Aging – Menopause & PAD Risk

Why does age affect my risk of peripheral artery disease?

Like other forms of heart disease, a woman’s risk of peripheral artery disease increases as she gets older. There are several reasons for this:

First, atherosclerosis, the buildup of fatty plaque in the arteries, is a lifelong process. Atherosclerosis is the most common cause of artery disease, including PAD. Fatty plaque gradually builds up over time, so the older you are, the greater the chances that an artery will have become narrowed or blocked enough to cause blood flow problems. As you age, other conditions that put you at risk for PAD also become more common and more severe, including high blood pressure, high cholesterol, and excess weight.

For women, the hormonal changes of menopause are an added dimension to the link between aging and PAD. During menopause (usually between age 45 and 55) a woman’s body begins producing less of the female hormones estrogen and progesterone. These hormones are thought to have artery-protecting effects, so as their levels drop a woman’s risk of heart and blood vessel disease increases.

How do age and menopause affect my risk of PAD?

Although PAD can occur at any age, it becomes much more common as you get older. This is true of all types of peripheral artery disease, including PAD in the legs, carotid artery disease, kidney artery disease, and aortic disease.

A woman is automatically at high risk for PAD if she is 70 or older. If she has other risk factors, she may be considered high risk at a younger age. Women 50 or older who have ever smoked or who have diabetes, and women younger than 50 who have additional PAD risk factors are considered high risk. Nearly 1 in 3 women older than 70, or 50 or older who smoke or have diabetes, have PAD.

The risk of PAD in arteries other than your legs also increases as you age. Only 1 in 25 women younger than 70 has carotid artery disease, compared with 1 in 10 older than 80. Aortic aneurysms (bulging out of the large artery that runs from the heart through the chest and abdomen) are 50 times more common in women 75 or older than in women under 55 years of age.

Should I consider hormone replacement therapy to reduce my PAD risk?

No. Studies have shown that replacement estrogen does not have the same benefits as your body’s natural estrogen in protecting your heart and blood vessels, and hormone replacement therapy (HRT) slightly increases a woman’s risk of developing heart disease and stroke. There is no evidence that HRT can reduce your risk of developing PAD, and it actually increases a woman’s risk of developing blood clots in the veins (deep vein thrombosis or pulmonary embolism) by 2 to 4 times.

To learn more about the overall risks and benefits of hormone therapy, as well as who may want to consider taking it to treat menopausal symptoms, see Hormone Therapy & Heart Disease.

What can I do to reduce my risk of PAD as I get older?

However much we might like to, we cannot change our age or its effect on our risk of heart and blood vessel disease. However, you can change many other characteristics and conditions that put you at risk for PAD. The older you get, the more important it becomes to get your other PAD risk factors under control. Older women with PAD are at especially high risk for potentially deadly complications of artery disease such as heart attack and stroke.

The first step in taking control of your PAD risk is to work with your doctor to find out what your risk factors are and develop a treatment plan to get your numbers where they need to be. Lifestyle changes such as a heart-healthy diet and exercise are a major part of risk factor control. Talk to your doctor about what level of activity is safe for you and aim for at least 30 minutes of exercise each day. It is never too late to start making heart-healthy changes to reduce your risk, and many of these changes can also help prevent heart disease and stroke.

You should also inform yourself about the signs and symptoms of PAD. Many older women with PAD may not notice the symptoms because they are not active enough to experience them, or they may not mention their symptoms to their doctor. Remember, pain in your legs is not necessarily a normal sign of aging. Proven treatments are available to relieve your symptoms and prevent complications, so be sure to discuss any symptoms you experience with your doctor. See Preventing PAD: The Basics for steps you can take to lower your risk and ensure you lead an active, healthy life well into old age.

If you have already been diagnosed with PAD, getting proper treatment can reduce your symptoms, improve your quality of life, and make you more independent and better able to engage in leisure and social activities.

Age & Menopause – Age and Stroke

How common is stroke in older women?

Stroke is a major health issue for postmenopausal women. Over half of all stroke patients older than 65 are women, and women account for 61% of all stroke deaths. Just like heart disease, your risk of having a stroke increases steadily as you grow older. For adults over 55 years of age, the lifetime risk of stroke is greater than 1 in 6. Women have a higher risk than men, perhaps because on average women live longer than men. About 2% of women aged 40 to 59 suffer a stroke; this goes up to 6% of women aged 60 to 79 and 12% of women older than 80 years.

Why does age affect my risk of stroke?

