Certain reproductive health events have been linked to increased risks for heart disease. But women and their doctors can do a lot to reduce those risks.
Anybody who gets an annual checkup knows that heart health is often at the top of the list, which is why measuring blood cholesterol, blood sugar, and blood pressure is important. These and other indicators, like family history, can help tell who’s at risk for problems like heart attacks and stroke down the road.
For women, though, researchers are finding that reproductive health events, such as having a pregnancy complication or experiencing early menopause, can also help predict future incidents of cardiovascular events. And knowing about these risks can be the first step to prevention.
“We want to make sure that women are aware that heart disease is their number one killer,” said Samar R. El Khoudary, Ph.D., M.P.H., an epidemiologist and associate professor of clinical and translational science at the University of Pittsburgh. If women know what’s driving that outcome, including these lesser-known risk factors, they can talk to their physicians, she explained. And their physicians can take extra steps to help them nurture a healthy heart. “Awareness is key,” she said.
Through papers recently published in Circulation Research and JAMA, medical researchers, including El Khoudary, shared what healthcare providers and the public should know about reproductive events that can influence women’s cardiovascular disease risks.
Early or Late Menstruation
Some girls begin their periods early – before age 12 or even before age 10 or 11, and research shows this early timing is linked to a 15-30% increased risk for cardiovascular disease. Late menstruation, starting after age 17, has also been associated with increased risks.
Researchers aren’t sure why these connections exist, but they have found that children who were born at a low birthweight, who have had weight fluctuations, and those with higher body weights were more likely to experience menstruation at earlier ages.
While it’s likely too early to talk to a young girl about her long-term risks for heart disease, El Khoudary said, she hopes her health care providers are aware about these links. “They could monitor the girl in this stage or even make an effort in educating her family,” she said. Paying attention to other events during the early reproductive years, including whether high blood pressure, or hypertension, develops, is also critical, she said.
“Cardiovascular risks and conditions are silent,” explained Patrice Desvigne-Nickens, M.D., a medical officer within the Division of Cardiovascular Sciences’ heart failure and arrhythmias branch at NHLBI. That’s why she encourages young people thinking about pregnancy to check in with their doctor in advance about any underlying risks. They can then work with their healthcare provider to create a plan to support a heart-healthy pregnancy.
Once a person becomes pregnant, a window to future health opens. “Pregnancy is a sensitive period that can tell healthcare providers a lot about the future,” said Lynn Yee, M.D., M.P.H., an assistant professor of maternal-fetal medicine at Northwestern University’s Feinberg School of Medicine.
For instance, developing high blood pressure or diabetes during pregnancy, as well as having a preterm birth or a baby who is small for its gestational age, are pregnancy complications linked to a nearly doubled risk for cardiovascular disease later in life.
“This continues to surprise people,” Yee said.
And it’s easy to see why, she explained. The focus of most pregnancies is on immediate outcomes, like having a healthy birth. Many expectant parents don’t realize that long-term risks are connected to complications that can happen during and soon after pregnancy.
One recent study found that women who developed gestational hypertension – high blood pressure that’s often diagnosed after 20 weeks of pregnancy – were more likely to have a heart attack or coronary event 30 years after their first pregnancy compared to other types of cardiovascular events. And those who developed preeclampsia, a rise in high blood pressure that can affect other systems and organs, had an increased risk for stroke as early as 10 years after their first pregnancy.
Researchers found that most of this increased risk can be explained by problems the person developed after pregnancy, like high blood pressure, high cholesterol, high blood sugar, or changes in body weight, such as being overweight or obese.
Yee said that when pregnant and postpartum individuals are made aware of this type of information, it resonates. She recalled one new mother with preeclampsia who, after hearing about her own increased risk for heart disease, said, “Nobody ever told me that before. I just figured that once my preeclampsia was done, it was done.”
The good news, Yee said, is that many new mothers seem eager to make changes once they know what’s at stake. “Sometimes just having that conversation, that health education moment, is all patients really need to be able to say, Okay, I’m going to get that primary care doctor, I’m going to work on the weight loss, I’m going to keep breastfeeding [which also helps protect the heart] for as long as I can,” she added.
Yee also emphasized the important role healthcare providers and systems have in helping to facilitate these connections.
Around the time women reach the end of their reproductive years – typically near age 50 – they and their doctors get another glimpse into their future heart health. And it often starts near the transition to menopause.
Changes in cholesterol that can increase the risk for heart disease can occur one year before and after menopause. Other changes, such as abdominal weight gain, hormonal fluctuations, and a narrowing and stiffening of the arteries, can also occur during this period.
It’s why El Khoudary said supporting the cardiovascular health of women preparing for this transition is critical. “Midlife is a special stage in a woman’s life,” she explained. They may be taking care of their parents or helping their children at college. They could have a career change. “Usually, women put everything aside for themselves and focus on the people around them.”
Cardiovascular risk factors may influence when menopause starts, research increasingly shows. Around 1 in 10 women start menopause early – between ages 40-45, or prematurely before age 40. And these women have increased risks for experiencing a future cardiovascular event, such as a heart attack or heart failure, years later.
El Khoudary said that as healthcare providers work with women on the best ways to counteract these risks, it’s essential for them to partner with women through clinical research studies.
“We learn from their participation,” El Khoudary said. “When women participate in clinical research, they provide researchers with data to help them, help their daughters, help their granddaughters, and empower women’s health in general.”
Through such studies, researchers are learning how women who have had previous cardiovascular events may benefit from added support, such as taking cholesterol-lowering medications or hormone therapy, to further reduce their risks for heart disease.
Yee said it’s also essential to find ways to help women, especially those with the greatest risks for heart disease, access this kind of care.
“We are just learning so much about women’s heart health,” Yee added. “And hopefully about ways to provide even more personalized interventions.”
To learn more about women’s heart health, visit https://www.nhlbi.nih.gov/health-topics/education-and-awareness/heart-truth/listen-to-your-heart.