PETALING JAYA: A cardiovascular and thoracic surgeon has urged menopausal women in their 50s and older to be vigilant about their heart health due to the increased risks they face.
Dr David Khoo Sin Keat of IHeal Medical Centre highlighted that in 2021, the average life expectancy of Malaysian women was 78.3 years, while the average age for the onset of menopause was 50.7 years.
“Women are expected to spend one-third or more of their lives in post-menopause, a state of oestrogen deficiency. While commonly associated with symptoms like hot flushes, fatigue and emotional changes, the impact of menopause on cardiovascular health is often overlooked,” he said.
Khoo explained that statistics show the rate of heart attacks in women doubles within 10 years of menopause. Lifestyle factors such as physical inactivity, stress, smoking and unhealthy diets further contribute to an earlier onset of menopause-related cardiovascular issues.
“Oestrogen protects the heart and with menopause, the risk of cardiovascular disease increases as its level decreases. By the age of 55, the incidence of cardiovascular disease in Malaysian men and women is equal, with coronary heart disease (CHD) being the leading cause of death in both sexes.”
He also noted that women often exhibit atypical symptoms of CHD, which are commonly linked to microvascular heart disease.
Their symptoms tend to worsen due to mental and emotional stress, unlike men, for whom physical exertion is the usual trigger.
“Oestrogen helps maintain blood vessel flexibility, reduces inflammation and regulates cholesterol by increasing ‘good’ high-density lipoprotein cholesterol while lowering ‘bad’ low-density lipoprotein cholesterol,” he said.
The loss of oestrogen during menopause leads to elevated levels of bad cholesterol, higher blood pressure and reduced blood vessel elasticity.
These changes significantly increase the risk of atherosclerosis (plaque buildup in the arteries), coronary artery disease, stroke and heart failure with “preserved ejection fraction”, a condition more common in women, in which the heart pumps normally but is too stiff to fill properly.
“Many women mistakenly view heart disease as a predominantly male issue. They ignore symptoms such as fatigue, shortness of breath and palpitations, which could indicate underlying cardiovascular problems,” Khoo said.
Menopause symptoms such as severe hot flushes and night sweats can strain blood vessels, while persistent fatigue may signal heart-related concerns.
Palpitation or irregular heartbeat are also warning signs that require medical attention.
Khoo emphasised that heart disease is largely preventable.
“Women can take proactive steps during perimenopause – the period shortly before menopause – and early menopause to reduce their risk. A heart-healthy lifestyle is key,” he said.
He recommended regular exercise such as brisk walking or swimming, combined with a balanced diet rich in fruits, vegetables, whole grains and lean proteins to significantly lower the risks.
Avoiding smoking, limiting alcohol intake and managing stress through mindfulness or yoga are equally important.
Routine health check-ups to monitor blood pressure, cholesterol and glucose levels are critical for early detection. In some cases, hormone replacement therapy under medical supervision may help alleviate menopause related symptoms and reduce cardiovascular risks.
“During menopause-related visits, healthcare providers should discuss the impact of declining oestrogen on heart health and provide tailored informational materials for perimenopausal and postmenopausal women,” he said.
Khoo also stressed the importance of community outreach through health talks, workshops and online campaigns, especially in collaboration with NGOs and women’s health organisations.
“Culturally sensitive communication plays a crucial role in Malaysia, where taboos around menopause may exist. By adapting messages to resonate with diverse cultural contexts and using relatable examples, healthcare providers can empower women to prioritise their heart health.”
