AHA Urges More Attention To Heart Risks During Menopausal Transition

Women going through the menopausal transition (MT) face "accelerating" risk for cardiovascular disease (CVD), underscoring the importance of monitoring their health and potentially intervening early, according to a new scientific statement from the American Heart Association (AHA).

"This is really the time that they should focus on their health and lifestyle changes as much as they can," lead author Dr. Samar El Khoudary of the University of Pittsburgh Graduate School of Public Health told Reuters Health by phone. "Women still are not aware of this to the level we want, and we are hoping that the health care providers would help in making this clear to women."

Data on how well women are doing in midlife when it comes to healthy habits are "extremely limited," Dr. El Khoudary added, although she noted that one study found just 7% were meeting physical-activity guidelines and less than 20% consistently ate a healthy diet.

Meanwhile, women going through the MT and their physicians lack awareness of the importance of this time for preventing CVD, the author noted. She cited a 2017 study that found nearly half of women aged 25 to 60 didn't know heart disease is the leading killer of women, and just 22% of primary-care physicians and 42% of cardiologists felt "extremely well prepared" to assess women's CVD risk.

The last AHA guidelines on CVD prevention in women, published in 2011, did not address the MT as a risk factor, Dr. El Khoudary and her colleagues note in the statement, published in Circulation. Longitudinal studies over the past two decades have found that adverse changes in body-fat distribution, lipid and lipoprotein levels and vascular health occur during the MT, they add, all of which can contribute to increased risk of CVD after menopause.

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Natural menopause occurs at a median age of 50, with menopause before age 40 considered premature and at age 40-45 classified as early, the authors explain. The MT is characterized by declines in estradiol and increases in follicle-stimulating hormone levels, they add, although these changes don't follow a uniform pattern for all women.

Vasomotor symptoms affect about 80% of women in midlife, they note, and have been linked to CVD. Sleep problems, a frequent problem for many women during the MT, are also associated with CVD and worse cardiovascular health.

A woman's natural age at menopause is a marker for overall health and somatic aging, the authors note, while there is evidence that CVD risk factors may contribute to earlier menopause. Smoking is also associated with earlier menopause.

Women who have menopause due to bilateral oophorectomy (BSO) and don't receive estrogen therapy are at greater risk of CHD than those who undergo natural menopause, the authors note, with higher risk for those who undergo BSO at younger ages. North American Menopause Society guidelines support menopausal hormone therapy (MHT) for women who have premature or early menopause due to natural or surgical causes, they add.

The authors also urge more research on MHT, noting that starting hormone therapy before age 60 or within 10 years of menopause has been linked to lower CVD risk.

They note that data on primary and secondary CVD prevention for women is scarce, and call for more research to support evidence-based guidelines. "We feel that this at-risk population is still not involved in clinical trials of intervention strategies as it should be," Dr. El Khoudary said.

—Anne Harding

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