The risk of having heart disease grows as a woman ages, so women need to be familiar with their heart disease risk factors, the American Heart Association (AHA) says.

Menopause factors into this risk in several different ways, with age, estrogen, symptoms and other body changes also playing a role.

Women who reach menopause at younger ages—before 45—have a significantly higher risk of heart disease, according to the AHA. When a woman has had surgical removal of her ovaries, forcing menopause early, she can also have a higher risk of heart disease.

However, the same surgery around the age of natural menopause does not raise risk, the AHA said. A hysterectomy, where the uterus is removed, also doesn’t appear to influence cardiovascular risk before or after menopause.

Some well-known symptoms of menopause are hot flashes and night sweats. They can last up to 10 years and are also associated with worse heart disease risk levels.

Depression and sleep problems have also been linked with heart disease risk.

So, too, has increased visceral fat, which is the fat in the abdominal cavity.

Estrogen is also a factor. This hormone keeps blood vessels relaxed and open. It starts to decline with the approach of menopause. Cholesterol may then build up in the artery walls, according to the AHA. That can increase the risk of heart disease or stroke.

Risk factors like cholesterol levels and metabolic syndrome appear to increase with menopause beyond just the impact of aging.

A person has metabolic syndrome if they have 3 out of 5 risk factors. These factors are: high blood pressure, high blood sugar, high triglycerides, low HDL (“good”) cholesterol and abdominal obesity.

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