Menopause and Heart Health: Navigating the Cardiovascular Changes

Every three minutes, someone dies of cardiovascular disease (CVD). Worldwide, CVD is the leading cause of death in both men and women.¹

Before the menopause, CVD occurs more frequently in men than in women however, a women’s cardiovascular risk can rise sharply after she goes through the menopause, quickly catching up to men of a similar age and health profile. Historically, women’s CVD risk has been under screened and undertreated as they tend to develop heart disease at an older age than men and may experience different symptoms.²

Menopause, heart health and cardiovascular risk

It has long been known that oestrogen provides a protective effect on heart health.³ However, only recently have we gained a fuller understanding of the extent of this protection and the implications of losing it during menopause.

Oestrogen (specifically E2) plays a crucial role in regulating cholesterol levels, reducing the risk of fat build up in the arteries, maintaining healthy blood vessels, lowering oxidative stress, and preventing blood clotting. As oestrogen levels decline during menopause, lipid profiles can deteriorate, with increases in ‘bad’ low density lipoprotein (LDL) cholesterol and triglycerides and a decrease in ‘good’ high density lipoprotein (HDL) cholesterol. These changes contribute to accumulation of fat, which can lead to the formation of atherosclerotic plaques in the arteries, significantly elevating the risk of heart disease.³

Interestingly, recent studies have also shown that follicle-stimulating hormone (FSH) can also contribute to increased cholesterol production in the liver, independent of oestrogen levels. In a study involving 278 perimenopausal women, researchers found that despite similar serum oestrogen levels, FSH, total cholesterol, and LDL cholesterol levels were higher in perimenopausal women compared to their premenopausal counterparts.⁴

Additionally, during menopause, the body becomes less effective at controlling blood glucose levels, which can lead to weight gain, particularly around the abdomen, as well as an increased risk of type II diabetes and high blood pressure.³ Together, these factors can lead to the development of metabolic syndrome. The heightened sensitivity to sodium during this time can also cause fluid retention, further contributing to cardiovascular risk.⁵

Cardiovascular disease prevention should begin early for both men and women. However, for women, the perimenopausal and menopausal periods are key times to assess risk and introduce effective interventions. Early menopause is often linked to a higher risk of cardiovascular disease, due to the increased amount of time a women may experience raised cholesterol, making it an important factor for timely screening and management.³

Reducing the risk of heart disease after menopause: The role of nutrition

A substantial body of research indicates that lifestyle factors, such as physical activity, smoking, and diet, can significantly impact cardiovascular health.6 For instance, the PREMIER Trial demonstrated that lifestyle interventions could reduce the 10-year heart disease risk by 12-14%.⁷ The good news is that these lifestyle factors are modifiable risk factors.

A poor diet over time can increase the risk of heart disease and stroke. Diets high in saturated fats and low in vegetables, fruits, and fish have been linked to cardiovascular risk, though the exact causal relationships remain a topic of debate.^6,8,9

What dietary patterns can reduce the risk of heart disease after menopause?

Strong evidence shows that dietary patterns like the Mediterranean, DASH, Portfolio diets as well as Heart UK’s Ultimate Cholesterol Lowering Plan (UCLP) can reduce the risk of heart disease and support a healthy weight.^8-11 While the benefits of these diets are well-established, adopting them can be challenging.

In my clinical practice, I often advise women to start with small, manageable changes they can build upon over time. For example, swapping meat for plant-based alternatives is a simple yet effective way to lower LDL cholesterol. Replacement of meat can be done with non-animal protein foods including mycoprotein based meat substitutes like Quorn. Mycoprotein is a high protein, high fibre and low in total and saturated fat food source that is the main protein source in Quorn products.¹²

Research spotlight: Focus on cholesterol

Studies show that reducing saturated fat intake helps maintain normal blood cholesterol levels and is part of healthy, balanced diet.^6-9 Meta-analyses of trials examining the effects of substituting animal-based protein from dairy and meat with plant-based proteins from soy, nuts or legumes have found significant reduction in total, LDL and non-HDL cholesterol concentrations.¹³ The research looking at the impact on cholesterol levels by replacing meat with non-animal protein like mycoprotein-based substitutes has been interesting.

