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Heart, Stroke Risks Appear Before Menopause

Experts: Don't wait until after the change

FRIDAY, May 4 (HealthScout) -- While a woman's risk of heart attack and stroke goes up substantially after menopause, a careful look at standard risk factors just before menopause can tell who's at greatest danger, a study finds.

"Prevention strategies should not be put off until menopause," says a statement by Karen A. Matthews, leader of the researchers reporting the finding in the May issue of Stroke: Journal of the American Heart Association.

The study, at the University of Pittsburgh Medical Center, followed 372 women whose average age was 47.5. years. They had tests for well-established risk factors for cardiovascular disease, including blood cholesterol levels, blood pressure, blood sugar levels and body weight, before menopause and then one and five years after their menstrual cycles stopped.

Risk of stroke was estimated by ultrasound imaging in the years after menopause to detect thickening of the carotid arteries, which carry blood to the brain. That thickening is caused by formation fatty deposits called plaque that eventually can block a blood vessel, causing a stroke.

The greatest changes in risk factors, including blood cholesterol, blood fat and body mass index, occurred as the women moved into menopause, say the researchers. But the premenopausal readings were the best indicators of impending trouble, they say.

"Women who had elevated cholesterol, higher blood pressures and increased body weight before menopause had increased blood vessel thickening and atherosclerotic plaque formation in the neck arteries after menopause," says the Matthews statement.

"What's important about this study is that it highlights the risk factors that can be picked up before menopause and, if acted upon, can reduce risk," says Dr. Nieca Goldberg, chief of the Women's Heart Program at Lenox Hill Hospital in New York City and a spokeswoman for the American Heart Association.

"The perception of women is that they are not at risk of cardiovascular disease," Goldberg says. "They are more likely to think of breast cancer as the greatest threat. In fact, cardiovascular disease affects both men and women. It is the leading cause of death and disability in both."

Readings did not have to be in the established danger zone to indicate future trouble, the researchers say. Premenopausal readings at the high end of the normal range were associated with thickening of the artery walls more so than higher readings during or after menopause.

The rules about what is the normal range of risk factors, such as blood pressure and cholesterol levels, might have to be rewritten for women facing menopause, says Dr. Gretchen E. Tietjen, associate professor and chair of neurology at the Medical College of Ohio, in Toledo, and co-author of an accompanying editorial.

"It may be that someone with blood pressure at the high end of normal will have more risk than someone at the low end of normal," she says.

The study "raises the question of whether we may have to reset what we regard as normal," Tietjen says. "When I was doing my residency in the 1980s, 300 was regarded as normal for cholesterol, because that was what people in the general population were running. Now it is set at 200."

Not addressed in the study was the impact of hormone replacement therapy on the risk of heart attack and stroke. The reduced production of estrogen that occurs with menopause is associated with an increased risk for those diseases. "Estrogen has effects both on cholesterol levels and the flexibility of blood vessels," Goldberg says.

What To Do

"Premenopausal women should be screened by their physicians," says Tietjen. "Lipid profiles should be done, and they should have their blood pressure checked. This is a time when women in general are thinking less about their health care than they should. It corresponds to the time when mammograms should be started."

For information about cardiovascular risk factors for women, check the American Heart Association or the Centers for Disease Control and Prevention.

Read other HealthScout articles about heart disease and women.

SOURCES: Interviews with Nieca Goldberg, M.D., chief, Women's Heart Program, Lenox Hill Hospital, New York City; Gretchen E. Tietjen, M.D., chair of neurology, Medical College of Ohio, Toledo; May 2001 Stroke: Journal of the American Heart Association
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