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Postmenopausal women with hardened arteries may need stronger treatment than men of the same age and health status to prevent heart attacks. Getty Images
  • New research finds that the risk of heart attack is higher for postmenopausal women with hardened arteries than it is for men of the same age and health status.
  • Women may need stronger treatment to help prevent heart attacks.
  • Researchers say the differences in risk are due to structural differences in the arteries between men and women.

Women with clogged arteries face a greater risk of heart attack and may need stronger treatments during postmenopausal years than men of the same age and health status.

“That’s all according to research presented at the European Society of Cardiology’s EACVI 2023 event and published in European Heart Journal Cardiovascular Imaging.”

The findings suggest the differences come down to structural differences in the arteries.

In other words, women’s coronary arteries are slightly more narrow than men’s so the same amount of plaque could have a more significant impact on blood flow.

The increased risk for women during this life stage is also attributed to the natural decline of heart-protective estrogen. During menopause, estrogen levels decline which may leave women more vulnerable to adverse heart disease outcomes.

The study included nearly 25,000 people who were originally referred for coronary computed tomography angiography (CCTA) to obtain 3D images of the arteries in the heart and then enrolled in the CONFIRM registry. The CONFIRM registry was conducted in six countries in North America, Europe, and Asia.

“Since atherosclerotic plaque burden is emerging as a target to decide the intensity of therapy to prevent heart attacks, the findings may impact treatment,” study author Sophie van Rosendael, MD, of Leiden University Medical Centre in the Netherlands says in a press release. “Our results indicate that after menopause, women may need a higher dose of statins or the addition of another lipid-lowering drug.” The study authors also note more studies are needed to confirm these findings.

“Females tend to have smaller coronary arteries and therefore, the same amount of plaque causes a relatively higher degree of obstruction and consequently has a larger impact on blood flow,” says Anja Wagner, MD, FACC, a cardiologist with St. Vincent’s Medical Center says.

“Another contributing factor may be the fact that women with the same risks as men are a third less likely to receive appropriate treatment,” she says.

Danine Fruge, MD, ABFP, medical director of Pritikin Longevity Center adds that maintaining the balance between the typical demands of life and self-care can be challenging for men as well as women of all ages.

“However, women in their postmenopausal years often experience the additional self-care challenge of ‘the sandwich generation’ or when they invest significant time caring for both their children and their aging parents,” says Dr. Fruge. “They may also care for siblings and other aging relatives, as well as having the responsibility of full-time employment, the home management, community, etc.,” she adds.

Know your risks

“Your best defense against heart disease is a healthy lifestyle with regular exercise and a healthy diet to reduce your risk factors,” Dr. Wagner tells Healthline.

She says heart attacks and strokes can be prevented if you follow American Heart Association guidelines including:

  • Not smoking
  • Eating a heart-healthy diet
  • Exercising for a minimum of 30 minutes per day 5 times per week
  • Managing weight
  • Keeping blood pressure under control

“When diet and exercise are not enough, medication to control cholesterol, and/or blood pressure may have to be initiated,” says Wagner.

Prioritize heart health with self-care

“Prioritize self-care,” says Fruge. “Self-care refers to taking the time to keep up with preventive medical health visits and screenings to prevent or detect disease in the early stages,” she explains.

In the case of heart disease, Fruge says prevention would include managing blood pressure, cholesterol, blood sugar, belly fat, sleep habits, and stress.

“Self-care also means making time for healthy food, exercise, and downtime, which also decreases risk of heart disease,” she says.

Consider the role of gender socialization in how we care for our health

Fruge adds more to the story.

“Traditionally, [cisgender] women have been socialized to care for everyone else first before taking care of their own needs,” she adds. “Even with the best intentions, a woman often runs out of time or energy or both before she is able to do what she needs to do to protect herself from disease.”

It’s important for women to know their personal risk factors and advocate for themselves with their physicians, experts say.

“It starts with awareness,” says Wagner. She then explained awareness goes beyond knowledge, it extends to self-advocacy. “Awareness means knowing personal risk factors and discussing ways to reduce their risk with their physician,” she explains.

For Fruge, it comes down to making an appointment with a preventive cardiologist to assess your personal risk factors and follow a plan to mitigate that risk.

“A simple imaging test that gives a coronary calcium score can be a useful screening along with advanced blood test analysis such as the Cardio IQ can be very useful in identifying early preclinical disease,” Fruge tells Healthline.