How is cardiovascular disease associated with menopause?

After menopause, a woman’s risk of cardiovascular disease increases. In women who have undergone early menopause (before age 50) or surgical menopause, the risk of cardiovascular disease is also higher, especially when combined with other risk factors.

Estrogen helps a woman’s body protect her against cardiovascular disease. After menopause, cardiovascular disease becomes more of a risk for women because of the reduced level of estrogen in the body.

A reduced level of estrogen causes:

  • Changes in the walls of the blood vessels that may cause plaque and blood clots to form
  • Changes in the level of lipids (fats) in the blood: Levels of low density lipoproteins (LDL, the “bad” kind) increase, and levels of high density lipoproteins (HDL, the “good” kind) decrease. These changes lead to the build-up of fat and cholesterol that contributes to heart attack and stroke.
  • An increase in fibrinogen (a substance in the blood that helps the blood to clot). Increased levels of blood fibrinogen are related to cardiovascular disease and stroke.

What are the other risk factors for heart disease in women?

In addition to menopause, nonmodifiable risk factors (those that cannot be changed) include:

  • Older age. Once a woman reaches the age of 50 to 52 (about the age of natural menopause), the risk of heart disease increases dramatically.
  • Family history of cardiovascular disease. If your parents have/had cardiovascular disease (especially if they were diagnosed before age 50), you have an increased risk of developing it. Ask your doctor when it’s appropriate for you to start screenings for cardiovascular disease so it can be detected and treated early.
  • Race. African Americans have more severe high blood pressure than Caucasians, and therefore have a higher risk of cardiovascular disease. Cardiovascular disease risk is also higher among Mexican Americans, American Indians, native Hawaiians, and some Asian Americans. This is partly due to higher rates of obesity and diabetes in these populations.

Modifiable risk factors (those you can treat or control) include:

  • Cigarette smoking or exposure to tobacco smoke
  • High blood cholesterol and high triglyceride levels, especially high LDL/bad cholesterol (over 100 mg/dL) and low HDL/good cholesterol (under 40 mg/dL). Some patients who have existing heart or blood vessel disease and other patients who have a very high risk should aim for an LDL level less than 70 mg/dL. Your doctor can provide specific guidelines.
  • High blood pressure (140/90 mm Hg or higher)
  • Uncontrolled diabetes
  • Physical inactivity
  • Being overweight (body mass index [BMI] 25-29 kg/m2) or obese (BMI higher than 30 kg/m2)

NOTE: How your weight is distributed is also important. Your waist measurement is one way to determine fat distribution. Your waist circumference is the measurement of your waist, just above your navel. The risk of cardiovascular disease is higher for women with a waist measurement over 35 inches (over 32 inches for Asian Americans) and men with a waist measurement over 40 inches (over 38 inches for Asian Americans).

  • Uncontrolled stress or anger
  • Diet high in saturated fat and cholesterol
  • Drinking too much alcohol

Unique risk factors for women include high blood pressure (preeclampsia) or diabetes while pregnant (gestational diabetes), polycystic ovary disease and autoimmune diseases such as rheumatoid arthritis or lupus.

The more risk factors you have, the greater your overall risk.

What can I do to reduce my risk of cardiovascular disease?

Reducing your risk factors involves making lifestyle changes, including those listed below. Your doctor will work with you to help you make these changes.

  • If you smoke, you should quit.
  • Make changes in your diet to reduce your cholesterol, control your blood pressure and manage your blood sugar if you have diabetes. Low-fat, low-sodium and low-cholesterol foods are recommended. Limiting alcohol is also important. A registered dietitian can help you make the right dietary changes. Cleveland Clinic offers nutrition programs and classes to help you reach your goals.
  • Increase your exercise/activity level to help achieve and maintain a healthy weight and reduce stress. Moderate exercise for 30 minutes a day, on most days is recommended. Check with your doctor before starting an exercise program. Ask your doctor about participating in a cardiac rehabilitation program.

Last reviewed by a Cleveland Clinic medical professional on 05/29/2019.

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