Menopause highlighted as a risk factor for cardiovascular disease

To mark World Menopause Day 2023, the International Menopause Society (IMS) has published research highlighting female-specific cardiovascular disease (CVD) risk factors.

The research paper Reproductive milestones across the lifespan and cardiovascular disease risk in women, notes the growing number of recognised milestones during a female’s life which are associated with increased risks for CVD. It also highlights the need for recognition of these risk factors so women and their healthcare providers can be informed and motivated to prevent cardiovascular disease developing.

What is cardiovascular disease?

Cardiovascular disease (CVD) is a general term for conditions affecting the heart or blood vessels. It includes coronary heart disease, stroke and vascular dementia. In spite of advances in diagnosis and treatment, CVD remains the number one cause of death in women throughout the world.

According to the World Heart Federation, CVD is the most common non-communicable disease globally, responsible for nearly 20.5 million deaths per year. It’s responsible for 35% of deaths in women each year – more than 13 times the rate of breast cancer and greater than all cancers combined.

In the UK, around 3.6 million women are living with heart and circulatory diseases, and heart disease kills more than twice as many women in the UK as breast cancer.

Despite these stark figures, the IMS research found that the perception of risk of CVD in women has declined in recent years. In 2019, versus a decade earlier, women in the US were 74% less likely to identify heart disease as a leading cause of death. There are concerns that this is resulting in fewer preventative measures being taken to avoid developing the disease. 

Risk factors for cardiovascular disease in women

Risk factors for CVD in women can include medical conditions such as hypertension, diabetes or lipid elevation (high levels of fats in the blood) along with lifestyle-related issues including obesity, unhealthy diet, sedentary lifestyle, smoking and exposure to air pollution. Psychosocial factors such as depression and anxiety, abuse or intimate partner violence can also increase the risk of developing CVD.

In publishing this research paper, the IMS aims to raise awareness of additional CVD risk factors which are sex-specific. They include conditions related to menstruation, adverse pregnancy outcomes and menopause.

The IMS paper advises the assessment of women across their lifespan to reduce CVD risks in later life. For example, the identification of abnormal menstrual patterns in adolescence may improve early identification of potential adult health concerns. Menstrual cycle characteristics related to increased cardiovascular risk include a woman having a premature or late first menstrual period, polycystic ovarian syndrome, and menstrual cycle irregularity.

Adverse pregnancy outcomes can include preeclampsia, gestational diabetes, premature birth and low birth weight. The IMS paper found that women with recurrent preeclampsia during pregnancy experienced a three-fold rise in the risk of developing heart failure.

High blood pressure or diabetes during pregnancy or menopause and experiencing premature menopause (before the age of 40) have all been recognised as CVD risk factors. 

Health changes associated with menopause have also been associated with increased risk of CVD in women. These include alterations in muscle composition and metabolism, menopause symptoms (particularly hot flashes, sleep disturbances and depression). 

Minimising the risk of cardiovascular disease in women

Despite these well-documented risk factors, the IMS paper voices concerns that sex-specific risks are rarely incorporated into medical interventions for minimising the risk of CVD in women.

The IMS aims to raise awareness and encourage the consideration of sex-specific risk factors of CVD in women. In particular, it is encouraging healthcare systems and healthcare professionals globally to target female-specific and under-recognised CVD risk factors through screening, detection and early intervention. 

Dr Cynthia Stuenkel, author of the IMS paper and Clinical Professor of Medicine at the University of California, said:

“Cardiovascular risk represents a lifetime of choices and experiences, but menopause offers the opportunity of a single point in time to step back, take stock, and do all you can toward promoting future cardiovascular health for the rest of your life.”

Professor Nick Panay, President of the International Menopause Society, added: 

“There is compelling and emerging evidence that the cardiovascular health of women at midlife and beyond reflects reproductive events over their lifespan. This includes issues related to the menstrual cycle, complications during pregnancy, and the effects of natural and premature menopause.

“During midlife, there is a great opportunity for most women, with the support of their healthcare providers, to improve their cardiovascular health and their future quality of life through healthy lifestyle choices such as following a well balanced diet, exercising, stopping smoking and moderating alcohol consumption. 

“It’s time to make women’s cardiovascular health a priority.”

The IMS has also produced cardiovascular health resources for women for World Menopause Day.  

Photo by Centre for Ageing Better on Unsplash