By Joel Kahn, MD

Reviewed by Kim Ross, DCN

January 23, 2024 

Did you know that for every year extra a woman continues to have a menstrual cycle, her risk of cardiovascular disease decreases by 1%?(1)

A focus on heart health

Cardiovascular disease (CVD) is an “umbrella term” that includes all diseases of the heart (cardio) and vessels (vascular), such as coronary heart disease, hypertension, myocardial infarctions (heart attack), and stroke. Cardiovascular disease is the leading cause of death in women, accounting for 50% of all cases as of 2023 (2), a drastic increase from previous reporting in 2021 in which heart disease accounted for one in every five deaths, as reported by the CDC. While many factors contribute to heart disease, such as smoking, physical inactivity, excess weight, stress, and excessive alcohol consumption, there is a clear distinction in the increased rate of CVD in postmenopausal women, including those who (2,3):  

• Are 55 years and older
• Experience premature onset of menopause (cessation of menses) before 40 years of age 
• Experience early menopause between 40 and 45 years of age
• Undergo surgical menopause (bilateral oophorectomy, regardless of if the uterus has been removed)

In addition, women who have vasomotor symptoms, sleep disorders, and depression also show an increased risk for CVD (2).

Cardiovascular disease is not just the number one cause of death in men and women 65 and older in the United States, but it is also a leading factor in deteriorating quality of life (4). Inefficient blood flow can occur, which leads to decreased oxygen delivery to tissues throughout the body, causing low energy and reduced endurance. Compromised cardiovascular health can also impact sexual health and put an end to many activities, travel, and experiences in your patient’s lives that bring them joy. 

Abnormal lab results can include high total cholesterol, (oxidized) LDL cholesterol, triglycerides, glucose and/or insulin levels, and decreased HDL cholesterol, including HDL fractions. Lipoprotein(a) cholesterol levels may also increase, putting arteries at risk. For more details on laboratory testing, see the blog called 4 Steps for Cardiovascular Health Prevention Using Laboratory Assessments. 

How does the loss of hormones impact cardiovascular disease?

Changes in lipids: The loss of hormones post-menopause results in the acceleration of increases in total cholesterol, low-density lipoprotein cholesterol (LDL), and triglycerides, while reductions of high-density lipoprotein cholesterol (HDL) can also occur (2,5). 

Changes in lipids lead to coronary artery disease or atherosclerosis (the narrowing of the arteries due to plaque buildup caused by fat, cholesterol, and calcium). It is reported that the protective effects of estrogens on the atherosclerotic process are the main reason women develop CVD 7-10 years later than men (2). 

Additionally, the hormone changes due to menopause likely directly affect the blood vessels, increasing pro-clotting factors and inflammation, decreasing blood flow, increasing vasoconstriction, and increasing circulating levels of nitric oxide and prostaglandins (2).

Glucose and insulin dysregulation: Postmenopausal women are at increased risk for metabolic syndrome, glucose dysregulation, weight gain, and central adiposity—all known risk factors for CVD (2).

Changes in heart rate and palpitations: Menopause is also associated with increased heart rate and palpitations, with 42% of perimenopausal and 54% of postmenopausal women experiencing this symptom (6). These symptoms may not be a sign of cardiac distress but rather a symptom of anxiety or stress (6), which are also known contributors to CVD.

The role of hormones in cardiovascular health:

• Estradiol helps to maintain the elasticity of arteries and blood vessels (7).
• Estradiol activates the gene responsible for the activity of high-density lipoproteins (HDL) (8). HDL helps transport cholesterol from the blood to the liver and other organs. 
• Estradiol aids in the reduction of low-density lipoproteins (LDL) and may also act as an antioxidant (9,10). 
• Estradiol acts as an insulin sensitizer (11). As cells become resistant to insulin, blood glucose rises, increasing diabetes and heart disease risk. 
• Progesterone helps protect arteries from spasms (12). 
• The adrenal hormone cortisol affects sleep, energy, hair growth, muscle growth, and weight. Adrenal dysregulation and the biological effects of stress, mediated by hormones produced in the adrenal glands, play a significant role in obesity and its consequences, including inflammation, insulin resistance, hypertension, atherosclerosis, and other conditions constituting metabolic syndrome (13,14).
• Thyroid hormones impact the metabolic rate (15).

Supporting hormones and heart health naturally

The clinical research on FemmenessencePRO™ (Maca-GO®) in peri and post-menopausal women provides insight into improving hormone levels and positively impacting multiple cardiovascular risk factors. 

FemmenessencePRO™ supports the body’s production of hormones, including estrogen (helping to maintain the elasticity of the arteries and blood vessels) and progesterone (protecting the arteries from spasms). Of note, when estradiol levels improved to an optimal level, based on that woman’s biological age, these levels plateaued, meaning levels were not increased to abnormally high or inappropriate for their age.

Image 1: Estradiol levels, placebo vs. Maca-GO®. Data extracted from (16)

Further, the clinical trials demonstrated improvements in triglycerides, LDL-cholesterol, HDL-cholesterol, body weight, and blood pressure.

