It has long been known that a woman's risk for heart disease rises after the onset of menopause. But is that the result of falling levels of the hormone estrogen that accompany menopause or actually a consequence of aging?
The answer to the question has long eluded researchers. Conflicting evidence has caused some to suggest that heart risk has an effect on menopause instead of the other way around, pushing women into an early end to their menstrual periods. A decade of controversy surrounding the risks and benefits of hormone replacement therapy—including whether it protects women against heart attacks—has fueled the confusion.
Now a provocative study led by researchers at the University of Pittsburgh sheds new light on the issue, demonstrating that a woman's LDL or bad cholesterol rises markedly during the year before and after menopause begins—the time period that coincides with a significant drop in levels of estrogen. The findings were published this month in the Journal of the American College of Cardiology.
In the study involving 1,054 women, average LDL levels ranged between 113 and 116 during three to five years before the last menstrual period, and then rose to above 125 by the year after menopause before leveling off in the subsequent three to five years at just below 130.
Current government cholesterol guidelines regard 130 as borderline optimal for most people, with levels below 100 viewed as optimal. For patients with other risk factors such as high blood pressure or being overweight or having a family history of heart disease, the predominant advice is to get LDL levels below 100.
The study "helps to understand the role of a woman's natural estrogen in protecting the heart and affecting risk factors for coronary disease," says JoAnn Manson, chief of preventive medicine at Harvard-affiliated Brigham and Women's Hospital, Boston, who wasn't involved with the study.
The Middle-Aged Heart
The level of LDL cholesterol jumps an average of 10% in the years around menopause. Here are some steps to take:
Get your LDL cholesterol checked and keep the level under 130; under 100 is optimal.
Get at least 30 minutes of aerobic exercise a day.