While many women consider heart disease to be a man’s disease, after the age of 55, cardiovascular disease (CVD) accounts for more than half of all deaths in women. Menopause does not cause cardiovascular problems, but after menopause, the risk of this condition increases.
Certain risk factors, such as a high-fat diet, alcohol, or other unhealthy activities, started earlier in life, escalate around the time of menopause.
Analysis Of CVD Risk In India
The Global Burden of Disease Report (2017) stated that CVD caused 2.64 million deaths in India in 2017 (1.18 million women and 1.45 million men); and ischemic heart disease (IHD) caused 1.54 million deaths (0.62 million women and 0.92 million men).
In India, population-based epidemiological studies have shown significant differences in risk factor understanding, prevention, and management, says a report by the “World Journal of Cardiology”.
A survey published in Lancet states that hypertension awareness varies from 20% to 60%, with rural women having the lowest understanding and urban men having the highest; fewer than a quarter of hypertension patients undergo diagnosis in rural areas. About half undergo treatment in urban areas.
Research published in the “Indian Journal of Medical Research” concluded that in Indian women, stroke and cardiovascular disease, and coronary heart diseases are the leading causes of death and morbidity. The same risk factors that are present in men are also present in women.
Changing habits, low physical exercise, elevated calorie consumption, and a high-fat diet is contributing factors. These risk factors are poorly understood, treated, and regulated, especially among rural women.
More research is needed into the context of gender inequality in the treatment of both acute and chronic cardiovascular disease. There is a scarcity of information on the prevalence, prevention, and treatment of cardiovascular complications in youth.
Cardiovascular fatality in women and children can be decreased by focusing on preventive strategies. More research is needed into the context of gender inequality in the treatment of both acute and chronic CVD.
There is a scarcity of information on the prevalence, prevention, and treatment of cardiovascular complications in youth. Cardiovascular fatality in women and children can be decreased by focusing on preventive strategies.
Menopause: Loss Of Hormonal Defense In Women
Several studies have shown that menopause impacts all women and happens when the ovaries cease releasing estrogen spontaneously due to the decline and termination of oocyte growth and ovulation needed for estrogen and progesterone output. Also, when the ovaries are damaged or removed due to other medical conditions.
A report from the “European Journal of Clinical Nutrition” (2013) states that women have a higher incidence of metabolic syndrome and diabetes than men.
Women in India have a much higher cardiometabolic risk of CVD than men, particularly after menopause when they lose their hormonal defense. The average age of normal menopause varies by country and is influenced by factors such as genetics, diet, smoking, and the age of menarche.
According to the survey published in the “Journal of Mid-Life Health in India”, the average age is about 46.2 years, somewhat lower than their western counterparts (51 years). Changes related to lowering estrogen levels can begin several years before oocyte quality, and the number starts to decline.
Estrogen deficiency can cause short, medium, and long-term health issues. Experiencing hot flashes, night sweats, insomnia, and mood swings are typical early menopausal well-known signs.
Vaginal dryness, fatigue, pain, and bladder changes are prevalent intermediate signs that, although not as well-known as hot flushes, are increasingly being identified and addressed more often than in the past.
The long-term effects of menopause on the bones, with a deficiency of estrogen contributing to bone loss (and ultimately, osteoporosis) and a higher chance of fracture, are well-known and widely discussed. However, the importance of menopause’s long-term impact on the cardiovascular system is overlooked.
A report by the “Obstetrical & Gynecological Survey” reveals that during menopause, particularly in the first year, there is a change in fat storage and distribution in women from the hips to the abdomen is more similar to the abdominal adipose tissue storage in men.
The exact role by which estrogen deficiency causes weight gain and shifts in fat distribution is unknown. However, since different hormonal secretions affect each other, there may be a link to an imbalance of androgens (females also contain a small number of androgens or male hormones) and leptin and thyroid activity changes.
How Is Women’s Health Affected After Menopause?
As per the Archives of Internal Medicine, the increase in these risk factors leads to four-fold increased risk of CVD in women in the ten years following menopause.
The notion that this increase is due to menopause or estrogen deficiency rather than purely age-related is supported by the findings that postmenopausal women of any age have an increased risk of CVD.
