Alice Kim, cardiologist at Brigham and Women’s Cardiovascular Associates are Care New England and co-director of Women’s Heart Health of Women & Infants.

By watching your food intake this way, you’ll help lower cholesterol and risk of obesity, along with the risk of heart disease.

But Dr. Minkin emphasizes that there is no particular diet that is superior to another in terms of losing weight. “Whatever works for you!” she says. “Many studies have shown that there really isn’t one particular fabulous diet – it’s whatever you can stick to that will work the best.”

Moderation of dietary intake appears to be as effective as any “diet,” however, says Dr. Hodis. Recommendations include total fat intake of less than 30 percent distributed among the three major fat types: 10 percent saturated fat, 10 percent unsaturated fat, and 10 percent of monounsaturated fat and cholesterol intake of less than 300 mg daily. He does point out that current evidence indicates that fat intake is the most important dietary factor.

Weight is indeed one of the most important risk factors for heart disease, Dr. Hodis says. Ideal body weight should be the goal, but even overweight or obese women who exercise fare better than women of similar weight who don’t exercise, he says.


The AHA recommends at least 150 minutes a week of moderate intensity exercise or 75 minutes of intense exercise to keep the arteries healthy. Dr. Minkin’s view is: In general, the more, the better. If you can exercise every day, that’s great. Even if you have 10 minutes to exercise, do it. Ten minutes three times a day is as good as 30 consecutive minutes, she says. Exercise is also good for stress control.


Indeed, controlling your stress is important, because “stress leads to elevated blood pressure and elevated stress hormones that stress the cardiovascular system,” says Dr. Hodis.

Managing stress and finding ways to enjoy life means “engaging in activities you enjoy, spending time with people you love, and laughing with abandonment,” says Dr. Steinbaum. They all make a difference.


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Lisa A. Goldstein

Lisa A. Goldstein

Lisa A. Goldstein is a freelance journalist with a Master’s in Journalism from UC Berkeley. She has two kids, a love of books and sweets, and wishes her metabolism is what it used to be.