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Long-term effects of the menopause: arterial disease LONG-TERM EFFECTS OF THE MENOPAUSE: ARTERIAL DISEASE
Disease of the arteries is the Number One cause of death in women over 50. Whether the cause is heart attack or stroke, arterial disease kills one woman in every four.
The arteries carry blood from the heart all round the body, and so it is important for our health that they remain in good condition. If they become narrowed, or clogged up, then the blood can't flow so freely, and there is a much increased chance that the flow will suddenly become completely restricted, causing a heart attack or a stroke.
Some of the factors that contribute to heart disease are outside our control, such as the natural ageing process, and the hereditary aspect of heart disease; other risk factors we can do something about, by giving up smoking, not drinking too much alcohol, taking enough exercise, eating the right diet and learning how to handle stress.
One of the factors that increases the risk of developing diseases of the arteries is being male; until the age of 40-50, far more men than women die of heart disease. In fact, it is unusual for otherwise healthy pre-menopausal women to have heart attacks, whereas, sadly, it is not unusual for men in this age group to do so. The reason is thought to be the protective effect of a woman's oestrogen. Once a woman is past the menopause (whether natural or surgical) her risk of having a heart attack increases, until by the age of 75-80 she has the same risk as men.
The reason for this is possibly to do with cholesterol. There are two forms of cholesterol flowing through the blood vessels: low density lipoproteins (LDLs) which build up on the walls of the blood vessels and are 'bad for you', and high density lipoproteins (HDLs) which are 'good for you' because they latch on to the LDLs and absorb them through the artery walls to be disposed of by other organs in the body. Many years of research have shown that oestrogen lowers the level of LDLs and raises the level of HDLs. As high levels of LDLs increase the risk of arterial disease (by blocking the arteries), and high levels of HDLs are good for you (because they remove the LDLs), oestrogen has a very positive protective effect.
Also, at times of increasing age, when the major arteries of the body are narrowing, HRT is thought to widen them and so allow blood to flow more freely. In fact, women on HRT tend to have healthier arteries than those not on it; even women of 70 or more can benefit from this protective effect of HRT.
As you will read in Chapter 8, there is a small but increased risk of developing breast cancer after several years on HRT, a fact that has received a lot of publicity. However, heart disease and stroke are the largest single cause of death among women in this country, completely dwarfing the number of deaths from breast cancer. The average reader of this book over the age of 50 is many times more likely to die from heart disease or stroke than from breast cancer (although under the age of 50 the risk of breast cancer is greater). A great deal of research has been carried out in recent years into HRT's effect on menopausal symptoms and osteoporosis, but much less into its effect on arterial disease. This balance is beginning to change, and over the next few years more will become known about the effect different hormones have on heart disease and stroke. Although HRT was originally prescribed primarily to treat hot flushes, etc, and more recently also to prevent osteoporosis, it is likely that in future years it will be prescribed mainly for its role in reducing the risk of heart disease and stroke. Even now, it is thought that women who take oestrogen have one-third to one-half the risk of developing these two conditions than women who don't.
(It is worth noting here that almost all the studies that show the beneficial effect of oestrogen on arterial disease have been carried out on women taking oestrogen alone, and not oestrogen with progestogen, although recent work suggests that progestogen may not detract from oestrogen's cardiovascular protection; there have not yet, however, been any results based on long-term data.
To gain significant protective effect against arterial disease, you may need to stay on HRT for two years or so, preferably longer, and the effect will diminish once you stop. Even then, the oestrogen only reduces your risk of developing these diseases, it cannot guarantee that you won't get them. We are not immortal!
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