The report further stated that women and men experience heart attack symptoms differently, with women being less likely to experience classic, well-known cardiovascular symptoms.
Myocardial infarction (MI) signs include extreme weakness, shortness of breath, nausea, digestive problems, and angina is mistaken for indigestion or heartburn.
On the other hand, women appear to present late in the disease phase, at which time they could already be suffering from other medical issues that may influence their prognosis.
Besides, it is well acknowledged that women are less likely to be given intervention and have historically been underrepresented in clinical trials. Women, unsurprisingly, have a poorer prognosis after a MI than males.
Higher cholesterol is without a doubt a significant risk factor for CVD. A review published in “Climacteric” stated that menopause is linked to a substantial rise in total cholesterol, with increases in low-density lipoprotein (LDL), lipoprotein, and triglycerides, and a reduction in high-density lipoprotein (HDL).
As a result, menopausal women are subject to a more atherogenic lipid profile than women who are not yet menopausal. Women’s total cholesterol levels rise at 55-65 years old, around ten years later than men’s.
The researchers at the University of Hong Kong concluded that women who smoke are around a year early to enter menopause than women who don’t smoke. This is problematic because the age at which a woman reaches menopause affects her bone and heart disease risk and breast cancer.
Also, diabetes is becoming more prevalent in both men and women, and after menopause, modifications in insulin secretion and insulin sensitivity lead to this rise in women.
Managing Health During Menopause
When menopausal signs appear, women and their healthcare consultants should address the symptoms and the long-term implications and risk factors for bone and heart health. The World Health Organization (WHO) estimates that food and lifestyle modifications will prevent 80% of CVD.
Controlling menopausal symptoms could be necessary first for women who are experiencing problematic health issues. Early discussion is also essential, and some improvements, such as losing weight, quitting smoking, and exercising, will help alleviate symptoms while still improving long-term health.
Regular women counseling, education, and encouragement to maintain a healthier weight by eating a healthy diet should be conducted.
A healthy diet including five servings of raw fruits and vegetables per day, wholegrain, high-fiber foods, reducing saturated fats, increasing prebiotic and probiotic and reducing salt. Also, increase physical activity, with at least thirty minutes of modest exercise or brisk walking five days per week.
Preventing CVD In Postmenopausal Women
Smoking cessation remarkably improves heart and bone wellbeing, and it should be a top priority for menopausal women. Blood pressure is usually tested as part of a menopause evaluation and then again as part of a follow-up for people taking hormone replacement therapy.
Increased exercise and calorie restriction can help lower blood pressure, but medication is often needed. Since cholesterol levels rise due to the hormonal alterations that arise during menopause, they should be routinely checked as part of the menopause evaluation.
Studies have shown that a 10% reduction in LDL cholesterol will result in a 20% reduction in CVD risk. Premature CVD is preventable in most cases.
Multilevel and multifactorial interventions combining regulation, clinical programs, process delivery, physician education, role changing, practice paradigm shift, primary prevention, improved patient management, population-wide initiatives, and patient ownership will significantly reduce the risk of developing CVD in postmenopausal women.
Indian Women Must Take Care Of Themselves
Even though CVD is by far the leading cause of death in women after menopause, both women and health providers still have a low depth of awareness.
The hormonal changes that arise during menopause increase CVD risk factors, such as variations in body fat distribution, decreased insulin sensitivity, abnormal lipid profile, higher blood pressure, increased sympathetic tone, endothelial dysfunction, and cardiovascular inflammation.
They all are amplified by menopause. Menopause discussions should evaluate risk factors for long-term health conditions, including osteoporosis and CVD. The cholesterol levels, blood pressure, and body mass index should all be measured routinely.
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REFERENCES:
Overweight, obesity and related non-communicable diseases in Asian Indian girls and women
Age of menopause and determinants of menopause age: A PAN India survey by IMS
Menopause, Cholesterol and Cardiovascular Disease
Menopause and cardiovascular disease: the evidence
Dyslipidemia in Menopause: Mechanisms and Management
Menopause and cardiovascular disease: the evidence