New Delhi: Women may need to pay more attention to their heart health well before menopause. A long-running study suggests that their cardiovascular clock may start ticking much earlier than previously thought.The study analysed 6,760 participants in the US and followed measurements from three visits over 14 years. Researchers found that pulse pressure began shifting from a falling to a rising trajectory around 37-39 years in women, compared with about 47 years in men.The study, recently published in the journal Hypertension, challenges the commonly held assumption that the rise in arterial stiffness and pulse pressure among women is primarily a consequence of the hormonal changes accompanying menopause. The widespread assumption has been that the rise in arterial stiffness among women is accompanied by the fall in oestrogen and the arrival of menopause.Pulse pressure reflects, among other factors, the stiffness of the large arteries. In younger adults, it tends to fall as the aorta grows and becomes better able to accommodate blood ejected by the heart. With ageing, the aorta progressively stiffens and pulse pressure begins to rise.The study suggests that the change in pulse pressure from a falling to a rising pattern begins in women in their late 30s, which is a decade earlier than in men. Among some women, this change comes nearly two decades before menopause.Dr Narender Singh Jhajhria, director professor and head of cardiothoracic and vascular surgery (CTVS) at Atal Bihari Vajpayee Institute of Medical Sciences and RML Hospital, said: “In India, the incidence of women with coronary artery disease before menopause is increasing for sure, although oestrogen was supposed to be a protective factor for women. So, an early screening and modification of prevalent risk factors among younger women in their 30s should be considered.”He added that the reasons could include the increasing prevalence of diabetes, lifestyle changes and metabolic syndrome or obesity in Indian women.What is striking in the new analysis is how early this transition appears to occur in women. Depending on the timing of menopause, the pulse-pressure low point was found six, 14 or 19 years before menopause. The researchers found no meaningful relationship between the age at which a woman reached menopause and when her pulse pressure began its upward trajectory.The study also found that although women had lower pulse pressure than men earlier in life, the rise became faster in women after midlife. By around 60 years, women had a higher average pulse pressure than men.For Dr Rekha Mishra, associate director, clinical & preventive cardiology, Medanta, Noida, the findings underline the importance of monitoring blood pressure, cholesterol, blood sugar, weight and other cardiovascular risk factors from early adulthood, particularly among those with a family history of heart disease or other risk factors.“Heart disease prevention cannot begin when symptoms appear. It needs to start much earlier because cardiovascular risk factors and vascular changes can remain silent for years. For women, it is important not to assume that cardiovascular risk begins only after menopause,” she said, adding that identifying and addressing the risk factors early could provide an opportunity to intervene before significant vascular changes or cardiovascular disease develop.Cardiologists also stress that the study does not establish that menopause has no cardiovascular effect, nor does it mean that pulse pressure alone should determine treatment. The research is observational and cannot establish cause and effect.Dr Aparna Jaswal, director, cardiology, Fortis Escorts Heart Institute, Okhla, said women should use their 30s and 40s as a prevention window. Her advice includes regular blood pressure checks, monitoring cholesterol and blood sugar/HbA1c, keeping track of weight and waist circumference, assessing family history of premature heart disease, hypertension, diabetes and stroke, and maintaining regular aerobic exercise along with strength training.She also advised a heart-healthy diet, no tobacco, limited alcohol intake, and paying attention to sleep and chronic stress.
