“By taking care of your heart, you take care of your brain and improve your overall health and wellbeing.”
— Samar El Khoudary, Ph.D., MPH, BPharm, FAHA
Whether working, exercising, relaxing, or even just sleeping, our heart keeps beating. It beats 100,000 times a day and pumps 2,000 gallons of blood per day. This amazing organ works non-stop to keep the rest of our body functioning by maintaining oxygenation thereby supplying fuel to all its parts. This is why it is critical to preserve heart health to support continued physical health and overall wellbeing as we age.
At the Translational Science Symposium on Midlife Wellbeing held in advance of the 2021 Annual Meeting of the North American Menopause Society, Dr. Samar El Khoudary, Associate Professor of Epidemiology at the University of Pittsburgh, School of Public Health, talked about the changes related to heart disease risk that occur in midlife. She also discussed which of those risk factors are modifiable, that is, under our control.
Changes in Risk for Heart Disease Occur in Midlife
Heart disease is the number one (#1) cause of death for women. It is not breast cancer! Annual US deaths from breast cancer are 44,000 and nearly 300,000 from heart disease – 1 in every 5 female deaths.
For reasons not yet completely understood, multiple negative changes related to heart health occur in midlife women between 40-65, a time period coincident with the menopause transition. Researchers are interested in which of these changes are related to overall aging and which to reproductive aging (the approach and arrival of menopause and the concurrent fluctuation and decline of progesterone and the subsequent decline of estrogen).
Changes occur with respect to cholesterol, body fat composition, weight, blood pressure, glucose, and insulin, all of which are important factors with respect to heart health. In addition, during midlife, women’s vascular health deteriorates with notable increases in arterial stiffness, carotid artery thickness, and narrowness in its diameter. Arteries are the parts of our circulation system that carry blood from the heart to the rest of the body. All of these changes increase a woman’s risk of cardiovascular disease (CVD).
Women and Men are Not the Same with Respect to Heart Disease
An emerging body of research indicates that women’s heart disease develops and presents differently from men’s heart disease. For many years, women were screened the same as men, which meant looking for heart disease in larger arteries. Research is now showing that blockages for women that lead to disease often begin in smaller vessels. Similarly, signs of a heart attack are different for men and women. For those that want a deeper dive, this Summary of Updated Recommendations for Primary Prevention of Cardiovascular Disease in Women provides a good overview of the latest research on women’s hearts.
Research Shows a Racial Difference
Research from The Study of Women’s Health Across the Nation showed that Black women with a given BMI had a lower amount of fat around abdominal organs and fat around their heart than white women. It is undetermined how this relates to risk.
What We Can Control About Our Heart Health
Although characteristics that can’t be changed such as age and genetics play an important role in one’s overall heart health, there are several modifiable factors that can help maintain a healthy heart. Life’s Simple 7 are seven risk factors, identified by the American Heart Association, that can be influenced by lifestyle changes to maximize heart health. These are blood pressure, total cholesterol, blood sugar, physical activity, diet, weight, and smoking.
Lifestyle Changes Can Move The Needle
There is data, although limited, suggesting that adherence to lifestyle guidelines involving diet, exercise and abstinence from smoking is associated with a very low risk of coronary heart disease. In a study of 2,764 women, 82% of coronary events were attributable to subjects that were not classified as having a “low risk” pattern for cardiovascular disease. The low-risk pattern was defined as those who were not currently smoking, had a body-mass index under 25, consumed an average of at least half a drink of an alcoholic beverage per day, engaged in moderate-to-vigorous physical activity (which could include brisk walking) for at least half an hour per day, on average, and scored in the highest 40 percent of the cohort for consumption of a diet high in cereal fiber, marine n–3 fatty acids, and folate, with a high ratio of polyunsaturated to saturated fat, and low in trans fat and glycemic load.
Knowing that heart disease is the number one cause of mortality in women and that risk increases significantly in midlife should be a wake-up call for those in their late 30s/ early 40s to take notice and take action. The time is now. Physical activity, not smoking, and heart-healthy eating can go a long way to modifying risk.
This information was presented at the Translational Science Symposium “Charting the Path to Health in Midlife and Beyond: The Biology and Practice of Wellness” held in advance of the 2021 Annual Meeting of The North American Menopause Society in Washington, DC. Excerpts from the Translational Science Symposium are presented as part of the Live From #NAMS2021: The Latest Breakthroughs in Women’s Midlife Wellness series published by Women Living Better and Lisa Health with permission from NAMS.
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