Aging and Heart Disease

Why does age affect my risk of heart disease?

Your risk of heart disease increases about 3-fold with each advancing decade. Older age is considered a risk factor for heart disease after age 55 for women and after age 45 for men. This is partly because many women younger than 55 have not yet gone through menopause and still have high levels of the female hormone estrogen in their blood. Estrogen produced by the body is thought to help protect the heart. After menopause, however, the levels of estrogen in a woman’s body drop significantly. On average, women develop heart disease about 10 to 15 years later than men.

Another reason that heart disease risk rises with age is because the buildup of fatty plaques in the arteries is a lifelong process. As you get older, blockages in the arteries get larger and may cause problems. These blockages can reduce the amount of blood and oxygen that reaches the heart, causing chest pain or heart attack.

How common is heart disease in older women?

More than 70 million Americans (37.6 million are women) have cardiovascular disease; almost 40% of these people are age 65 or older. On average, women have their first heart attack at age 70, while men have their first heart attack at age 66.6 For women who live to age 70 without heart disease, their remaining lifetime risk is 25%, while for men it is more than 30%.

Will age affect my chances of surviving a heart attack?

Yes. More than 83% of people who die from heart disease are older than 65 years. In part because they develop heart disease at an older age than men, women are more likely than men to die within a few weeks of having a heart attack.

Should my heart disease be treated differently because of my age?

No. However, there is evidence that doctors may under treat older patients anyway. This may be due to the mistaken belief that heart disease treatments are less effective in elderly people who often have other medical conditions as well as heart disease. In reality, the elderly benefit as much as younger heart disease patients from medical and surgical treatment to reduce the risk of dying or having a heart attack. It is also just as important for elderly people to reduce their risk factors, such as smoking and high blood pressure, as it is for younger people.

Treating high blood pressure with medication is particularly beneficial for patients 60 to 80 years of age. With these medications, older patients can reduce their blood pressure just as much as younger patients.

Managing cholesterol may be even more beneficial for elderly men and women than for younger patients. In one study of people with high cholesterol, cholesterol-lowering statin drugs didn’t significantly cut heart attack rates for those under 65 years of age, but they did cut the rate by 39% in those 65 years of age and older. Statins also reduced the risk of dying from a heart attack by 45% in men and women 65 years of age and older.

Older patients also do well with treatments to unblock clogged arteries including balloon angioplasty, stents, and heart bypass surgery. In fact, these treatments improve quality of life and decrease the severity of chest pain for the elderly more effectively than less invasive procedures.

What is menopause?

Menopause is a normal change in a woman’s life when her period stops. That’s why some people call menopause “the change of life.” During menopause, a woman’s body slowly makes less of the hormones estrogen and progesterone. This usually happens between the ages of 45 and 55. A woman has reached menopause when she has not had a period for 12 months in a row, and there are no other causes for this change (such as pregnancy). Menopause is considered early or premature if it occurs before age 40. The average age of menopause is 51 years.

During and after menopause, a woman’s ovaries no longer produce estrogen, though her body still produces a small amount of this hormone. It is partly this lack of estrogen that increases a woman’s risk for developing heart disease.

What is surgical menopause?

Surgical menopause is when your periods stop because of the surgical removal of the uterus. This procedure is called a hysterectomy, and it may also involve removing one or both ovaries. Your periods stop once your uterus is removed; however, your body will continue to produce estrogen if your ovaries are left intact . Eventually you will stop producing estrogen with natural menopause probably a year or 2 earlier than if you still had a uterus.

You may also have surgery to remove your ovaries that leaves your uterus in place. This procedure is called oophorectomy. If both ovaries are removed, you will enter menopause. If only one is removed, you will continue to have periods until natural menopause. In addition, some medical treatments such as radiation treatment (e.g., for cancer) may damage the ovaries and trigger menopause.

Each year, more than 600,000 hysterectomies are performed in the US. About one third of women in the United States have had a hysterectomy by age 60. Black, Hispanic, and American-Indian women are significantly more likely to have a hysterectomy than white women, while Asian/Pacific Islander women are less likely.

