Report on latest menopause science looks at heart risks

The years in a woman's life leading to menopause are a critical time for preventing heart disease, according to a new report that summarizes the latest science on this midlife transition and its connection to cardiovascular risks.

The most recent data on the years just before menopause – a time when cardiovascular risks accelerate – includes a look at the timing of hormone replacement therapy, the age when menopause begins and the lifestyle factors that affect a woman's risk during that time.

"Over the past 20 years, our knowledge of how the menopause transition might contribute to cardiovascular disease has been dramatically evolving," Samar R. El Khoudary, an associate professor of epidemiology at the University of Pittsburgh's Clinical and Translational Science Institute, said in a news release. She led the writing committee for the American Heart Association's scientific statement, published Monday in its journal Circulation.

Monitoring a woman's health and lifestyle is especially important in midlife to prevent heart disease and stroke, and "health care professionals may consider an aggressive, prevention-based approach for women during this stage in their lives," El Khoudary said.

The change from the reproductive to the non-reproductive phase of life is marked by changes in menstruation, and it typically begins when women are in their late 40s to early 50s.

Before this transition, women produce estrogen, the female sex hormone, which also may protect the heart. But during natural menopause, the ovaries stop producing as much estrogen. This also can happen surgically, after a partial or full hysterectomy, which includes removal of one or both ovaries.

Some research, according to the new statement, has shown there are potential cardiovascular benefits from certain combinations of hormone replacement therapy when initiated in early menopause. Some studies also have shown the therapies can decrease the risk of Type 2 diabetes and protect against bone loss. Further research is needed to evaluate the role of other hormone therapies and how long they impact health, the statement authors said.

In addition to summarizing hormone therapy research, the statement includes these highlights:

– The characteristic hot flashes and night sweats of menopause are associated with worse levels of cardiovascular disease risk factors. Depression and sleep disturbances, linked in some studies to an increased risk of heart disease, are also common among women during menopause.

– Women who experience menopause at an earlier age have a higher risk of heart disease. The age menopause begins can be influenced by length of menstrual cycle, worse cardiovascular health during reproductive years and socioeconomic factors. Race and ethnicity also play a role, with many Hispanic and Black women experiencing menopause at younger ages.

– Physical activity and nutrition may affect the timing of menopause for all women. Women who drink little to moderate amounts of alcohol may have later onset of menopause, and cigarette smokers are likely to start about a year earlier than nonsmokers.

– Only 7.2% of women in menopause get the recommended amount of physical activity, and fewer than 20% consistently maintain a healthy diet.

– Cholesterol levels, the risks for developing metabolic syndrome and changes in the structure of blood vessels all appear to increase with menopause, beyond the effects of normal aging. Metabolic syndrome is when a person has three or more of the following: abdominal obesity; high triglycerides; low "good" HDL cholesterol; high blood pressure or high blood sugar.

While healthy lifestyle changes are critical to maintaining a healthy heart, there is a dearth of research testing these interventions specifically during the menopause transition, said Dr. Matthew A. Allison, vice chair of the statement writing committee. He also is a professor and chief of the Division of Preventive Medicine in the University of California San Diego Department of Family Medicine and Public Health.

"Similarly, we need randomized clinical trials of therapeutic interventions, like cholesterol-lowering medications and menopause hormone therapy, in women who are transitioning through menopause," Allison said in a news release. "This at-risk population has not been the focus of previous clinical trials, thus leaving us with questions about how the results from these studies might apply to women during this earlier phase of menopause."

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