Women's Heart Health

Heart disease may present differently in women than men, and it’s not just because women have smaller bodies, and therefore, smaller hearts. Female hormones play a significant role in cardiovascular physiology, and as women lose sex hormones in menopause, the risk for heart disease increases.

Because heart disease tends to be underdiagnosed in women, especially in the early stages, heart health is an essential topic in women’s health and disease prevention. Keep reading to learn more about:

• Rates of heart disease in U.S. women
• Heart disease risk factors
• Types of heart disease, including coronary artery disease
• The role of estrogen and women’s hormones in heart health
• Heart disease risk and menopause
• How to protect your heart with monitoring, lifestyle factors, and bioidentical hormones

Let’s dive in!

Heart Disease Statistics and Risk Factors in Women

Heart disease (cardiovascular disease) accounts for one in every five deaths for American women, according to 2021 CDC data. It’s the number one cause of death.

Over 60 million U.S. women (44%) are living with some form of heart disease. Additionally, 80% of women between the ages of 40 and 60 have at least one heart disease risk factor, such as:

• Chronic inflammation
• Hypertension (high blood pressure)
• Insulin resistance and diabetes
• Stress
• Toxin exposures
• Sitting and sedentary behavior
• Poor diet and lifestyle habits
• Elevated LDL cholesterol
• Elevated Apolipoprotein B
• Smoking
• Excess visceral fat (around the midsection)
• Excess alcohol use
• Gum disease
• Menopause and hormonal imbalances (more on this below)

Types of Heart Disease in Women

Heart disease can take many forms, and the term covers a range of conditions affecting the heart. The most common type of heart disease in women is coronary artery disease, where atherosclerotic plaque builds up in the arteries, constricting blood flow. Coronary artery disease can lead to a heart attack.

Other types of heart disease include:

• Stroke
• Heart failure – the heart muscle becomes weak
• Arrhythmia – Irregular heartbeat, such as atrial fibrillation
• Various artery diseases

Some women will have signs of heart disease, such as pain in the chest, upper back, or jaw or increased fatigue, but others may be asymptomatic until they experience a heart attack or stroke.

Heart disease continues to be underdiagnosed and undertreated in women, yet it is so prevalent and may be preventable. You can do so much in terms of prevention from an integrative perspective.

Women’s Hormones and Heart Health

With so many women at risk for heart disease, a condition that’s overlooked until later stages by conventional medicine, it’s essential to understand the role that female hormones play.

Cells throughout the cardiovascular system have estrogen receptors; when estrogen (primarily estradiol) binds to the receptors, it has a cardioprotective effect. Estrogen helps keep arteries flexible, the heart muscles strong, and benefits insulin sensitivity and lipid balance.

As women lose estrogen (and progesterone) in perimenopause and menopause, the risk of heart disease accelerates.

Declining estrogen is associated with:

• Increased total cholesterol, LDL cholesterol, and apolipoprotein B levels (lipid markers of heart disease risk)
• Insulin resistance and metabolic syndrome
• Increased carotid atherosclerosis (plaque in the carotid artery)
• Changes in body composition, including more visceral (midsection) fat accumulation

Age of menopause, the 12-month mark without a period, is also a risk factor. Women who experience early menopause (before age 45), either naturally or surgically, have an increased risk of heart disease. Those with later menopause (over age 51) have a lower risk. Also, women who experience vasomotor symptoms (like hot flashes) and sleep disturbance tend to have a greater risk of heart disease and atherosclerosis.

Besides menopause, there are other hormone-related risk factors for heart disease to be aware of. Your risk may increase due to a history of:

• Early onset of the menstrual cycle
• Polycystic ovarian syndrome (PCOS)
• Endometriosis
• Gestational diabetes
• Pre-eclampsia during pregnancy
• Giving birth to a premature baby
• Autoimmune disease

Hormone Therapy and Heart Disease Prevention

Hormone replacement therapy has a confusing history, and many providers are still hesitant to prescribe it despite the many benefits and significant new research. Hormone therapy is becoming more accepted and prescribed to treat perimenopausal and menopausal symptoms (primarily hot flashes) and improve quality of life. However, it may also have a place for chronic disease prevention, including osteoporosis and heart disease.

Menopause hormone therapy may lower the risk of developing heart disease. Estrogen (and progesterone) replacement address some cardiovascular risk factors; estrogen supports:

• Healthy body fat distribution
• Insulin sensitivity (lowers the risk of insulin resistance and diabetes)
• Vascular health

Using hormone replacement therapy for the primary prevention of cardiovascular disease is still controversial. Some research says that when initiated around the onset of menopause, estrogen therapy is protective against heart disease, while other research doesn’t show this protective benefit.

