Menopause & Heart Health: Navigating Cardiovascular Wellness As We Age with Dr. Jayne Morgan

Heart disease is the number one killer of women. But, it’s not talked about nearly as much as it is with men. Are you even surprised? At Alloy, we want to help you live as healthfully as you can for as long as you can. And, we’re lucky to have friends like Dr. Jayne Morgan to help us do just that!

Dr. Jayne Morgan is a cardiologist and the Executive Director of Health and Community Education at the Piedmont Healthcare Corporation in Atlanta, GA. Her resume is incredibly impressive–she’s received many awards for her work and has been published in the areas of Congenital Heart Disease, Interventional Cardiology, and Covid19. For more about Dr. Morgan, check out her website and follow her on Instagram @drjaynemorgan.

She recently sat down with Alloy’s community manager Rachel Hughes to talk about heart health and menopause, which are more connected than you might realize. Here are some highlights from the interview, which has been edited for clarity and brevity. Watch the whole thing on our YouTube!

Rachel Hughes:

Let’s get started. Hello, Dr. Morgan. Welcome everyone. 

To begin, let’s lay some foundation around heart disease and menopause. Can you explain the changes that occur in a woman’s cardiovascular system during perimenopause and menopause? And can you talk about how hormonal fluctuations affect our heart health?

Dr. Jayne Morgan:

Sure! That’s a great question, and unfortunately it’s still poorly understood.

As we get older, and certainly as we enter the perimenopausal years, which can start in your thirties even if you’re still having regular menstrual cycles and are not symptomatic, your estrogen levels may begin to go down. Estrogen has cardioprotective factors to it. That’s right, estrogen itself provides some protection for the heart. The other thing to know is that estrogen also has anti-inflammatory properties. Chronic inflammation is a causative factor for the progression of what we call hardening of the arteries, or atherosclerosis, which is plaque buildup in your arteries that can lead to heart attacks. So, estrogen is so important. It’s one of the reasons that prior to menopause, women have half the risk of heart disease compared to that of men. That’s significant. And once we’re in our seventies, we actually have a higher risk of heart disease than men. So, we’re trying to dial this back, unravel it, and understand the role of estrogen. 

Rachel Hughes:

That's fascinating. One of the things that actually prompted me to start taking menopausal hormone therapy was that my father had died of heart disease, and my heart palpitations were intense, and my hot flashes and night sweats were intense. I know palpitations may not be an indicator of heart disease, but hot flashes can be. Is that right? 

Dr. Jayne Morgan:

Both are right. Palpitations can certainly be an indicator of heart disease, and you should never ignore them if you're having palpitations. The caveat to that is, if you're in the perimenopausal years, the drop in estrogen can also cause palpitations, and so that would mimic heart disease in a patient when it's not actually heart disease. But, if you’re having them, you should always get it checked out, even if you think it’s perimenopause or menopause. 

The first thing to do if you’re having palpitations is to see your physician to make sure there’s no cardiac cause for them. There probably isn’t, but we don’t want to miss something because heart disease remains the number one killer of all Americans. If your workup is negative, it’s time to talk with your physician about Menopausal Hormone Treatment, because palpitations don’t feel good, and you don’t have to suffer. Globally, women’s suffering is accepted. We’re supposed to suffer. We even accept it ourselves. But there’s no reason to. 

And we’re just now connecting a lot of dots. And so when you go to a doctor, you may actually have more information than them. So arm yourself. Have the information, provide the resources, and get second opinions where you feel you should. And when it comes to things having to do with menopause, you may want to look for physicians who are menopause-certified.

Rachel Hughes:

Thank you for that, Dr. Morgan. I was thinking as you were speaking that many of us don't realize the interplay between conditions like high blood pressure, cholesterol, blood sugar, if I'm not mistaken, and heart disease. So could you just shed light on some of those secondary conditions that might contribute to heart disease or the risk of heart disease?

Dr. Jayne Morgan:

And we have to think about other things like arthritis and rheumatoid arthritis, all of these things. How are they interconnected, and how are they giving us hints as to our health and how should we move forward? 

So, as we enter into menopause and as we are going through perimenopause, our estrogen levels are dropping, and your blood pressure may start to increase, even if you’ve never had issues before. And that needs to be controlled, and you may need blood pressure medication. Because, like I mentioned, heart disease is the number one killer of women. It’s not breast cancer. It’s heart disease. So, if you’re prescribed medication, take it.

But, also be aware that this may be related to your dropping estrogen levels. So, have that conversation with your doctor too. And if you use Menopausal Hormone Treatment, it may help. But the most important thing is to control your blood pressure. Even if it is your hormones. Control it.

And that goes for diabetes and cholesterol, too. These are risk factors for heart disease, and that's how we start to inch closer and closer and closer to the risk of a heart attack as we get older. We also struggle with sleeplessness, and duration and quality of sleep, we now know, is a risk factor for heart disease. We need to look at the risk factors and get them under control.

Rachel Hughes:

I appreciate that. Can you just talk a bit about a heart attack and how that differs in men and women and when should we be taking the possibility of a heart attack seriously? It sounds so weird to ask it that way!

Dr. Jayne Morgan:

No, it's a great question. How are we describing heart attacks and why don't we take it seriously? The first heart attack of a woman is more often fatal than the first heart attack of a man. And that is because we don't take our symptoms seriously and our doctors don't take our symptoms seriously. Now, you’re probably saying, “That’s not me. If I have chest pain, I’m going straight to the emergency room.”