Image 4: HDL Cholesterol levels,placebo vs. Maca-GO®.Data extracted from (18)

Image 5: Body weight, levels, placebo vs. Maca-GO®.Data extracted from (18)

Image 6: Systolic blood pressure, levels, placebo vs. Maca-GO®.Data extracted from (18)

Image 7: Diastolic blood pressure, levels, placebo vs. Maca-GO®.Data extracted from (18)

Concluding Thoughts

Hormones, specifically balanced hormones, are essential to heart health in peri and post-menopausal women. However, many other factors must be assessed and treated as part of a comprehensive, personalized plan, such as nutrition, physical activity, emotional and mental health support, and addressing environmental factors impacting hormones and heart health. 

With this in mind, the Symphony Natural Health Medical Team created a comprehensive Heart Health Guide that can be a resource for you and your patients. It can be found in the Clinical Toolkit.

 

About the Author: Dr. Joel Kahn is a cardiologist and expert in plant-based nutrition and holistic care. He is a clinical professor at Wayne State University and the founder of the Kahn Center for Cardiac Longevity.

References

1. Hall PS, Nah G, Howard B V., Lewis CE, Allison MA, Sarto GE, et al. Reproductive Factors and Incidence of Heart Failure Hospitalization in the Women’s Health Initiative. J Am Coll Cardiol. 2017;69(20). 

2. Kamińska MS, Schneider-Matyka D, Rachubińska K, Panczyk M, Grochans E, Cybulska AM. Menopause Predisposes Women to Increased Risk of Cardiovascular Disease. J Clin Med. 2023 Nov 13;12(22):7058. 

3. Malek AM, Vladutiu CJ, Meyer ML, Cushman M, Newman R, Lisabeth LD, et al. The association of age at menopause and all-cause and cause-specific mortality by race, postmenopausal hormone use, and smoking status. Prev Med Rep. 2019;15. 

4. Centers for Disease Control and Prevention. Heart Disease Facts [Internet]. 2022 [cited 2023 Apr 20]. Available from: https://www.cdc.gov/heartdisease/facts.htm

5. Derby CA, Crawford SL, Pasternak RC, Sowers M, Sternfeld B, Matthews KA. Lipid Changes During the Menopause Transition in Relation to Age and Weight: The Study of Women’s Health Across the Nation. Am J Epidemiol. 2009;169(11). 

6. Carpenter JS, Sheng Y, Pike C, Elomba CD, Alwine JS, Chen CX, et al. Correlates of palpitations during menopause: A scoping review. Womens Health (Lond). 2022;18:17455057221112268. 

7. Guo X, Razandi M, Pedram A, Kassab G, Levin ER. Estrogen induces vascular wall dilation: Mediation through kinase signaling to nitric oxide and estrogen receptors α and β. Journal of Biological Chemistry. 2005;280(20). 

8. Lopez D, Sanchez MD, Shea-Eaton W, Mclean MP. Estrogen activates the high-density lipoprotein receptor gene via binding to estrogen response elements and interaction with sterol regulatory element binding protein-1A. Endocrinology. 2002;143(6). 

9. LaRosa JC. Metabolic effects of estrogens and progestins. Fertil Steril. 1994 Dec;62(6 Suppl 2):140S-146S. 

10. Sugioka K, Shimosegawa Y, Nakano M. Estrogens as natural antioxidants of membrane phospholipid peroxidation. FEBS Lett. 1987 Jan 1;210(1):37–9. 

11. Yan H, Yang W, Zhou F, Li X, Pan Q, Shen Z, et al. Estrogen improves insulin sensitivity and suppresses gluconeogenesis via the transcription factor Foxo1. Diabetes. 2019;68(2). 

12. Miyagawa K, Rösch J, Stanczyk F, Hermsmeyer K. Medroxyprogesterone interferes with ovarian steroid protection against coronary vasospasm. Nat Med. 1997 Mar;3(3):324–7. 

13. Kargi AY, Iacobellis G. Adipose tissue and adrenal glands: Novel pathophysiological mechanisms and clinical applications. Vol. 2014, International Journal of Endocrinology. 2014. 

14. Jeong IK. The role of cortisol in the pathogenesis of the metabolic syndrome. Vol. 36, Diabetes and Metabolism Journal. 2012. 

15. Mullur R, Liu YY, Brent GA. Thyroid hormone regulation of metabolism. Physiol Rev. 2014; 

16. Meissner HO, Mscisz A, Reich-Bilinska H, Mrozikiewicz P, Bobkiewicz-Kozlowska T, Kedzia B, et al. Hormone-Balancing Effect of Pre-Gelatinized Organic Maca (Lepidium peruvianum Chacon): (III) Clinical responses of early-postmenopausal women to Maca in double blind, randomized, Placebo-controlled, crossover configuration, outpatient study. Int J Biomed Sci. 2006; 

17. Meissner, HO Mscisz, A Bilinska-Reich, H, Kapczynski, W, Mrozikiewicz, P Bobkiewicz-Kozlowska, T Kedzia, B Lowicka, A Barchia I. Hormone-Balancing Effect of Pre-Gelatinized Organic Maca (Lepidium peruvianum Chacon): (II) Physiological and Symptomatic Responses of Early-Postmenopausal Women to Standardized doses of Maca in Double Blind, Randomized, Placebo-Controlled, Multi-Centre C. Int J Biomed Sci. 2006;2(4):360–74. 

18. Meissner HO, Reich-Bilinska H, Mscisz A, Kedzia B. Therapeutic Effects of Pre-Gelatinized Maca (Lepidium Peruvianum Chacon) used as a Non-Hormonal Alternative to HRT in Perimenopausal Women - Clinical Pilot Study. Int J Biomed Sci. 2006;