CLEVELAND — Heart disease is the number one killer of women and in a way it seems the deck is stacked against them. Women are less likely to receive CPR by a stranger and 50% more likely of having a heart attack misdiagnosed.
But it wasn't until 2020 that menopause was finally considered a significant risk factor.
That year, the American Heart Association published a 2020 scientific statement on cardiovascular disease risk for menopausal women.
They supported the notion that the transition of menopause, independent of chronological and ovarian aging, leads to increased cardiovascular risk and mortality. And women in midlife should be routinely counseled on lifestyle interventions to help combat this risk. Some of those interventions include smoking cessation, weight management, optimization of cholesterol levels and blood pressure and fasting blood glucose, daily physical activity, and dietary approaches to stop hypertension.
Another concerning issue is that menopausal symptoms can often mimic those of a heart attack.
"One kind of atypical symptoms of menopause is palpitations or feeling your heart race or beat faster, sometimes that gets misdiagnosed as anxiety or some other kind of thing when in and of itself it is due to menopause," said Dr. Alexa Fiffick, a family medicine practitioner specializing in women's health and menopause in Westlake.
Dr. Fiffick says when estrogen levels drop, that can increase the risk of fatty buildup in the arteries leading to atherosclerosis. Common menopause symptoms such as aches and pains in the chest area and dizziness can also be confused as menopause, when it may be something more serious.
"One of the symptoms of having a myocardial infarction or heart attack can be just sweating, getting overheated and feeling nauseous, which oftentimes gets mistaken in and of itself for a hot flash. So it's one of those things that you can't really ignore. You need to tell your doctor, Hey, this is happening so that they're able to figure out," Dr. Fiffick said.
Dr. Fiffick says menopause can increase the risk of heart disease in any woman completely independent of family history, personal history, or even general aging.
Menopause is known to cause body fat to move to the belly area, causing visceral fat to surround vital organs. It can also cause changes in cholesterol levels.
"The total cholesterol, our bad cholesterol and a couple other chemical markers increased dramatically within the two year span of the first year prior to being in menopause. And the one year immediately after, even we see the HDL or good cholesterol, whose job it is to reverse kind of the transportation of the bad cholesterol to where it can cause blockages, that functionality weakens," Dr. Fiffick said.
The million dollar question is what can women do about it. It's easy to tell them to lose weight, exercise and eat better, but it doesn't take into account slower metabolism and other chemical changes in the body.
That's why it's imperative for women to pay attention to the symptoms more closely. Work with her healthcare professional about steps to take to mitigate menopausal issues. Recognize when something doesn't feel right and seek medical care. Advocate for herself when healthcare professionals seem dismissive of symptoms that seem abnormal and understand that the inevitiable change of life raises the risk of heart attack and stroke.