Here’s the thing. If you have chest pain, you will go straight to the emergency room. If you have shortness of breath, you will go straight to the emergency room. But a lot of women don’t have those symptoms. And because we're not taught about these other symptoms of a heart attack that may be more specific to women, we're less likely to seek help for them. We don't recognize them as related to our heart. And your physician may not recognize them either. Your symptoms might be tiredness, or cold and flu symptoms that linger and linger. They may include back pain. Or jaw pain. Do those make you think of your heart?

Rachel Hughes:

Amazing.

Dr. Jayne Morgan:

And here's the caveat to that. If we just look in the United States, the majority of people living in the United States are women. We're more than 51% of the population. And yet most studies are done on white men.

And so this is how we are where we are. By the time you seek help, your symptoms may have gone untreated for so long that it may be too late. And interestingly, only 22% of primary care physicians admitted in a survey that they even felt comfortable treating a woman with heart disease, and only 42% of cardiologists. That seems crazy. 

Rachel Hughes:

I just want to pivot for a moment. I know you also wanted to talk about nutrition and movement. 

Dr. Jayne Morgan:

Yes, I did. When we look at nutrition, and that means food, we are understanding increasingly that food is medicine, and that it is really our primary medicine. It's also our primary preventive medicine. So, how are you dosing yourself every day? 

I mentioned inflammation earlier. There’s acute inflammation, where we respond to trauma to heal ourselves, and then there’s chronic inflammation. We don’t want to be in a state of chronic inflammation, but obesity keeps your body in a state of chronic inflammation, which increases your risk of both heart disease and cancer. 

And food can be anti-inflammatory or pro-inflammatory. And you can have an anti-inflammatory diet that includes meat or not. Because you do need protein, especially as you age. 

But when we talk about anti-inflammatory foods, we’re typically talking about fruits and vegetables. Berries have higher anti-inflammatory components than other types of fruits, for example. And when it comes to vegetables, leafy green vegetables are anti-inflammatory. And if you need a cheat sheet, think of things that are textured and/or colorful. Oatmeal is anti-inflammatory, quinoa is anti-inflammatory. And there are exceptions, of course, like nightshades (eggplant, tomatoes), which are considered pro-inflammatory. But in general, think of fruits and vegetables. 

Rachel Hughes: 

Thank you. I’d like to get to questions from our audience. Someone asks, what is the role of calcium in heart health? At what point is it too much calcium?

Dr. Jayne Morgan:

It is important to have calcium in your diet, especially as we age, because we lose estrogen. And it’s important for things like osteoporosis. But I’m a cardiologist, so let’s talk about calcium score. This is the test that we give that is a measurement of your long-term risk of heart disease. And it is a one-time test that you receive. It's like an X-ray or MRI. And it gives us a risk, an indicator of your risk factor. I think everybody should do a calcium score at least once in their life. It will guide doctors, even if you're asymptomatic, even if you are young, in terms of how aggressive they should or shouldn't be. If you end up with a high calcium score, and you're asymptomatic, and you're healthy, the physicians now know that we may need to do more aggressive intervention with you earlier to decrease your risk of heart disease. Remember, heart disease is the number one killer. Everybody should have a calcium score once in their life. 

Rachel Hughes:

Thank you, Dr. Morgan. 

What could be some causes of higher LDL during perimenopause?

Dr. Jayne Morgan:

So, the causes of higher LDL can be those dropping estrogen levels. Not only can your LDL, or the “bad cholesterol” HDL, which is the “good cholesterol,” can also start to decrease. So you can have less of your good cholesterol, more of your bad cholesterol, and also more triglycerides, which also are a measure of fat. So again, menopause isn't doing us any favors with our health, which is why it's important for us to consider how we best manage it. Meet with a doctor who has a menopause certification and make certain that you can mitigate as much of your heart health risk as you possibly can.

Rachel Hughes:

Thank you. Tell us about exercise, movement, and fitness.

Dr. Jayne Morgan:

It is important. I do want to end on exercise because it is important to continue to exercise as we age. One, we know that for heart health, walking can be incredibly helpful. Just the act of walking, it provides resistance because it's anti-gravity. You're having to walk against gravity and stand upright. Very, very, very helpful. But we also know that it decreases your risk of heart disease and it is related to the amount of steps that you take. Now we used to say 10,000 steps a day. That's what you do. We now know you don't need to go 10,000 steps. We know as few as 2,500 steps, which is about one and a quarter mile. So on average, 500 steps, should we say, is about a quarter of a mile. So one and a quarter mile.

Many people get that in just in your regular every day, not even taking a walk. But just think about that. And then walking, we know has a lot of benefits of mental clarity as well. And stress reduction, which we also know is also important for heart disease. Then there’s weight and resistance. Go as heavy as you can while maintaining good form. You don’t want to get injured lifting something heavier than you should and get sidelined!

I also want to talk about Pilates because I'm a big proponent of Pilates. We don't necessarily use heavy weights, but you use your body as resistance. It works on flexibility and strengthening, which we need more and more of as we get older. We have no animal model to follow because most mammals do not live beyond their reproductive years. Human beings are an exception. 

Rachel Hughes:

Thank you so much for all of that.

Dr. Jayne Morgan: 

Thank you!

We couldn’t possibly fit all of this incredible interview into one blog post, so we HIGHLY recommend you check out the whole webinar on our YouTube! 

Here’s Dr. Jayne Morgan’s website. 

For information about upcoming webinars, follow us everywhere @myalloy!