Study Reveals the Top Predictor of Heart Disease for Women Over 45
New research points to poor sleep as a cause of poor heart health in menopausal women.
The study analyzed health data from about 3,000 women who participated in the Study of Women's Health Across the Nation.
Sleep ended up being the biggest predictor of having a cardiovascular disease event and dying from any cause.
The underlying causes of heart disease are varied and complicated, and doctors and scientists are still uncovering all the ways our genetics and lifestyle might affect our heart health.
Now, new research published in the journal Menopause suggests that slacking on sleep can actually be a big problem for heart health, especially in menopausal women. What's behind the connection? Top experts in the sleep and cardiovascular fields explain why sleep is so tied to heart health and what this study means for you.
Meet the experts: W. Christopher Winter, MD, is a neurologist and sleep medicine physician with Charlottesville Neurology and Sleep Medicine and host of the Sleep Unplugged podcast; Jennifer Wider, MD, is a women's health expert and co-host of the Open Wider podcast; Jessica Shepherd, MD, author of Generation M: Living Well in Perimenopause and Menopause: Samar R. El Khoudary, PhD, MPH, study co-author and a cardiovascular and women's health epidemiologist at the University of Pittsburgh School of Health
What did the study find?
For the study, researchers analyzed health data from about 3,000 women who participated in the Study of Women's Health Across the Nation (SWAN), which is an ongoing, longitudinal study of midlife women in the US. The researchers specifically looked at scores for Life's Essential 8, a health assessment tool created by the American Heart Association.
After crunching the data, the researchers found that four components in Life's Essential 8 (blood glucose, blood pressure, sleep quality, and nicotine use) were the most important factors in predicting participants' future risk of developing cardiovascular disease. But sleep ended up being the biggest predictor of having a cardiovascular disease event and dying from any cause. And those who had better sleep quality had a lower risk of both of these outcomes. 'Midlife sleep quality may uniquely contribute to future event risk,' the researchers wrote in the conclusion.
How is sleep related to heart health?
There are a few potential factors at play here. 'Poor sleep can lead to inflammation in the body,' says Jennifer Wider, MD, women's health expert and co-host of the Open Wider podcast. 'Research shows that even relatively mild sleep problems can cause inflammation in cells that line the veins in the heart, which could significantly contribute to the development of cardiovascular disease.'
But there can be an indirect impact of sleep on heart health, too. 'Lack of sleep may promote poor eating habits which over time can contribute to poor nutrition, diabetes, and heart disease,' Dr. Wider says.
Consistent lack of sleep is also linked to high blood pressure, increased risk of heart attack and stroke, poor blood sugar control, and obesity, points out W. Christopher Winter, MD, a neurologist and sleep medicine physician with Charlottesville Neurology and Sleep Medicine and host of the Sleep Unplugged podcast. 'All of these are cardiovascular risk factors,' he says.
What is considered 'poor sleep'?
In the study, the sleep score was based on participants' responses to three questions about their sleep habits over the past two weeks, focusing on trouble falling asleep, frequent night awakenings, and early morning awakenings with difficulty returning to sleep, explains Samar R. El Khoudary, PhD, MPH, study co-author and a cardiovascular and women's health epidemiologist at the University of Pittsburgh School of Health.
Why do menopausal women need to prioritize sleep for heart health?
"As cardiovascular disease is the number one killer of women, it is important to protect heart health as much as possible," says Jessica Shepherd, MD, author of Generation M: Living Well in Perimenopause and Menopause. "As menopause affects every middle-aged woman, many post-menopausal women suffer from increased risks for cardiovascular diseases (CVD) and sleep problems."
But menopausal women in particular face potential issues with heart health due to declining levels of estrogen, Dr. Wider says. Estrogen is protective of the heart, she explains. As it drops in the body, a woman's risk of developing cardiovascular conditions, including heart disease, increases.
"Sleep disturbances are common during the transition," El Khoudary says. "These issues, worsened by hormonal changes, vasomotor symptoms, and other factors, can increase with age and are linked to higher cardiovascular risk."
Menopausal women also tend to see a "sharp increased risk" for sleep apnea, which usually leads to worse sleep and a higher risk of heart issues, Dr. Winter says. But Dr. Winter stresses that women shouldn't assume they're doomed to have poor sleep—and potentially developing cardiovascular disease as a result—during menopause. 'This is such a positive place for menopausal women to focus, because it is a variable that can be measured and improved upon,' he says.
Ultimately, if you're struggling with sleep, it's a good idea to check in with a healthcare provider. Starting a good treatment plan could do more than make you feel well-rested the next day—it may support better heart health.
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