Nearly twice as many women in the US die of heart disease and stroke as from all forms of cancer, including breast cancer.

Women usually don't have heart problems until after they reach menopause. The hormone, estrogen, is believed to be good for your heart as it protects women against heart disease.

The natural aging process and the loss of estrogen at menopause put women at higher risk for developing cardiovascular disease (CVD), which is the number one killer of women in the United States.

Before the onset of menopause, women only have one-fifth the rate of heart disease as men of the same age. Within 10 years following natural menopause, the women's rate is equal to their male counterparts. Contrary to popular belief, cardiovascular disease is the number one killer of women in the United States and is responsible for 43,000 more women than men each year.

Estrogen may be linked to the reduction of heart disease risk but its role is not totally understood. It has been shown to increase the good cholesterol  (HDL) and lower bad (LDL) and appears to affect the blood levels by helping them stay open. However, it is not approved by the FDA for heart disease prevention.

At menopause, you should undergo a careful assessment of your risk factors for heart problems and discuss with your physician ways to prevent this serious life threatening disease. Women who undergo early menopause or surgical menopause  are at a greater risk for developing heart disease.

Cigarette smoking more than doubles your risk for developing heart disease. It speeds up the development of atherosclerosis and also can raise blood pressure and restricts oxygen to the body.

0.1. Have a Heart

The heart is always working and pumping and has life-sustaining powers. It is an impressive machine that is strong and complex. Blood vessels that weave and wind through the body come from and are powered by the heart. During menopause, it is important to be concerned about your heart.

As we face a time of physical and emotional change, help your heart by making changes to your lifestyle. There is no better time to nourish and protect it than now. A change of heart can potentially save your life! We encourage you to explore the various changes and ways to help your heart during menopause including stress, cholesterol and blood pressure.

Our heart sometimes talks to us during menopause by palpitating or fluttering a bit. This can be normal as our hormones change and is particularly noticeable during perimenopause. Heart palpitations can lead to the well-known hot flash many menopausal women experience. However, it can be an indicator of a heart condition.

Hot flashes can increase your heart rate between 8 and 16 beats per minute and can indicate a variety of cardiovascular problems. Discuss your hot flashes, heart health and menopause with your healthcare provider.

0.2. Cardiovascular disease (CVD)

Cardiovascular disease is the term that describes many conditions that affect the heart’s blood vessels, muscles and electrical system. Coronary heart disease, stroke, heart attack and high blood pressure (hypertension) are all considered diseases that restrict the flow of blood to the heart or brain and are considered parts of CVD.

It is possible to prevent CVD if you know the risks and management strategies. Aggressive preventative strategies are necessary if you are at higher risk.

0.3. Heart disease risk factors for women

• Advanced age, especially after 65
• Black race/ethnicity
• Cigarette smoking
• Physical inactivity
• High blood pressure
• Abnormal cholesterol levels
• Stress 
• Smoking
• Sedentary lifestyles
• Diabetes
• Drinking more than three alcoholic beverages daily
• Family history;a close blood relative who had a stroke; a father or brother who had a heart attack before age 55; a mother or sister who had a heart attack before age 65
• Weight more than 20% over ideal
• Early menopause, especially if reached before age 35
• Personality - a higher incidence of heart disease and better cholesterol profiles have been found in women who feel like they don't have control over their lives.

0.4. Common symptoms of heart problems

Symptoms of heart problems include chest pain or discomfort and pressure. Pain can also spread to the arms, neck, back or jaw. Rapid or irregular heartbeat. Shortness of breath that is unusual or unexpected and intense fatigue can also be symptoms. If you are worried about having a heart problem, talk to your doctor. Some women don't have any symptoms so a regular checkup is important.

0.5. Healthy heart habits

You may not have control over some of these risk factors but you can actively do a part to maintain your heart health by consciously altering your lifestyle. First, get a complete medical checkup. Here are some healthy heart tips:

• Don't smoke!
• Exercise regularly
• Maintain a healthy weight or lose weight if you are overweight
• Control your cholesterol
• Reduce stress
• Control blood pressure
• Prevent diabetes
• Control your diet and avoid fatty foods and sugars

Regular visits to the doctor are important for your heart health. If you are one of the many women who don't have the usual symptoms of heart problems, an evaluation is a good preventative step.

Your healthcare provider will ask you questions about your heart health history and will most likely listen to your heart, lungs and blood vessels with a stethoscope. They may be able to detect signs of heart failure, heart valve problems and evidence of artery blockage. If your heart health continues to be a concern, you will need to visit a cardiologist (heart specialist).

If you have not had a lipid profile done, we recommend one within a year after your last menstrual period. Lipid profiles are good indicators of heart attack or stroke risks. Lipid profiles are discussed more in our cholesterol section.

0.6. Heart tests

There are tests available to diagnose heart disease. Cardiologists and healthcare providers may suggest one or many of the following tests to further examine the condition of your heart:

• Blood tests: These include lipid profiles (measuring good and bad levels of cholesterol), blood sugar (detects the presence of diabetes), blood count, thyroid studies, arterial blood gases and more to help diagnose other conditions that may be causing symptoms.
• Electrocardiogram (EKG or ECG): Electrodes are placed on your chest while you are lying down or during stress to measure the heart's electrical activity (rate and rhythm).
• Chest X-ray: This test takes a picture of your heart and lungs to measure the size and shape of them. This test requires the exposure of a small amount of radiation.
• Stress test: A variety of tests that can determine if your arteries are blocked. These tests require you to work your heart by exercising and detect any abnormalities or symptoms you may experience.
• Nuclear imaging (myocardial perfusion imaging, MPI): Can detect blockages in arteries and damage to the heart muscles by injecting a liquid into your blood stream that flows through the heart.
• Echocardiography: This test gives information about heart muscles, valves, chambers and major blood vessels around the heart by using ultrasound waves.
• Magnetic resonance imaging (MRI): Provides a 3-D image of your heart by using strong magnets. It can detect coronary artery disease.
• Electron beam computed tomography (EBCT): Provides a 3-D image of your heart and examines the large arteries and veins around your heart. It can detect coronary artery disease.
• Angiography: A more invasive type of test, it involves inserting a long, thin tube to your heart. This test can detect the exact locations of any blockages in the arteries.

