Age – Menopause and Heart Failure

How does age affect my risk of heart failure?

A woman’s risk of developing heart failure dramatically increases with age, as seen in the figure below.

As we age, so does our heart. Pumping the equivalent of about 1 million barrels of blood in an average lifetime through 60,000 miles of blood vessels takes its toll on the heart. An aging heart takes longer than a younger heart to relax and fill with blood and to contract and pump out blood, 2% to 5% longer each year after the age of 45.

Aging reduces the amount of muscle cells in your heart and causes your blood vessels to lose elasticity and become stiffer. The heart has to work harder to pump blood through these stiffer blood vessels. To compensate for this added stress, the remaining muscle cells enlarge up to 40%, and the wall of the pumping chambers (the ventricles) grow thicker so that they can pump with more force. For a while, this adaptation works well at supplying the body’s need for oxygen-rich blood. In the long term, however, a thicker wall can become stiff and limit the heart’s ability to fill with blood, which may be why older people with heart failure (the majority are women) are more likely to have diastolic heart failure.

The heart’s ability to adapt to these age-related changes slows down in the oldest ages; this may explain why women over 80 years of age have a much higher risk of developing heart failure than a 60-year old woman. Conditions such as high blood pressure and coronary artery disease, all of which become more prevalent with age, can also worsen the enlargement of the heart muscle cells and the stiffening of the blood vessels.

One age-related change unique to women is the shrinking of the ovaries, the main suppliers of estrogen. A woman’s risk of developing heart failure increases after menopause.

How common is heart failure in older women compared with men?

About 70% of women with heart failure are over the age of 50, according to data from a national survey and the Framingham Heart Study. Although the risk of developing heart failure is higher in men than in women, after the age of 80 a greater number of women than men have the condition because more women than men live into their 80s, when heart failure is most common. Women tend to develop heart failure later in life than men and are, on average, about 5 years older than men when first diagnosed with heart failure. Women are also more likely to have diastolic heart failure than systolic heart failure.

The risk of developing diastolic heart failure increases with age. Women aged 65 and older are twice as likely as men to have diastolic heart failure. Nearly 50% of all heart failure patients over the age of 70 have diastolic heart failure, compared with 33% between the ages of 50 and 70 years and 15% at younger than 50 years.

Does age affect my chances of surviving heart failure?

Older women are more likely to die of heart failure than younger women are because the conditions that lead to heart failure progress over time, causing more damage or becoming more severe. Older women are also likely to have other medical conditions that may reduce their body’s ability to cope with the effects of heart failure, such as high blood pressure.

The likelihood of dying of heart failure increases with age. About 90% of all deaths caused by heart failure occur in people over the age of 65. One study of nearly 8000 adults (25% were women) with heart failure found that each 10-year increase in age was associated with a 28% increase in the risk of dying. Another study found that the average survival for women after being first hospitalized for heart failure decreased with age, as shown in the table below.

Women’s Average Survival After – First Hospitalization For Heart Failure
Age Average Survival
67 to 74 4 years
75 to 84 3 years
85 and older Less than 2 years

More women than men die of heart failure each year, most probably because women live longer than men and are usually older when first diagnosed with heart failure. Women accounted for nearly 60% of US heart failure deaths in 2004.

Should my risk of heart failure be treated differently because of my age?

It is just as important for older people to reduce their risk factors for heart failure as it is for younger people. The risk of developing high blood pressure and diabetes increases with age. Treating high blood pressure with medication is particularly beneficial for women after menopause. Menopause coincides with stiffening arteries and an increase in blood pressure; whether this is due to aging, estrogen deficiency after menopause, or other unknown factors is not clear.

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