Twelve years after her mom died of congestive heart failure at age 80, Heather Davis (not her real name) experienced menopause. As the vivacious, active African-American woman celebrated her 54th birthday, she worried about the effect menopause might have on her genetic predisposition to heart disease. This life change raises certain risk factors for cardiovascular illnesses, and Davis was concerned.

Experts agree that women should be cognizant of their health during menopause, as females face an overall increase in heart attacks about 10 years after they stop menstruating for good.

During menopause women undergo a decline in estrogen, a female hormone that helps to relax blood vessels to facilitate blood flow. When estrogen levels drop, blood vessels can stiffen and lose their flexibility. In addition, when women don’t produce enough estrogen, levels of LDL, or bad cholesterol, can increase while quantities of HDL, the good cholesterol, decrease. The imbalance can cause fat and cholesterol in the arteries to build up, which contributes to the risk for heart attack and stroke.

But additional changes that occur during menopause, such as an elevation in blood pressure and increases in triglycerides (a type of fat in the blood), may also boost women’s risk for heart disease.

To counter these problems, doctors advise individuals to embrace a healthy lifestyle, which means they should maintain an appropriate body weight, exercise throughout the week, eat well, avoid or quit smoking, and treat and control any medical conditions.

“I think going through menopause is one of the most challenging things,” says Suzanne Steinbaum, DO, a spokesperson for the American Heart Association. “One of the things I often say to women is, ‘Train for menopause like you’re training for a marathon because you’re in it for the long haul.’

“It’s not about the quick fix on Monday, Tuesday and Wednesday,” she continues. “It’s about making lifestyle changes during menopause that are sustainable because it’s going to go on for a while. What I say to women is: Don’t give up, don’t get frustrated and just keep going.”

This is exactly what Davis did. Every morning she gets up at 6:30 and meets her sister, Bernice, who is almost 16 years older, at a local high school track. They walk for about an hour and then go home to eat a healthy breakfast that they take turns preparing.

“We’ve been able to control our weight and manage the aches and pains that come and go with age,” Davis says. “Neither she nor I are on any prescription medications for heart problems, or any health issues, and we definitely want to keep it that way.”

Unlike their mother, who smoked from age 19 to 59, the sisters never puffed on cigarettes. “My mother developed an enlarged heart from years and years of hard work,” Davis says. “That period of time she was a smoker certainly didn’t help to keep her heart healthy. Nowadays, people know much more about how certain habits and behaviors can ruin their health. My mom could have probably lived for many more years if she’d never started smoking.”

The 40 years that Davis’s mother smoked cigarettes coincides with her entering the age range during which women become more likely to develop metabolic syndrome. This collection of risk factors for heart disease, stroke and diabetes may rise rapidly in the years prior to menopause, according to findings.

“I guess you can say that’s why we ladies of a certain age just keep it moving,” says Davis with a brief, low laugh that ends in a wistful smile.

Get Smart

Make these changes and help your heart.

Jennifer H. Mieres, MD, FACC, and Stacey E. Rosen, MD, FACC, are leading cardiologists, each with 25 years of experience in medicine. The two wrote the book Heart Smart for Women: Six S.T.E.P.S. in Six Weeks to Heart-Healthy Living to help women create an action plan to boost their heart health.

“This can be anything from choosing to move every day to decreasing the amount of unhealthy fats in your daily diet,” they say. “Any type of daily exercise, combined with small but meaningful changes in your daily food choices, can have a tremendous impact on your health.”

In addition, Mieres and Rosen urge women to learn their family history and consider their chances of developing heart disease. “Some risk factors can be controlled, such as blood pressure, smoking, cholesterol and a lack of regular activity,” they advise, adding, “even though you can’t control factors such as age, gender and family.”

What’s more, the cardiologists tell women they should know their levels of total cholesterol, HDL and LDL cholesterol, blood pressure, blood sugar, body mass index (a ratio of height to weight) and waist circumference, since these numbers alert individuals about the state of their health.

The doctors’ complete six-week plan prompts women to assess their personal risk factors, offers clear step-by-step instructions on how to begin or advance an exercise regimen, helps women choose heart-healthy foods to eat—at home and when dining out—and suggests ways to form and maintain a strong partnership with their physicians to improve the health of their heart.