0.7. Preventing and treating CVD

For postmenopausal women, cardiovascular disease is 2-3 times more likely to occur than in perimenopausal women. The loss of estrogen may be there reason for the higher incidence. But, hormone therapy is not recommended for preventing CVD for postmenopausal women.

In fact, the Women's Health Initiative (WHI) studies were halted in 2002 for many reasons including an increased risk for heart disease and stroke associated with estrogen and progestin therapy. WHI trials were controversial regarding combined therapy and coronary risk factors due to the type of progestin used for the study. Many people believe natural progesterone or another form of progestin would have shown different results.

The 2004 estrogen-alone leg of the study also found an increased risk of stroke and no reduction in the risk of heart disease in postmenopausal women who have had a hysterectomy. It is currently recommended that hormone therapy should not be prescribed as a preventative step for cardiovascular disease for the postmenopausal woman. In the near future, look for more research on the effects of hormone therapy and your heart. In the meantime, there are many other methods available to lower heart disease risk in women.

Controlling blood pressure and lowering cholesterol can lower your risk and/or treat cardiovascular disease as well. If lifestyle interventions do not work for you, certain medications are available including aspirin, statins, beta-blockers and ACE-inhibitors. Discuss these options with your healthcare provider and choose the best method for your personal health.

Using complementary and alternative medicines (CAMs) to treat or prevent heart disease is a controversial subject. Vitamins and supplements are available but few studies have been conducted to prove the efficacy of these treatments for CVDs.

Whole soy (not supplemental soy) is commonly used to lower cholesterol and prevent heart disease. The benefits of soy are very appealing to the menopause community due to the positive effects it has on symptoms. However, studies from the American Heart Association on soy or isoflavone supplements revealed these supplements are unlikely to reduce your risk of heart disease. Heart health may be benefited by eating foods that contain soy protein to replace food high in animal fats.

Fish oil capsules or ground up flaxseed oils are sometimes recommended by cardiologists. The efficacy of flaxseed oils were proven in the The Lyon Heart Study. This American Heart Association trial focused on the effects of a Mediterranean Diet on heart health. Data from the study revealed a significant reduction in the incidence of heart problems.

0.8. Fast facts on heart disease and women

The following statistics were compiled by the National Center on Health Statistics; National Heart, Lung and Blood Institute and American Heart Association's 2002 Heart and Stroke Statistical Update:

• 8,000,000 American women are currently living with heart disease - 10% of women ages 45 - 64 and 25% age 65 and over.
• 6,000,000 of women today have a history of heart attack and/or angina or both. Nearly
• 13% of women age 45 and over have had a heart attack.
• 435,000 American women have heart attacks each year; 83,000 are under age 65 and 9,000 are under age 45. Their average age is 70.4.
• 4,000,000 women suffer from angina, and 47,000 of them were hospitalized in 1999.

Mortality:

• Heart disease is the leading cause of death of American women and kills 32% of them.
• 43% of deaths in American women, or nearly 500,000, are caused by cardiovascular disease (heart disease and stroke) each year.
• 267,000 women die each year from heart attacks, which kill six times as many women as breast cancer.
• 31, 837 women die each year of congestive heart failure, or 62.6% of all heart failure deaths.

At-Risk:

The age-adjusted rate of heart disease for African American women is 72% higher than for white women, while African American women ages 55-64 are twice as likely as white women to have a heart attack and 35% more likely to suffer from coronary artery disease.

• Women who smoke risk having a heart attack 19 years earlier than non-smoking women.
• Women with diabetes are two to three times more likely to have heart attacks.
• High blood pressure is more common in women taking oral contraceptives, especially in obese women.
• 39% of white women, 57% of black women, 57% of Hispanic women, and 49% Asian/Pacific Islander women are sedentary and get no leisure time physical activity.
• 23% of white women, 38% of black women, and 36% Mexican American women are obese.

Compared with Men:

• 38% of women and 25% of men will die within one year of a first recognized heart attack.
• 35% of women and 18% of men heart attack survivors will have another heart attack within six years.
• 46% of women and 22% of men heart attack survivors will be disabled with heart failure within six years.
• Women are almost twice as likely as men to die after bypass surgery.
• Women are less likely than men to receive beta-blockers, ACE inhibitors or even aspirin after a heart attack.
• More women than men die of heart disease each year, yet women receive only:

1. 33% of angioplasties, stents and bypass surgeries
2. 28% of implantable defibrillators and
3. 36% of open-heart surgeries

• Women comprise only 25% of participants in all heart-related research studies.

0.9. Heart Resources

The Heart Truth: The National Heart, Lung and Blood Institute (NHLBI) and partner organizations sponsor this national campaign to make women more aware of the danger of heart disease. Targeted for women ages 40 to 60, this is an important website that alerts people about the heightened risk of heart disease for this age bracket. Please visit this site and see how you can make an impact by wearing a Red Dress of your own!