Menopause is an ideal time to address CVD risk

Menopause provides the ideal opportunity to review with patients their risk for cardiovascular disease, and to reinforce heart-healthy behaviors.

“There is no doubt that risk of heart disease increases with menopause,” as stated at the annual meeting of the Society of Obstetricians and Gynecologists of Canada.

In Canada, one in three women dies from heart disease or stroke, which makes these two conditions the leading cause of death among women, greater than all forms of cancer combined. “For the first time in 30 years, women have caught up to men when it comes to the number of deaths from cardiovascular disease,” a cardiologist who directs the cardiac prevention and rehabilitation center at St. Michael’s Hospital and is a spokesperson for the Heart and Stroke Foundation of Ontario, both in Toronto said.

Moreover, the risk of dying within the first 30 days of a myocardial infarction is 16 percent higher for women compared with men. The same goes for stroke, which confers an 11 percent higher risk of death within 30 days for women compared with men. “Women are less likely to be treated by a specialist, are less likely to be transferred to another facility for treatment, and are less likely to undergo cardiac catherization or revascularization.”

Despite the well-known risks, awareness of heart disease risk among women is generally poor, only one in eight Canadian women understands that heart disease and stroke are her most serious health concerns, whereas only one woman in three knows that the condition are the leading causes of death.

In an effort to improve the current knowledge gap, St. Michael’s is teaching primary care physicians to administer a Framingham risk calculation as a way to assess a woman’s risk of developing coronary artery disease. A software program circulates the woman’s 10-year risk of a heart attack based on factors including age, blood pressure, smoking status, lipids, fasting blood glucose, and family history. The score “may underestimate some risk, but it’s what we are using.”

(The assessment is similar to the National Heart, Lung, and Blood Institute’s tool for estimating the 10-year risk of having a heart attack.)

It also recommends a discussion of risk reduction strategies — including smoking cessation, healthful eating choices, exercise, and weight-loss tips when needed — during each visit. “It’s very hard to make lifestyle changes,” “ encourage people to make small changes over time. Most heart attacks aren’t sudden — they take many years of preparation.”

Most smokers want to quit, yet only about one-third of smokers report receiving smoking-cessation advice from their physician.

Finding a way to personalize the effects of smoking cessation is also the key. “Tell the women their skin will look better and younger if they quit.“ “That’s an important motivator.” So is the phrase, “Your children want you to quit so you can be around for your grandchildren.”

That visceral obesity is associated with conditions that lead to heart disease, including increased LDL cholesterol, decreased HDL cholesterol, high triglycerides, diabetes, insulin resistance, increased insulin levels, abnormal blood clotting, glucose intolerance, and poor blood-vessel function. “In menopause, the fat distribution of women changes.” “They are more likely to take on an apple-shaped figure than a pear-shaped one.”

The Heart and Stroke Foundation of Canada has launched “The Heart Truth” campaign aimed at educating women about their risk for coronary heart disease. The campaign includes a dedicated Web site where women can receive a customized risk profile; a public awareness campaign including television, public-service announcement, brochures, and posters; and a documentary DVD on women survivors of heart disease.

The campaign advises women to take action and talk with health care professionals about treatment options for risk factors such as high cholesterol, high blood pressure, and smoking.

“You have a role to play. You have an opportunity to take care of women around the time of menopause and try to reduce their risk factors.”