Should I consider hormone therapy to reduce my risk of heart disease?

No. Even though your body’s natural estrogen can help protect your heart, studies have shown that simply taking replacement estrogen doesn’t have the same benefits. In fact, in some studies, women taking hormone therapy actually had a higher risk of heart disease. Scientists now think that the estrogen a woman’s own body produces acts differently than manufactured forms of the hormone. Ongoing trials of hormone therapy are investigating whether these findings are true for all postmenopausal women and all types of hormone therapy. One recent study indicated that heart risk did not increase, and may even have dropped slightly, in younger woman who start taking hormones soon after menopause.

How will menopause affect my risk of developing heart disease?

Whether or not you have gone through menopause is more important than your age in terms of your risk of heart disease. Heart disease rates in women after menopause are 2 to 3 times that of premenopausal women of the same age. Among the 2,873 women in the Framingham Heart Study, heart disease rates in postmenopausal women aged 45 to 54 were twice that of premenopausal women of the same age.

Early or premature menopause has been linked to early death. A 1999 study of more than 6,000 women found that those who underwent early menopause (ages 35 to 40) had a greater likelihood of dying early from any cause and specifically dying from heart disease. Early surgical menopause may also increase a woman’s risk for heart attack and stroke, particularly if the ovaries are removed.

Does age or menopause have an effect on other risk factors for heart disease?

Yes. The risk of developing diabetes, high blood pressure, and high cholesterol increases with age. Almost all risk factors become more common in women than in men at older ages because women live longer than men. Only smoking remains more common in older men.

Menopause, either natural or surgical, increases your levels of total cholesterol. It also increases levels of chemicals involved in the body’s immune system response, such as interleukin-6, and it increases levels of homocysteine, a protein linked to the development of damaged arteries. Both of these compounds may increase your risk for heart disease.

The risk of developing metabolic syndrome – a collection of risk factors including a large waistline, higher than normal blood sugar, blood pressure, and triglycerides – is higher in postmenopausal women than premenopausal women.

Age & Menopause – Age and Stroke

How common is stroke in older women?

Stroke is a major health issue for postmenopausal women. Over half of all stroke patients older than 65 are women, and women account for 61% of all stroke deaths. Just like heart disease, your risk of having a stroke increases steadily as you grow older. For adults over 55 years of age, the lifetime risk of stroke is greater than 1 in 6. Women have a higher risk than men, perhaps because on average women live longer than men. About 2% of women aged 40 to 59 suffer a stroke; this goes up to 6% of women aged 60 to 79 and 12% of women older than 80 years.

Why does age affect my risk of stroke?

Stroke risk increases with age for many reasons. To start, the buildup of fatty plaque-in the arteries is a lifelong process. As arteries become gradually more blocked over time, the chances of a blockage being large enough to cause problems increase. Nearly all of the body’s energy-transforming (metabolic) processes are affected in some way by aging, and this often means that risk factors that increase stroke risk also become more common and more severe the older you get. After menopause, hormonal changes mean that women lose some of the protective effects that the female hormone estrogen has against risk factors for stroke and cardiovascular disease. As women age, they are more likely to develop stroke risk factors such as high blood pressure, high cholesterol and triglycerides, and to become overweight. These factors can combine to greatly increase a woman’s stroke risk.

Will age affect my chances of surviving a stroke?

Yes – the likelihood of dying if you have a stroke increases gradually as you age. Nearly 90% of stroke deaths occur in people aged 65 and older—the average age at death from stroke is 80 years.

Stroke leads to death more often in older people because the disorders that lead to stroke progress over time, causing more damage or becoming more severe. In addition, older people are likely to have other medical conditions that may reduce their body’s ability to cope with the effects of a stroke.

Because women live longer than men and are usually older at the time of a stroke, more women than men die of stroke each year. Women accounted for 61% of US stroke deaths in 2004, even though they accounted for less than 50% of all strokes.

Despite the aging of the population as a whole, stroke death rates have actually been decreasing. Researchers believe this is due to better detection and treatment for risk factors such as high blood pressure.

Should my risk of stroke be treated differently because of my age?

