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Disease Risk Management
Menopause, Cholesterol and Cardiovascular Disease
a report by
Heather Currie
Associate Specialist Gynaecologist and Obstetrician, Dumfries and Galloway Royal Infirmary
with additional contribution from
Christine Williams
Professor of Nutrition and Dean, Faculty of Life Sciences, Reading University
Cardiovascular disease (CVD) is the leading cause of death in both men mood changes. Intermediate symptoms of vaginal dryness, irritation,
and women, yet the extent of the problem in women is frequently discomfort and bladder changes are very common and, although
underestimated and, compared with men, women are less likely to be discussed less often than hot flushes, are gradually being reported and
offered interventions, are less likely to be represented in clinical trials and treated a little more often than in the past. The long-term effect of
have a worse prognosis. This article aims to examine the extent of the menopause on the bones, with the lack of oestrogen leading to loss
problem of CVD in women, summarise the physiology and effects of of bone strength (and eventually osteoporosis) with an increased risk of
menopause, explore the link between menopause and CVD risk factors fracture, is fairly well known and frequently addressed. However, there is
and offer suggestions to reduce the risk of CVD in menopausal women. incredibly poor appreciation of the important long-term effects of the
menopause on the cardiovascular system.
Cardiovascular Disease in Women – How Big a Problem?
CVD is the leading cause of death in women after the menopause and in The Effect of Menopause on Risk of Cardiovascular Disease
fact more women die from heart disease and stroke than from the next
five causes of death combined, including breast cancer (see Figure 1).
1,2
Weight
Although many women perceive that one of the leading risks to their Being overweight is a significant risk factor for CVD and is an increasing
health is breast cancer, globally women are nine times more likely to die problem in the western world. Obesity is more common in men than in
of CVD than of breast cancer.
3
CVD is traditionally thought of as being a women before 45 years of age, but after this point the trend reverses.
problem of middle-aged men, but in fact CVD affects just as many During the menopause, and in fact starting within the first year of the
women as men – if not more – albeit on average a decade later (see menopause, there is a shift in fat distribution and storage in women from
Figure 2).
4
This delay is thought to be due to the protective effects of the hips to the waist, more resembling that of the abdominal visceral fat
oestrogen that occur in the years before the menopause. As oestrogen storage in men. These are often referred to as ‘pear’ and ‘apple’ shapes,
levels drop, often from the mid-40s onwards, the protective effect is lost the apple shape being associated with an increased risk of CVD. Waist
and changes occur that lead to an increased risk of heart disease in the circumference reflects this risk: women with a waist circumference
ensuing years. Figures from 2005 show that in Europe 55% of women >80cm have an increased risk of CVD, with even greater risk for those
died from CVD as opposed to 43% of men.
5
Sadly and surprisingly, whose waist circumference is ≥88cm.
5
The exact mechanism by which
awareness of this major health risk to women appears to be very low, oestrogen deficiency leads to weight gain and change in fat distribution
with a recent survey showing that only 31% of healthcare professionals is not clear, but is thought to be related to a relative excess of androgens
and 38% of women were aware that menopausal women are at an equal (post-menopausal ovaries still produce some androgens) together with
or greater risk of CVD than men, and that only 31% of women associate changes in leptin and thyroid function.
menopause with heart disease. The health risks that women were most
concerned about at menopause were physical menopausal symptoms, Blood Pressure
osteoporosis and breast cancer.
6
Hypertension is also a major risk factor for CVD, and after 45 years of age
more women than men develop hypertension.
4
The Role of Menopause
Menopause affects all women and occurs when the ovaries either Cholesterol
naturally stop producing oestrogen due to the decline and cessation of There is no doubt that raised cholesterol is a significant risk factor for
oocyte development and ovulation, which is essential for the CVD. Menopause is associated with a progressive increase in total
production of both oestrogen and progesterone, or when the ovaries
are removed or damaged by other therapies. The average age at natural
Heather Currie is an Associate Specialist Gynaecologist
menopause varies between countries and is affected by factors such as
and Obstetrician in Dumfries, Scotland and Managing
genetics, nutrition, smoking and age of menarche; in Europe it is Director of Menopause Matters Ltd. Her key research
around 51 years. As oocyte quality and number decline gradually,
interests include pre-menstrual syndrome, subfertility and
colposcopy. She is a member of the Council of the British
changes related to lowering levels of oestrogen may commence a
Menopause Society (BMS). Dr Currie has lectured
number of years beforehand.
extensively both nationally and internationally on issues
related to menopause, pre-menstrual syndrome and
subfertility, and has had many publications in women’s
Oestrogen deficiency can lead to early, intermediate and long-term magazines, peer-reviewed journals and textbooks.
health problems. There is widespread awareness of the common early
E:
currieclan@btinternet.com
menopausal symptoms such as hot flushes, night sweats, insomnia and
© TOUCH BRIEFINGS 2008 17
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