What is heart health?

Heart health is a concern during aging, as well as for women experiencing menopause. As we age our hearts tend to become enlarged and start to stiffen, this decreases how well our hearts can fill with blood leading to an increased risk of cardiovascular disease (CVD) [1]. Additionally, our arteries become thicker and less elastic, often causing hypertension, or an increase in blood pressure, in older adults [2, 3]. 

How does the menopause effect heart health?

In terms of heart health during menopause, the decrease in oestrogen experienced can increase the risk of CVD. Oestrogen is a protective factor against CVD as it helps to control cholesterol levels. Therefore, reducing the risk of cholesterol building up in blood vessels and causing blockages to blood flow. It increases the levels of HDL cholesterol (which removes “bad” cholesterol from the blood) and decreases the levels of LDL cholesterol in the blood [4]. 

When oestrogen levels reduce, this increases the risk of cholesterol build up increases. This increases the risk of coronary heart disease occurring, a condition in which the heart’s blood supply is disrupted or blocked due to the cholesterol build up. This condition can lead to further complications such as heart attack or stroke, if left untreated [5]. 

High blood pressure (hypertension) is also a risk factor for coronary heart disease. As previously mentioned, the thickening and loss of elasticity in arteries due to age can contribute to this, as the heart must work harder to push enough blood around the body to transport oxygen. Treating high blood pressure is another technique that could be implemented to reduce the risk of coronary heart disease [6].

Finally, weight gain during the menopause may be another risk factor for CVD. Women gain an average of 1-2kg during the perimenopausal period, or more if they are overweight or obese before menopause. Weight gain occurs due to changes in hormone levels. Low oestrogen levels can cause hard to lose visceral fat to be stored in the lower abdomen area. Fat storage in this area can lead to an increased risk of insulin resistance and type 2 diabetes, as well as heart disease [7]. 

How can nutrition be used to benefit heart health?

Nutrition can be an effective way to manage symptoms of aging and to decrease the risk of developing CVD, for example:

1. Increasing intake of unsaturated fats (to increase HDL cholesterol levels) and decrease intake of saturated and trans fats (to decrease LDL cholesterol levels) [8]. 
2. Decreasing intake of processed and red meats and replacing with plant-based protein sources, fish, and poultry as this is associated with a lower incidence of CVD [9]. 
3. Try implementing elements of the DASH diet, aimed at reducing blood pressure, by consuming whole grains, fruit, vegetables, and low-fat dairy products, and avoiding foods high in salt and saturated fats [10].
4. Increase your intake of foods containing plant sterols (fruit and vegetables), which helps to reduce blood cholesterol levels [11]. 
5. Aim to increase intake of fruit and vegetables as these have protective effects on CVD, with risk decreasing up to an intake of 800g per day [12].
6. Increase intake of pulses, such as beans and lentils. These foods are associated with a reduced risk of chronic heart disease [13].
7. Consume fish at least once a week, preferably oily fish. These foods are high in omega-3 fatty acids and have been shown to reduce the risk of mortality in coronary heart disease. They are also used to treat hyperlipidaemia and hypertension. Some plant-based omega-3 sources include walnuts, seaweed, edamame, and chia seeds [14].
8. Similarly, to the DASH diet, the Mediterranean diet has a protective effect against CVD. This diet consists of fruits, vegetables, legumes, nuts, beans, cereals, wholegrains, fish, and unsaturated fats, with a low intake of meat and dairy [15].

Top Tips for Heart Health in Menopause

1. Use beans and lentils instead of mincemeat in spaghetti Bolognese, cottage pie, and lasagne.
2. Ensure that you add at least one source of fruit or vegetables into each meal, to increase intake of plant sterols. You can use frozen and tinned foods too.
3. Snack on carrot sticks, apples, and unsalted nuts, instead of products high in salt to decrease overall salt intake.
4. Bake, steam, and roast foods in oils low in saturated fats, rather than frying in butter.
5. Add flavour to meals by using herbs and pepper, rather than adding extra salt when cooking or at the table.

References

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6616540/

[2] https://www.ahajournals.org/doi/10.1161/hypertensionaha.114.03617 

[3] https://www.msdmanuals.com/en-gb/home/heart-and-blood-vessel-disorders/biology-of-the-heart-and-blood-vessels/effects-of-aging-on-the-heart-and-blood-vessels 

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5688223/ 

[5] https://www.bhf.org.uk/informationsupport/support/women-with-a-heart-condition/menopause-and-heart-disease 

[6] https://www.ahajournals.org/doi/10.1161/hypertensionaha.114.03617 

[7] https://pubmed.ncbi.nlm.nih.gov/23460719/ 

[8] https://pubmed.ncbi.nlm.nih.gov/11593354/ 

[9] https://heart.bmj.com/content/early/2021/10/10/heartjnl-2019-316373 

[10] https://heart.bmj.com/content/early/2021/10/10/heartjnl-2019-316373 

[11] https://pubmed.ncbi.nlm.nih.gov/24468148/ 

[12] https://heart.bmj.com/content/early/2021/10/10/heartjnl-2019-316373

[13] https://heart.bmj.com/content/early/2021/10/10/heartjnl-2019-316373

[14] https://pubmed.ncbi.nlm.nih.gov/25720716/ 

[15] https://pubmed.ncbi.nlm.nih.gov/29177567/