Heart and vascular health

• What are the risk factors for heart disease and stroke?
• How can I reduce the risk of heart disease and stroke?
• How does hormone therapy affect my risk for cardiovascular disease?
• How does hormone therapy impact risk of stroke?

What are the risk factors for heart disease and stroke?

While family history and genetics do play a small role in the risk of heart disease, around 94% of risk factors for cardiovascular disease are those that can be modified by changes in lifestyle. These risk factors include:

• Diabetes
• High blood pressure
• Abdominal obesity
• Current smoking
• Psychosocial stress
• Smoking
• Inactive lifestyle

Menopausal women are at increased risk compared to pre-menopausal women, due to the loss of the protective effect of estrogen. Genetics and lifestyle can also impact lipids. These should be checked as a baseline at the time of menopause. If there are abnormalities discovered, the issue should be addressed.

Women who had pregnancy complications are also at increased risk for heart disease. Hypertension in pregnancy, pre-eclampsia, diabetes in pregnancy and pre-term birth are all factors that predispose women to heart disease. Tell your doctor if you have had any of these complications.

How can I reduce the risk of heart disease and stroke?

A healthy lifestyle is the key to preventing heart disease and stroke. A healthy lifestyle means:

• Not smoking
• Maintaining a healthy body weight
• Exercising (at least 150 minutes per week)
• Eating well, increasing the number of colourful vegetables on your plate, moderating red meat and salt
• Maintaining a healthy blood pressure
• Moderating alcohol consumption

How does hormone therapy affect my risk for cardiovascular disease?

The relationship between hormone therapy and risk of heart disease is still an active area of research. The timing of starting estrogen is important. For older women, those who initiate combined hormone therapy 10 or more years after menopause are at increased risk for cardiac events. This increased risk does not apply to women who were started at an earlier age, and are still on hormones. Women with established coronary artery disease are advised not to start hormone therapy. On the other hand, women who start hormone therapy shortly after menopause have a reduced risk for heart disease or death. In spite of these benefits, hormone therapy is not recommended for cardiac protection, the mainstay of prevention remains the healthy lifestyle as listed above.

How does hormone therapy impact risk of stroke?

Risk of stroke increases with high blood pressure, age, previous cardiovascular disease, and use of oral hormone therapy. There is no increased risk of stroke in women younger than 60 or who are within 10 years of menopause. Hormone therapy increases risk of stroke in women over 60 or more than 10 years past menopause, but the incidence is very low.