Severe Menopause Symptoms Raise Heart Risks

FRIDAY March 14, 2008 -- Women who have the most severe menopausal symptoms may also be at a higher risk of cardiovascular disease, a new study suggests.

Dutch researchers surveyed 5,648 women, aged 46 to 57, about their menopausal complaints and collected data on other health information such as their cholesterol and blood pressure.

Night sweats were reported by 38 percent of women; flushing by 39 percent.

Those with flushing had higher cholesterol levels than those without the symptom. They also had higher blood pressure, higher body mass index (BMI, a ratio of weight to height) and a slightly higher chance of developing heart disease over the next decade. The women with night sweats had comparable results.

The researchers, from the University Medical Center Utrecht, conclude that the connection between severity of symptoms and heart disease risk may be the result of reduced beneficial effects of estrogen on the functioning of blood vessel walls, as estrogen declines during menopause.

The Dutch researchers were scheduled to present their findings Friday at the American Heart Association's Cardiovascular Disease Epidemiology and Prevention Conference, in Colorado Springs, Colo.

"The implication is the women with the worst symptoms may be at higher risk, clinically, for heart disease," said Dr. Suzanne Steinbaum, director of women & heart disease, at the Heart & Vascular Institute at Lenox Hill Hospital, in New York City.

But the American Heart Association does not advise postmenopausal women to take hormone therapy to reduce heart disease or stroke risk, due to clinical trials that show the hormones, over time, actually increase cardiovascular risks. Hormone therapy is only recommended to relieve very severe symptoms of menopause, and only for the shortest possible period.

The take-home point from this study for the general population, according to Steinbaum, is to pay close attention to improvement in lifestyle habits before menopause and before estrogen levels decline. "One of the things I talk about is lifestyle management to control high blood pressure, high cholesterol," she explained.

If women keep in check the risk factors of heart disease, such as high blood pressure and high cholesterol, by eating healthfully and exercising often before menopause, the transition "doesn't have to be as terrible" as many women fear it will be.

Among her suggestions: Exercise at least 20 to 30 minutes three to five days a week, and eat a diet filled with fiber, vegetables, fruits, multi-grains, legumes and omega-3 fatty acids.

In a second study, also scheduled to be presented Friday at the conference, French researchers found the type of hormone delivery method affects the risk of blood clots in postmenopausal women.

Researchers from Paul Brousse Hospital in Villejuif, France, compared women who did not use hormones with those who used estrogen, taking it either orally or transdermally with a patch. Some women took only estrogen, others took estrogen plus progesterone, pregnane, norpregnane or nortestosterone.

The researchers found that transdermal estrogen alone or in combination with progesterone or pregnane derivatives did not raise the risk for blood clots, while other delivery systems did.

They looked at a population of nearly 86,000 French women -- including 984 with blood clots -- who were followed for more than 10 years.

"This [study] is one more piece of the puzzle," said Dr. Jennifer Wu, an obstetrician-gynecologist at Lenox Hill Hospital in New York City. When women take hormones orally, she said, the metabolism involves much more processing through the liver, for instance.

While the study concluded that the patch delivery is less risky when it comes to blood clots, Wu said "the indications remain the same" for hormone therapy. It should be used only for very severe menopausal symptoms interfering with daily life, for the shortest possible time.

More information

To learn more about menopause and heart disease risks, visit the American Heart Association.

Posted: March 2008


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