No. It is just as important for elderly people to reduce their risk factors, such as smoking, excess weight, and high blood pressure, as it is for younger people.

Treating high blood pressure with medication is particularly beneficial for patients aged 60 to 80 years. With these medications, older patients can reduce their blood pressure just as much as younger patients.

Managing cholesterol may be beneficial for elderly men and women too. In one study of people with high cholesterol, cholesterol-lowering statin drugs cut the rate of stroke by 40% in those 65 years and older.7 Statins reduce the chances of having a first stroke by about 30% in women who have high cholesterol. Stroke survivors who take statins have a 16% lower chance of having another stroke within 5 years and are 43% less likely to die of a stroke.

Age – Menopause and Stroke Risk

What is menopause?

Menopause is a normal change in a woman’s life when her periods stop—some women call menopause “the change of life.” During menopause, a woman’s body slowly makes less of the hormones estrogen and progesterone. This usually happens between the ages of 45 and 55. A woman has reached menopause when she has not had a period for 12 months in a row, and there are no other causes for this change (such as pregnancy). Menopause is considered early or premature if it occurs before age 40.  The average age of menopause is 51 years.

During and after menopause, a woman’s ovaries no longer produce estrogen, though her body still produces a small amount of this hormone. It is partly this lack of estrogen that increases a woman’s risk of having a stroke.

What is surgical menopause?

Surgical menopause is when your periods stop because of the surgical removal of the uterus. This procedure is called a hysterectomy, and it may also involve removing one or both ovaries. Your periods stop once your uterus is removed; however, your body will continue to produce estrogen if your ovaries are left intact.10, 11 Eventually you will stop producing estrogen with natural menopause, probably a year or 2 earlier than if you still had a uterus. You may also have surgery to remove your ovaries but that leaves your uterus in place. This procedure is called oophorectomy. If both ovaries are removed, you will enter menopause. If only one is removed, you will continue to have periods until natural menopause. Some medical treatments, such as radiation treatment for cancer, may damage the ovaries and trigger menopause.

Each year, more than 600,000 hysterectomies are performed in the US. One in three women in the US have had a hysterectomy by age 60.  African-American, Hispanic, and American-Indian women are significantly more likely to have a hysterectomy than white women, while Asian/Pacific Islander women are less likely.

Should I consider hormone therapy to reduce my risk of stroke?

No. Clinical trial data indicate that estrogen plus progestin hormone therapy, as well as estrogen alone, increases stroke risk in healthy postmenopausal women and provides no protection against stroke for women with established heart disease. The Women’s Health Initiative clinical trial examined 16,608 generally healthy postmenopausal women and found that estrogen plus progestin increased stroke risk by 44%, including in women with no history of cardiovascular disease.

If you are currently taking hormone therapy and are worried about increased stroke risk, see your doctor about gradually tapering off.

Does age at menopause affect my risk of having a stroke?

Early or premature menopause has been linked to early death. A study of more than 6000 women found that those who underwent early menopause (ages 35 to 40) had a greater likelihood of dying early from any cause.

However, with respect to stroke, a study involving close to 20,000 Norwegian women found no link—after a 37-year follow-up – between age at natural menopause (early, normal, or late menopause) and dying from stroke. A Spanish study also found no significant relationship between having a stroke and particular age at menopause.

Do age and menopause have an effect on other risk factors for stroke?

Yes. The risk of developing diabetes, high blood pressure, and high cholesterol increases with age. Almost all risk factors become more common in women than in men at older ages because women live longer than men, and after menopause women lose the protective benefits of estrogen. Only smoking remains more common in older men.

Menopause, either natural or surgical, increases your levels of total cholesterol. It also increases levels of chemicals involved in the body’s immune system response, such as interleukin-6, and it increases levels of homocysteine, a protein linked to the development of damaged arteries. Both of these compounds may increase your risk of stroke.The risk of developing metabolic syndrome – a collection of risk factors for both heart disease and stroke, including a large waistline (greater than 35 inches), higher than normal blood sugar, blood pressure, and triglycerides – is higher in postmenopausal than premenopausal women.

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