Stroke risk increases with age for many reasons. To start, the buildup of fatty plaque in the arteries is a lifelong process. As arteries become gradually more blocked over time, the chances of a blockage being large enough to cause problems increase. Nearly all of the body’s energy-transforming (metabolic) processes are affected in some way by aging, and this often means that risk factors that increase stroke risk also become more common and more severe the older you get. After menopause, hormonal changes mean that women lose some of the protective effects that the female hormone estrogen has against risk factors for stroke and cardiovascular disease. As women age, they are more likely to develop stroke risk factors such as high blood pressure, high cholesterol and triglycerides, and to become overweight. These factors can combine to greatly increase a woman’s stroke risk.

Will age affect my chances of surviving a stroke?

Yes – the likelihood of dying if you have a stroke increases gradually as you age. Nearly 90% of stroke deaths occur in people aged 65 and older – the average age at death from stroke is 80 years.

Stroke leads to death more often in older people because the disorders that lead to stroke progress over time, causing more damage or becoming more severe. In addition, older people are likely to have other medical conditions that may reduce their body’s ability to cope with the effects of a stroke.

Because women live longer than men and are usually older at the time of a stroke, more women than men die of stroke each year. Women accounted for 61% of US stroke deaths in 2004, even though they accounted for less than 50% of all strokes.

Despite the aging of the population as a whole, stroke death rates have actually been decreasing. Researchers believe this is due to better detection and treatment for risk factors such as high blood pressure.

Should my risk of stroke be treated differently because of my age?

No. It is just as important for elderly people to reduce their risk factors, such as smoking, excess weight, and high blood pressure, as it is for younger people.

Treating high blood pressure with medication is particularly beneficial for patients aged 60 to 80 years. With these medications, older patients can reduce their blood pressure just as much as younger patients.

Managing cholesterol may be beneficial for elderly men and women too. In one study of people with high cholesterol, cholesterol-lowering statin drugs cut the rate of stroke by 40% in those 65 years and older. Statins reduce the chances of having a first stroke by about 30% in women who have high cholesterol. Stroke survivors who take statins have a 16% lower chance of having another stroke within 5 years and are 43% less likely to die of a stroke.

Age, Menopause, and Stroke Risk

What is menopause?

Menopause is a normal change in a woman’s life when her periods stop—some women call menopause “the change of life.” During menopause, a woman’s body slowly makes less of the hormones estrogen and progesterone. This usually happens between the ages of 45 and 55. A woman has reached menopause when she has not had a period for 12 months in a row, and there are no other causes for this change (such as pregnancy). Menopause is considered early or premature if it occurs before age 40. The average age of menopause is 51 years.

During and after menopause, a woman’s ovaries no longer produce estrogen, though her body still produces a small amount of this hormone. It is partly this lack of estrogen that increases a woman’s risk of having a stroke.

What is surgical menopause?

Surgical menopause is when your periods stop because of the surgical removal of the uterus. This procedure is called a hysterectomy, and it may also involve removing one or both ovaries. Your periods stop once your uterus is removed; however, your body will continue to produce estrogen if your ovaries are left intact.10, 11 Eventually you will stop producing estrogen with natural menopause, probably a year or 2 earlier than if you still had a uterus. You may also have surgery to remove your ovaries but that leaves your uterus in place. This procedure is called oophorectomy. If both ovaries are removed, you will enter menopause. If only one is removed, you will continue to have periods until natural menopause. Some medical treatments, such as radiation treatment for cancer, may damage the ovaries and trigger menopause.

Each year, more than 600,000 hysterectomies are performed in the US. One in three women in the US have had a hysterectomy by age 60. African-American, Hispanic, and American-Indian women are significantly more likely to have a hysterectomy than white women, while Asian/Pacific Islander women are less likely.

Should I consider hormone therapy to reduce my risk of stroke?

No. Clinical trial data indicate that estrogen plus progestin hormone therapy, as well as estrogen alone, increases stroke risk in healthy postmenopausal women and provides no protection against stroke for women with established heart disease. The Women’s Health Initiative clinical trial examined 16,608 generally healthy postmenopausal women and found that estrogen plus progestin increased stroke risk by 44%, including in women with no history of cardiovascular disease.

If you are currently taking hormone therapy and are worried about increased stroke risk, see your doctor about gradually tapering off.

Does age at menopause affect my risk of having a stroke?

Early or premature menopause has been linked to early death. A study of more than 6000 women found that those who underwent early menopause (ages 35 to 40) had a greater likelihood of dying early from any cause.

However, with respect to stroke, a study involving close to 20,000 Norwegian women found no link—after a 37-year follow-up—between age at natural menopause (early, normal, or late menopause) and dying from stroke. A Spanish study also found no significant relationship between having a stroke and particular age at menopause.

