Until around the age of 50, men have a much higher incidence of cardiovascular diseases than women of the same age range. However, as a recent study presented at the annual meeting of the American College of Cardiology has shown, women’s cardiovascular health declines rapidly after menopause, quickly reaching the same level of risk as men. of similar age and health profile.
In the study, researchers led by Ella Ishaaya, an internist at Harbor-UCLA Medical Center (Torrance, California), followed nearly 580 women who underwent two heart scans to determine their CAC score, a measure that tracks the accumulation of plaque (fat, calcium, and other substances) in the arteries of the heart. Each of them was related to a man with a similar profile. Those women who had a CAC value between 1 and 99 in the first test saw this increase in the second test by an average of eight points, twice as much as in the case of men. Those who started with a value between 100 and 399 also doubled the increase in the CAC level compared to men: 31 points on average by 16.
“It is a very interesting article because, reinforcing something that we already knew, it adds something new: instead of analyzing the incidence of cardiovascular accidents, it focuses its attention on a score of risk, the CAC, which allows us to verify the increased cardiac risk in women much earlier, before clinical complications appear,” Manuel Anguita, cardiologist at the Reina Sofía University Hospital in Córdoba, explains to EL PAÍS. member of the Spanish Society of Cardiology (SEC).
Anguita also highlights another strong point of the research: all the women who participated in the study were taking statins, a drug commonly used to control cholesterol levels. Its consumption, however, failed to stop the increase in cardiovascular risk. “This is a very striking aspect of this study and it is also new, because it indicates that this increase in risk that occurs after menopause is so intense that it is not counteracted even by taking statins, at least in low doses as the participants in the study were doing,” he reflects.
Why does this increase in cardiovascular risk occur in women? Both the principal investigator of the study and the SEC spokesperson agree in pointing out a hormonal factor: the drop in estrogen levels that women experience during menopause. The female sex hormone, according to scientific evidence, has a protective effect against the development of arteriosclerosis, since it reduces cholesterol levels. bad and increases “good” cholesterol. “By having a healthier fat lipid profile, premenopausal women have a lower risk of suffering from coronary arteriosclerosis. A protection that, as seen in this study, is lost after menopause,” says Manuel Anguita.
The cardiologist also points out the importance of the study results due to the fact that there is still a great lack of knowledge about this relationship and about the significance of cardiovascular and coronary disease in women. “On a medical level, I think it is a better-known topic, but in any case, we often still have the misconception in our minds that women are more protected against cardiovascular disease even after menopause. This study once again shows that this is not the case,” says Anguita, who believes that more attention must be paid to the symptoms of cardiovascular disease that appear in women (“not as characteristic as those of men, which often delays the diagnosis”), extend to women after menopause the same check-up, control, revision measures, etc., as other high-risk people, and, finally, “be more aggressive to lower cholesterol levels by increasing the dose of treatment with statins.
Risk of cognitive impairment
Of every ten cases diagnosed with Alzheimer’s, seven are named after a woman. There are several interrelated factors that could explain why dementia is a markedly feminine disease. One of them, as noted in the volume Neurology and women, edited by the Spanish Society of Neurology, is menopause and, especially, menopause when it occurs early, before the age of 45. A recent investigation, published in the journal Neurology, which followed more than 8,000 age-matched women and men enrolled in the Canadian Longitudinal Study on Aging, has shown for the first time that earlier menopause and increased cardiovascular risk are two risk factors that “work together.” ” and influence cognitive outcomes in women. Specifically, women in the study who had these two risk factors had significantly lower cognitive scores three years later.
The reason for this relationship, suggests Jennifer Rabin, a researcher at the University of Toronto (Canada), could also be explained in part from a hormonal point of view. According to the lead author of the study, menopause causes a decrease in levels of estradiol, a hormone that has many beneficial effects on the brain, including supporting the growth, development and protection of brain cells. “Women may lose some of these protective effects after menopause, which could explain why we see abrupt increases in dementia risk in women around this time. Not to forget, interestingly, we now know that brain changes related to Alzheimer’s disease begin to emerge decades before people develop memory problems, which coincides with the time when most women experience menopause. ”, he reflects.
Neús Falgás, member of the Behavior and Dementia Study Group of the Spanish Society of Neurology, recalls that menopause is associated with an increase in two risk factors for dementia: the aforementioned cardiovascular risk and an increase in disorders. related to sleep. “The lack of quality sleep and cardiovascular disease have always been closely linked to the increased risk of dementia and cognitive decline, because in some way they cause your brain to be more fragile. If you have a brain that has suffered from high blood pressure, sugar, cholesterol, etc., for many years, that brain is going to be more vulnerable to neurodegenerative diseases,” he explains.
The researcher at the Alzheimer’s and other cognitive disorders Unit at the Hospital Clínic of Barcelona regrets that there is still “little awareness” about this relationship and that women who live this life stage barely know that there are risk factors for dementia that are beginning to increase. after menopause “and that they have to take better care of themselves to try to stop this risk of neurological pathology.” In this same sense, Jennifer Rabin finally speaks out, considering that her research brings to the table an increasingly contrasted reality: “that women with menopause and cardiovascular risk represent a high-risk group for implementing specific prevention strategies.” of dementia.”
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