If you ask most women over 40 what they think their biggest health risk would be, most would think of breast cancer. And while it is true that awareness campaigns over mammography and early detection have brought breast cancer much more into our consciousness, the truth is that coronary heart disease (CHD) is actually the leading cause of death in North American women. Rates are also increasing in developing countries, making this an increasingly global problem.
It is true that heart disease is relatively rare in pre-menopausal women: our higher levels of estrogens appear to have a protective effect. Lower estrogens after menopause, however, appear to cause changes in our lipid profile, and levels of heart disease gradually rise to rates similar to men’s.1
In terms of the ‘numbers’, it turns out that low levels of HDL or ‘good’ cholesterol are actually the best predictor of heart disease risk in post-menopausal women. The reason for this appears to be that the mechanism for coronary blockages in women is slightly different than men.
Statin drugs, also, may not be as effective for women as they are for men, one study showed that 65-75% of cardiovascular events (heart attacks and strokes) still occurred even with the use of these drugs. There is also little current evidence that drug therapy is actually that helpful for women who do not have established heart disease or elevated risk of heart disease due to diabetes or familial factors.
So what can be done to raise HDL cholesterol and lower heart disease risk? This is an area where dietary and lifestyle interventions—the kind of health promotion strategies central to naturopathic medicine—can have a critical effect. Increasing numbers of studies, for example, are showing that a Mediterranean style diet, rich in fruits, vegetables, olive oil and omega-3 fats, and low in processed carbohydrates, can both raise HDL levels and greatly lower cardiovascular risk. Additionally, it appears that the HDL effects of this diet are greater in women than men, suggesting an even greater beneficial effect.
Gentle aerobic exercise, additionally, has been shown to preferentially increase HDL levels while decreasing levels of LDL and total cholesterol, affecting rates of heart disease in women. And it doesn’t have to be Olympic level-exercise to be beneficial—several studies showed lowering of heart disease risk with 3.5 hours/week of moderate walking (about 30 minutes a day), particularly when subjects were previously sedentary. While it is also true that risk of heart disease and stroke decreases further with higher activity levels, women who currently struggle to fit exercise programs into busy work and family commitments should be encouraged that even a little exercise is good for your heart.2
Similarly with sleep—many women in my practice say they struggle with finding regular restful sleep. This could be due to many factors--menopausal hot flashes, snoring partners, or job stress are a few common factors. However, regular sleep is a more important factor than many of us may realize: recent studies are showing that chronically cutting back on sleep can increase the stress hormone cortisol, which can increase baseline blood sugar, and both decrease HDL and increase risks for heart disease and diabetes. 3
For women who may still need help to raise HDL levels above and beyond what can be accomplished with a healthy plant-based diet and gentle exercise, your ND may consider supplementation with omega-3 fatty acids, soluble dietary fibres such as inulin, or food-based nutrient therapies such as policosanol or niacin (vitamin B3). Often these gentle therapies can help raise HDL levels and lower inflammation without causing unpleasant side effects such as muscle weakness, headaches, nausea, or back pain, among others. Another nutrient that may be beneficial to lower cardiovascular risk is supplementing with Vitamin D, which most Canadians are deficient in during our winter months.5
Hormone therapies for post-menopausal women can sometimes be used to increase HDL and lower heart disease risk. However, standard HRT use has been controversial since the publication of the Women’s Health study in early 2000s showed increased risks of both heart disease and breast cancer when HRT medications were used in women more than 10 years’ post-menopause. That being said, one often overlooked fact is that the WH trial and all of the large trials from this period in North America studied synthetic HRT products—molecules which are not identical to naturally produced human hormones. During this same period, several less publicized studies (several from France) that used bio-identical hormones (BHRT) did not show increases in heart disease or breast cancer risk when used in women within 10 years of menopause.5,6
When appropriately used, natural estrogens and progesterone can improve HDL and LDL cholesterol levels, as well as favourably influencing bone density, menopausal symptoms and quality of life. While not a panacea, when added to appropriate dietary, exercise, and supplementation programs, bio-identical hormones can be used safely and effectively for some patients to help support healthy heart function.
Globally, many of my patients are surprised at how much control they actually have over many of the factors that cause heart disease, as well as the fact that it isn’t just a question of cholesterol and not smoking. Of course, quitting smoking remains the most important thing any woman can do to decrease her risk of heart attack and stroke, but beyond that, it can be a pleasant surprise to find out that small, easily accomplished changes to diet, and gentle, regular exercise, and focused supplementation or medicines can have a beneficial effect on not only the numbers, but also the quality of life as women move beyond menopause.
- Kafonek SD. Postmenopausal hormone replacement therapy and cardiovascular risk reduction. A review. Drugs 1994;47(Suppl 2):16-24.
- Carnethon MR Physical activity and cardiovascular disease: how much is enough? Am J Lifestyle Med. 2009 July; 3(1 Suppl):44S-49S.
- Anderson JL et al. Relation of vitamin D deficiency to cardiovascular risk factors, disease status and incident events in a general healthcare population. Am J Cardio 2010
- Shankar A, Syamala S, Kalidindi S. Insufficient rest or sleep and its relation to cardiovascular disease, diabetes and obesity in a national, multiethnic sample. Plos One. 2010 Nov; 5:11, e14189.
- Clarkson TB J Repr Med 1999;44(2 Suppl): 180-84.
- Fournier A et al. Breast cancer risk in relation to different types of hormone therapy in the E3N-EPIC cohort. Int J Cancer 2005; 114:3:448-454.
For additional information about Dr. Marianne Trevorrow
ND please visit: www.drmarianne.ca