Do age and menopause have an effect on other risk factors for stroke?

Yes. The risk of developing diabetes, high blood pressure, and high cholesterol increases with age. Almost all risk factors become more common in women than in men at older ages because women live longer than men, and after menopause women lose the protective benefits of estrogen. Only smoking remains more common in older men.

Menopause, either natural or surgical, increases your levels of total cholesterol. It also increases levels of chemicals involved in the body’s immune system response, such as interleukin-6, and it increases levels of homocysteine, a protein linked to the development of damaged arteries. Both of these compounds may increase your risk of stroke.The risk of developing metabolic syndrome – a collection of risk factors for both heart disease and stroke, including a large waistline (greater than 35 inches), higher than normal blood sugar, blood pressure, and triglycerides—is higher in postmenopausal than premenopausal women.

Age – Menopause and Heart Failure

How does age affect my risk of heart failure?

A woman’s risk of developing heart failure dramatically increases with age, as seen in the figure below.


As we age, so does our heart. Pumping the equivalent of about 1 million barrels of blood in an average lifetime through 60,000 miles of blood vessels takes its toll on the heart. An aging heart takes longer than a younger heart to relax and fill with blood and to contract and pump out blood, 2% to 5% longer each year after the age of 45.

Aging reduces the amount of muscle cells in your heart and causes your blood vessels to lose elasticity and become stiffer. The heart has to work harder to pump blood through these stiffer blood vessels. To compensate for this added stress, the remaining muscle cells enlarge up to 40%, and the wall of the pumping chambers (the ventricles) grow thicker so that they can pump with more force. For a while, this adaptation works well at supplying the body’s need for oxygen-rich blood. In the long term, however, a thicker wall can become stiff and limit the heart’s ability to fill with blood, which may be why older people with heart failure (the majority are women) are more likely to have diastolic heart failure.

The heart’s ability to adapt to these age-related changes slows down in the oldest ages; this may explain why women over 80 years of age have a much higher risk of developing heart failure than a 60-year old woman. Conditions such as high blood pressure and coronary artery disease, all of which become more prevalent with age, can also worsen the enlargement of the heart muscle cells and the stiffening of the blood vessels.

One age-related change unique to women is the shrinking of the ovaries, the main suppliers of estrogen. A woman’s risk of developing heart failure increases after menopause.

How common is heart failure in older women compared with men?

About 70% of women with heart failure are over the age of 50, according to data from a national survey and the Framingham Heart Study. Although the risk of developing heart failure is higher in men than in women, after the age of 80 a greater number of women than men have the condition because more women than men live into their 80s, when heart failure is most common. Women tend to develop heart failure later in life than men and are, on average, about 5 years older than men when first diagnosed with heart failure. Women are also more likely to have diastolic heart failure than systolic heart failure.11-18

The risk of developing diastolic heart failure increases with age. Women aged 65 and older are twice as likely as men to have diastolic heart failure. Nearly 50% of all heart failure patients over the age of 70 have diastolic heart failure, compared with 33% between the ages of 50 and 70 years and 15% at younger than 50 years.

Does age affect my chances of surviving heart failure?

Older women are more likely to die of heart failure than younger women are because the conditions that lead to heart failure progress over time, causing more damage or becoming more severe. Older women are also likely to have other medical conditions that may reduce their body’s ability to cope with the effects of heart failure, such as high blood pressure.

The likelihood of dying of heart failure increases with age. About 90% of all deaths caused by heart failure occur in people over the age of 65. One study of nearly 8000 adults (25% were women) with heart failure found that each 10-year increase in age was associated with a 28% increase in the risk of dying. Another study found that the average survival for women after being first hospitalized for heart failure decreased with age, as shown in the table below.

Women’s Average Survival After First Hospitalization For Heart Failure
Age Average Survival
67 to 74 4 years
75 to 84 3 years
85 and older Less than 2 years

More women than men die of heart failure each year, most probably because women live longer than men and are usually older when first diagnosed with heart failure. Women accounted for nearly 60% of US heart failure deaths in 2004.

Should my risk of heart failure be treated differently because of my age?

It is just as important for older people to reduce their risk factors for heart failure as it is for younger people. The risk of developing high blood pressure and diabetes increases with age. Treating high blood pressure with medication is particularly beneficial for women after menopause. Menopause coincides with stiffening arteries and an increase in blood pressure; whether this is due to aging, estrogen deficiency after menopause, or other unknown factors is not clear.


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