However, a new study dives into the all the data. It shows that pooled observational studies show a 40% reduction in cardiovascular risk when women are younger and seek hormone therapy for menopausal symptoms. Data from clinical trials, like the Women’s Health Initiative, tend to evaluate older women well past menopause. 

The study suggests: “HRT significantly reduces all-cause mortality and cardiovascular disease (CVD) whereas other primary CVD prevention therapies such as lipid-lowering fail to do so.”

Yet, timing does matter. For the maximum benefits of menopausal hormone replacement therapy and lower risk, it needs to be initiated close to the onset of menopause, under the age of 60, and within ten years or less of menopause.

In this framework, the benefits of hormone therapy outweigh the risks for most women. Yet, hormone therapy still requires a personalized approach with a knowledgeable practitioner. I always recommend choosing bioidentical (body-identical) hormones.

How to Protect Your Heart

An integrative and functional medicine approach to heart disease means paying attention to risk factors and ideally intervening before heart disease develops. Many early warning signs, like insulin resistance, may be overlooked in conventional medicine.

Monitoring risk factors becomes especially important in midlife, through the menopausal transition, when cardiometabolic health can decline rapidly.

Here are some ways to protect your heart:

• Test labs regularly. Work with your healthcare provider and monitor blood labs, including:
  • Lipid panel
  • Fasting blood glucose
  • Fasting insulin
  • Hemoglobin A1C
  • Apolipoprotein B
  • Lp(a), one time – only test
  • C-reactive protein

Tracking blood pressure and waist circumference (hip-to-waist ratio) is also helpful. If some of these markers are high, gather more information by testing the particle size of your lipids and a carotid ultrasound to look for plaque buildup.

• Dial in nutrition. Eating a nutrient-dense, whole-food diet and limiting (or eliminating) processed foods and added sugar supports cardiometabolic health. You may want to start with a Mediterranean template and personalize it to your body’s needs. Working with a TārāMD nutritionist is incredibly beneficial.

Some foods to add to your diet for heart health are:

• Meeting your daily fiber needs – at least 25 grams per day – with plant foods like legumes, whole grains, and starchy vegetables
• Including omega-3 fats by eating cold-water fish three times per week
• Including fermented condiments and colorful produce to support gut and metabolic health
• Eating nuts, seeds, avocados, and olive oil for healthy fats

• Get Zone 2 Cardio Exercise. Zone 2 cardio is a relatively light exercise, working at 60 to 70% of your maximum heart rate or where you can comfortably hold a conversation. Zone 2 helps make your heart stronger while building endurance. To calculate your Zone 2, subtract your age from 220 and multiply that by 0.60 for your lower end and 0.70 for your upper end of your Zone 2 training.

Try to get in around 150 minutes of Zone 2 cardio per week, along with strength training to preserve lean body mass and a healthy body composition.

• Stop smoking and avoid (or limit) alcohol. Smoking and alcohol use won’t do your heart any favors and are considered modifiable risk factors. While alcohol was once considered “heart healthy,” especially red wine, newer research suggests the benefits may be overstated. You can still get helpful polyphenols, like the resveratrol you find in red wine, from foods like red grapes, pomegranates, peanuts, cacao, green tea, and supplements.

• Manage stress. Stress is a risk factor for chronic disease. Learning ways to practice self-care to reduce and manage stress now will support your health throughout your life, even through periods of higher stress out of your control.

• Consider bioidentical hormone replacement therapy. Discuss hormone replacement therapy during perimenopause with your TārāMD You’ll want to discuss the pros and cons of hormone replacement, along with the possible long-term risks associated with not initiating hormone therapy, such as increased heart disease risk. While not everyone will be a candidate, it is a helpful option for many women and deserves an in-depth conversation.

Heart disease is the number one cause of death for women, but it doesn’t have to be. Many risk factors for heart disease are modifiable with nutrition and lifestyle strategies. Additionally, we now have the knowledge and correct forms of hormones to use hormone replacement therapy appropriately to benefit women (and their hearts) over the long term.

Caring for your heart should be top priority. Use this information and guidance from your healthcare provider, to implement the best preventative strategies for you. Are you looking for a team knowledgeable on this topic and trained in bioidentical hormones? Look no further than TārāMD; we are here to support you!

References

1. Centers for Disease Control and Prevention. Women and Heart Disease. Accessed January 8, 2024.
2. NIH National Heart, Lung, and Blood Institute. Coronary Heart Disease - Women and Heart Disease. Accessed January 8, 2024.
3. American Heart Association. 2023 Heart Disease and Stroke Statistics Update Fact Sheet. Accessed January 8, 2024.
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