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Cardiovascular Disease Prevention and Menopause: Timing Matters–don’t wait!

Cardiovascular Disease Prevention and Menopause: Timing Matters–don’t wait!


Cardiovascular Disease Prevention and Menopause: Timing Matters–don’t wait!

Towards the end of 2020, the American Heart Association (AHA) published a statement on “Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention.” Below are the salient take home points for patients, in order of importance.

Cardiovascular disease (CVD) is the leading cause of death in women. Around the time of menopause, CVD risk in women jumps up, in part due to menopause related changes in hormone levels. For a woman who is approaching menopause, this is an important time to visit her primary care physician (PCP) to review her CVD risk profile and to devise a personalized plan to minimize risk of developing significant CVD, and thus avoid falling victim to its CVD-related morbidity and mortality.

Things to discuss with your PCP:

  1. What can I do to improve my cardiovascular health? There are 7 key risk factors known as “AHA Life’s Simple 7.” They are: good nutrition, physical activity, not smoking, and having normal BMI, blood pressure, cholesterol, and fasting blood sugar numbers. “Eating right” and “regular exercise” are easier said than done, as evidenced by following statistics: 42% of US women 40-59 years old have a BMI in the obese range; 17% eat a healthy diet; and a mere 2.3% of women > 60 years old adhere to physical activity recommendations. In other words, the majority of us have lots of room for improvement.[1] Thus a good next step is work with your PCP to set “SMART” goals and making a follow up appointment to track your progress (and troubleshoot if needed). I also recommend asking what resources are available to help you (eg. referral to a health coach).
  2. Should I take hormone replacement therapy (HRT)? If you and your PCP decide that HRT is an appropriate consideration for you, ask about timing of HRT and its importance. There is a “timing hypothesis” which suggests that, especially in patients who undergo menopause prior to age 45, taking HRT has overall benefits including lowering CVD risk and improving bone health. However, as with all medications, HRT also comes with its risks. When HRT is taken for more than 5-10 years in patients beyond 60-65 years of age, we worry about increased risk for stroke, blood clots, and breast cancer. At that time, the cardiovascular and mortality benefits seen with taking HRT at a younger age also disappears. A thorough discussion with your PCP about taking HRT will help ensure that you are taking the optimal medication, dose and formulation, at the optimal time interval to maximize benefits and minimize risks. Transdermal estrogen appears to have the best benefit vs risk profile pertaining to cardiovascular health.
  3. Should I take a statin? If you’ve had a heart attack or stroke in the past, you’re likely already taking cholesterol medication, and should continue it. Otherwise, every year your PCP will re-assess your CVD risk profile to help answer this question. It’s all about the risk vs benefit of taking medication for cholesterol and will require a personalized decision-making process.

Some people may find these statistics to be abysmal, however also consider that there are several causes for optimism. First, you are not alone if you are struggling, in fact you’re in the majority. Second, there is lots of room for improvement! Finally, mean life expectancy at birth for a US woman is still 81 years. By working toward recommended health goals, you can expect even greater longevity, and be in even better health to enjoy it. Imagine the real possibility of a scenario where at 90, you are still living independently, enjoying life to the fullest, traveling and proudly able to hoist a carry-on into the overhead compartment on the plane without help. Now there’s a goal to aspire to!

In conclusion:

Recognizing that CVD is the leading cause of death in women and that our average lifetime risk for CVD is nearly 50%, doing everything in our power to reduce CVD risk is a major strategy in ensuring a long and healthy life. Knowing that CVD risk jumps up around menopause, this is also an important time to convene with your doctor to address modifiable risk factors and optimize your health.