A pooled outcome of a recent comprehensive systematic review and meta-analysis of controlled trials of 12 studies found that swapping some or all meat with plant based or mycoprotein-based substitutes may lower circulating cholesterol concentrations and improve cardiometabolic risk factors.¹⁴ In a home-based intervention study including 72 overweight male and female adults, half of participants (n=39) ate meat and fish products daily as part of their regular diet, while the other half (n=33) were provided with mycoprotein products.¹⁵ Findings showed that participants who ate two servings of Quorn mince (180g of mycoprotein) had a 10-percent reduction in LDL cholesterol over the four-week intervention period. This equates to a 0.3 millimole per litre (mmol/L) decrease in LDL cholesterol levels in less than one month.¹⁵ Research reports that a decrease of 0.39 mmol/L in LDL cholesterol is associated with a 25-percent lower lifetime risk of heart and circulatory disease, so these findings are promising.¹⁶

Researchers in this study and similar studies attributed the observed benefits in cardiometabolic risk factors, particularly the reduction in LDL cholesterol, to the soluble fibre in mycoprotein.^15,17 The role of soluble fibre in absorbing cholesterol and promoting its excretion is well-established.

The fibre in Quorn mycoprotein is predominantly (80%) in the form of beta-glucan. Although the precise mechanisms are still under investigation, several theories have been proposed. One suggests that bacteria in the large intestine ferments soluble fibre into short-chain fatty acids (SCFAs), which helps lower cholesterol levels. Another theory proposes that soluble fibre may inhibit gut lipases (enzymes involved in fat digestion) and impair cholesterol and bile absorption.¹⁵

More research is needed, but current evidence indicates that regularly replacing meat with mycoprotein is a heart-healthy and easy-to-implement option. Additionally, the fibre in mycoprotein may help nourish the estrobolome ( the subset of microbes within your gut bacteria that impact the metabolism and the balance of hormones particularly oestrogen), regulate blood sugar levels, and control appetite—all crucial factors for women during menopause.^4,18

How can lifestyle factors help reduce the risk of heart disease after menopause?

While a healthy diet is crucial in preventing or reducing the risk of cardiovascular disease, no single food or nutrient serves as a cure-all. Lifestyle factors also play a significant role. Smoking, alcohol consumption, physical activity, mental stress, and obesity must be considered as part of a comprehensive approach to heart health.²

Additionally, evidence suggests that hormone replacement therapy (HRT) can lower the risk of coronary heart disease, heart attacks, and strokes.³ As health professionals, it is our responsibility to equip women going through menopause with the knowledge and tools they need to take effective and timely preventive measures, ensuring they understand the importance of heart health and how to reduce their individual risks.

About the Author:

Dr Linia Patel (PhD), RD, MBDA

Linia is a leading Dietitian, Sports Nutritionist and public health researcher with extensive experience in several nutrition settings including sports nutrition, women’s health, corporate wellness and public health. She also has a PhD in Public Health. Her passion is translating nutritional science into easy-to-digest and practical advice. She is the author of the book Food for Menopause.¹⁸

Website: www.linianutrition.com
Linkedin: https://www.linkedin.com/in/dr-linia-patel-phd-374012b/?originalSubdomain=uk

References

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3. Ryczkowska K et al. 2022. Menopause and women’s cardiovascular health: is it really an obvious relationship?Arch Med Sci 19(2):458-466
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12. Quorn Website. What is Quorn? 2024. Accessed here: https://www.quorn.co.uk/mycoprotein
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14. Gibbs et al. 2023. The effect of plant based and mycoprotein-based meat substitute consumption on cardio metabolic risk factors: a systematic review and meta-analysis of controlled intervention trials. Dietetics,2, 104 – 122
15. Pavis et al. 2024. A four-week dietary intervention with mycoprotein-containing food products reduces serum cholesterol concentrations in community dwelling, overweight adults: a randomised controlled trial. Clinical nutrition. 43 – 649 – 659
16. British Heart Foundation. 2024. A life of low cholesterol and BP slashes heart and circulatory disease risk. Accessed here: https://www.bhf.org.uk/what-we-do/news-from-the-bhf/news-archive/2019/september/a-life-of-low-cholesterol-and-bp-slashes-heart-and-circulatory-disease-risk
17. Shahid et al. 2022. The effect of mycoprotein intake on biomarkers of human health: a systematic review and meta-analysis. The American Journal of Clinical Nutrition. 118: 141 – 159
18. Patel Linia. 2024.Food for menopause. London. Murdoch Books.