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Heart Disease: Risk factors for CVD

Weight: Being overweight is a significant risk factor for CVD and is an increasing problem in the western world. Obesity is more common in men than women before the age of 45, but after 45, the trend reverses. During the menopause, there is a shift in fat distribution and storage in women from the hips to the waist, more resembling that of men. This is often referred to as the “pear” to “apple” shape, the apple shape being associated with an increased risk of CVD. Waist circumference reflects this risk; women with a waist circumference greater than 88cms are thought to have an increased risk of CVD.

Blood pressure: High blood pressure (hypertension) is also a major risk factor for CVD and after the age of 45, more women than men develop hypertension. Control of hypertension has been shown to reduce the risk of heart disease and stroke.

Cholesterol: Cholesterol is a waxy substance, which is required by the body to form part of every cell, and to produce important chemicals like vitamin D and some hormones. There is “good” cholesterol (HDL) and “bad” cholesterol (LDL). If there is too high a level of LDL and/or too low a level of HDL, cholesterol can be deposited inside blood vessels causing narrowing and increasing the risk of CVD. Raised cholesterol is therefore a significant risk factor for CVD. Menopause is associated with a progressive increase in total cholesterol, with, in particular, an increase in LDL and decrease in HDL. Total cholesterol levels peak in women at 55-65; about 10 years later than the peak in men.

Smoking: Tobacco use is one of the most important risk factors for CVD for both men and women, although the risks associated with smoking are consistently higher in women than in men. Although more men than women in general smoke, the important and encouraging decline in tobacco use among men is worryingly less apparent in women.

Diabetes:  Diabetes is becoming increasingly common in both men and women. The risk of death from heart disease associated with diabetes is higher in women than men.

Untreated early or premature menopause: estrogen has favourable effects on the cardiovascular system and consequently loss of estrogen affects cardiovascular risk, with significant increased risk if estrogen is lost at an earlier age than usual. All women who experience an early or premature menopause should be offered and should consider taking hormonal therapy, at least until the average age of the menopause, uness they have a medical reason not to take HRT.

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