Heart risk in women increases.

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Monitoring women’s health and lifestyle, while integrating early intervention strategies for good cardiovascular health, are important, especially during midlife and during menopause to help prevent heart disease, according to a new Scientific Statement from the American Heart Association. Within the heart, disease can affect the physical structure including the valves for example, congenital mitral valve prolapse or rheumatic heart disease.

Women's Heart

For many women, the menopause transition — the change from the reproductive to the non-reproductive phase of life marked by changes in menstruation — begins when they are in their late 40s to mid-50s. Before this transition, women produce estrogen, the female sex hormone, which may also have cardioprotective effects. When women go through the natural menopause transition, their ovaries stop producing as much estrogen.

Heart disease risk during menopause is associated with a decrease in the production of the hormone estrogen, health care professionals and scientists have studied if hormone therapy might help reduce cardiovascular risk. There is research indicating the potential cardiovascular benefits of certain combinations of hormone therapy when initiated in early but not late menopause. Further research is needed to evaluate the role of other hormone therapies, and how long these interventions impact cardio-metabolic health. Because the body was not designed to have high levels of cholesterol (specifically LDL) in the blood, immune cells called macrophages move it into the blood vessel walls to get it out of the circulation. In this process, it becomes oxidized, and this is what triggers the inflammatory process. The macrophages become overwhelmed with the oxidized LDL, try to engulf it, becoming “foam cells.” These foam cells trigger the need for further “clean up,” and the body tries to sequester the unhealthy foam cells and forms a hard plaque around it. These plaques cause further inflammation within the tissue of the artery wall; this is how atherosclerosis progresses.

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The benefits of hormone therapy, including a decreased risk of type 2 diabetes and protection from bone loss, seem to outweigh the risks for most women in early menopause. Current recommendations from leading professional medical societies endorse the use of hormone therapy for women who have recently begun the menopause transition, with appropriate indications.

Differences between how atherosclerosis develops in men and women. In general, women are more likely to have plaque formation in a single coronary vessel and in smaller blood vessels. Overall, atherosclerosis or obstructive cardiovascular disease is a less common form of heart disease among women, although when plaques do form, the plaques are comprised of lipid-filled foam cells, which are both more easily treated and reversed.

It is thought that this difference is at least partially due to protective hormonal effects because women’s risk increases after menopause. Women who undergo early menopause, either due to surgical removal of their ovaries or premature ovarian failure, have similar rates of cardiovascular disease as age-matched men. Most women have one or more risk factors for cardiovascular disease.


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