References:

El Khoudary SR, Aggarwal B, Beckie TM, Hodis HN, Johnson AE, Langer RD, Limacher MC, Manson JE, Stefanick ML, Allison MA; on behalf of the American Heart Association Prevention Science Committee of the Council on Epidemiology and Prevention; and Council on Cardiovascular and Stroke Nursing. Menopause transition and cardiovascular disease risk: implications for timing of early prevention: a scientific statement from the American Heart Association. Circulation. 2020;142:e506–e532. doi: 10.1161/CIR.0000000000000912

Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association. Circulation: Volume 142, Issue 25, 22 December 2020; Pages e506-e532 https://doi.org/10.1161/CIR.0000000000000912

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Eileen West, MD about 10 hrs ago
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The scenario plays out like this… you’re sitting at home watching reruns of Friends when your vision blurs. Minutes later your head feels like it's set in a vice, and someone is cranking the lever. With your head throbbing, the nausea kicks in. After making a bathroom stop (goodbye lunch), you climb into bed and pull the covers over your face, lying still in the dark. Can you relate? This is called migraine, and sadly this illness is all too common. ● Approximately 39 million people in the US and 1 billion people worldwide have migraines ● Most people with migraine have 1 to 2 attacks per month which can extend from 4 hours to 3 days ● 36 billion is spent each year on healthcare and loss of productivity due to migraines Add onto those staggering stats this surprise—WOMEN are at greatest risk. Studies show that 8 out of 10 people with migraine are females. While research isn’t fully conclusive as to why, the data points to women’s hormone levels changing. ➡️ If you are battling migraines, please know that you do not need to suffer alone. At Eileen West, MD, and Associates, we are here to help you find the right treatment to prevent migraines and make them less painful. You have a life to lead. We’re here to help you on that journey and provide exceptional care. ⭐️ June is National Migraine & Headache Awareness Month. Share your migraine questions below… We’d love to help. #youdeservebetter #msmedicine #fairfaxphysician #conciergemedicine #lifestylemedicine #doctorsofinstagram #femalephysician #womenshealth #fairfaxdoctor #fairfax #fairfaxva #fxva #dc #washington #loveVA #fairfaxcounty #virginia #northernvirginia #nova #dcarea #dmv #va #nham

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Eileen West, MDabout 2 days ago
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IT’S SELF-CARE SUNDAY. We’re back this week to focus on the importance of self-care and giving you tips on how to practically care for the physical, mental, emotional, & social parts of you. Today’s self-care tip is simple but necessary: Find Ways To Relax Our American society prides itself on doing, doing, doing. Here’s the truth - busy doesn’t equal beneficial. We need a balance of work, play, and rest. Your mind, body, and emotions need periods of relaxation in order to refuel. Here are 10 Ways You Can Relax: ● Meditate ● Do Yoga ● Get a massage ● Take a nature walk or hike ● Journal ● Swim ● Listen to calming music ● Sit in the sun ● Color ● Read a book Self-care isn’t selfish, it is essential. Your brain and body need downtime. Do yourself a favor & RELAX. ➡️ What is your favorite way to relax? Tell us in the comments. #youdeservebetter #msmedicine #fairfaxphysician #conciergemedicine #lifestylemedicine #doctorsofinstagram #femalephysician #womenshealth #fairfax

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Eileen West, MDabout 6 days ago
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More than 80% of women experience hot flashes during menopause. Hot flashes can occur during the day or night and have a range of severity. If you fall into the category of moderate to severe, here are 6 tips to help you find relief: 1. Keep the temperature in your home cool. 2. Reduce stress with yoga, tai chi, meditation, biofeedback, acupuncture & massage. 3. Eliminate hot drinks, hot foods, alcohol, caffeine, and cigarette smoking 4. Wear light, breathable clothing during the day and to bed. 5. Sleep with cooling products, including sprays, gels, and a cool-fabric pillow. Use layered bedding that can be easily removed during the night. Cool down with a bedside fan. 6. When a hot flash is starting, try “paced respiration”—slow, deep, abdominal breathing, in through your nose and out through your mouth. Breathe only 5 to 7 times per minute, much more slowly than usual. ➡️ There are some prescription treatments to help with menopausal symptoms. Talk with your primary care doctor to discuss the best path for you. If you currently are seeking a provider, we are here to advocate for your total wellbeing and provide knowledgeable and personal care. Please reach out to schedule an appointment and learn more about how we can help! References: The North American Menopause Society (mnflashes.pdf), Stat from National Library of Medicine #youdeservebetter #msmedicine #fairfaxphysician #conciergemedicine #lifestylemedicine #doctorsofinstagram #femalephysician #womenshealth #fairfaxdoctor #fairfax #fairfaxva #fxva #dc #washington #loveVA #fairfaxcounty #virginia #northernvirginia #nova #dcarea #dmv #va #menopause

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