Cardiometabolic Disorders in Menopausal Women: A Comprehensive Overview

5 min readJun 20, 2024

Written and edited by Sarah Bonza MD, MPH, FAAFP, DipABLM, NBC-HWC

Woman in perimenopause meditating at heart chakra

Introduction

As a board-certified family physician and founder of Bonza Health, I am dedicated to helping menopausal and perimenopausal women reclaim their vitality. Cardiometabolic disorders, including cardiovascular disease (CVD) and type 2 diabetes, are significant health concerns for women during menopause. This blog will provide an overview of the epidemiology of cardiovascular disease in women, the impact of menopause on cardiovascular health, and the importance of lifestyle modifications and preventive treatments.

Epidemiology of Cardiovascular Disease in Women

Cardiovascular disease remains the leading cause of death among women in the United States, accounting for approximately one in every three female deaths [1,2]. Despite advances in diagnosis, prevention, and treatment, CVD continues to pose a significant threat to women’s health, particularly during and after menopause [18].

Menopause and Cardiovascular Disease Risk

Menopause is associated with several changes that increase the risk of cardiovascular disease. These include:

Palpitations: Hormonal fluctuations during menopause can lead to palpitations, which may be a sign of underlying cardiovascular issues.
Lipid Changes: Menopause often results in increased levels of low-density lipoprotein cholesterol (LDL-C) and decreased levels of high-density lipoprotein cholesterol (HDL-C), contributing to atherosclerosis [11].
Traditional Risk Factors: These include diabetes, smoking, obesity, physical inactivity, hypertension, and dyslipidemia [17].

Emerging Nontraditional Risk Factors

Several nontraditional risk factors also contribute to cardiovascular disease risk in women, including:

Preterm Delivery: Associated with an increased risk of CVD later in life.
Hypertensive Disorders During Pregnancy: Conditions like preeclampsia increase future cardiovascular risk [12].
Gestational Diabetes: Increases the risk of developing type 2 diabetes and CVD.
Autoimmune Diseases: Conditions such as lupus and rheumatoid arthritis are linked to higher CVD risk.
Breast Cancer Treatment: Certain treatments can increase cardiovascular risk.
Depression: Associated with an increased risk of CVD [7].

Lifestyle Modifications

Lifestyle changes are crucial for reducing cardiovascular risk in menopausal women. These include:

Tobacco Cessation: Smoking cessation significantly reduces cardiovascular risk.
Counseling: Behavioral counseling can help women adopt healthier lifestyles.
Physical Activity: Regular exercise is essential for cardiovascular health.
Dietary Intake: A diet rich in antioxidants, B-vitamins, vitamin D, plant sterols, and soy isoflavones is beneficial. The Mediterranean Diet and Dietary Approaches to Stop Hypertension (DASH) are particularly effective [18].
Weight Maintenance and Reduction: Maintaining a healthy weight and reducing waist-to-hip circumference are important for cardiovascular health.

Preventive Treatments

Several preventive treatments can help manage cardiovascular risk:

Daily Low-Dose Aspirin: Recommended for women with significant risk factors for CVD and a low risk of gastrointestinal bleeding.
Hormone Therapy (HT): While randomized controlled studies do not show that estrogen therapy reduces cardiovascular heart disease risk, observational studies suggest it may reduce cardiovascular risk. HT should be used under close medical supervision.
Management of Hypertension: Includes medications, weight loss, the DASH diet, exercise, and abstaining from alcohol.
Management of Hyperlipidemia: Statins are recommended for women with cardiovascular disease or those with LDL-C levels ≥190 mg/dL. Women aged 40–75 years with LDL-C levels between 70 mg/dL and 189 mg/dL and a 10-year risk of less than 7.5% using the ASCVD risk calculator should also consider statin therapy.

Metabolic Syndrome

Metabolic syndrome is a major risk factor for cardiovascular disease and includes:

Central Obesity: Waist circumference greater than 35 inches.
Elevated Serum Triglycerides: >150 mg/dL.
Low Serum HDL-C: <50 mg/dL.
Elevated Blood Pressure: >130/85 mmHg.
Fasting Plasma Glucose Level: >110 mg/dL [18].

Management of Prediabetes and Type 2 Diabetes

Menopausal women are at increased risk for diabetes due to decreasing estrogen levels, which result in decreased insulin sensitivity. Management includes:

Lifestyle Modifications: Consistent carbohydrate diet and regular physical activity.
Pharmacotherapy: Medications such as metformin, GLP-1 receptor agonists, empagliflozin, and liraglutide are effective in preventing cardiovascular disease in women with diabetes [4].
Antihyperglycemic Agents: Include sulfonylureas, dipeptidyl peptidase-4 inhibitors, thiazolidinediones, meglitinides, sodium-glucose cotransporter-2 inhibitors, GLP-1 receptor agonists, or insulin. The target A1c is less than 7% [4].

Conclusion

Cardiometabolic disorders are a significant concern for menopausal women. By understanding the risk factors and implementing lifestyle modifications and preventive treatments, we can help reduce the incidence of cardiovascular disease and improve the overall health and well-being of menopausal women. At Bonza Health, we are committed to providing comprehensive care and support to help women navigate this critical stage of life.

REFERENCES:

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