Getting To The Bottom Of Your Heart Health

Keeping Your Heart Healthy: Know Your Baseline

As you enter into menopause and your period has stopped for 12 consecutive months, your estrogen levels are now markedly lower. This means your risk of heart disease will increase. The reason for this is estrogen has a protective function for our heart and blood vessels. There are also other physiological changes that are associated with menopause that put your heart and health at an increased risk such as a decline in insulin sensitivity, an increase in storage of visceral fat, and more. Knowing some key information about your heart prior to menopause allows you to begin to track and monitor the impact your lifestyle improvements are making on your health, including your heart. 

Dr. Katherine MacGregor, MD FCPC IFM-CP, Family Physician 

According to Dr. Katherine MacGregor, MD FCPC IFM-CP, family physician with special interest in cardiometabolic women’s health, assessing heart health as early as possible is helpful.  To assess risk, physicians need to understand all of your risk factors, including personal and family history, history of smoking, diet and exercise history, alcohol use, disordered sleep history as well as markers related to blood pressure, cholesterol, inflammation, blood sugar and body composition.

 Ensuring that you can give your doctor accurate information about your family history of heart disease is really important. 

• Did family members have heart attacks or strokes and at what age?  Did they have any procedures (like cardiac stents or bypass surgeries)?  
• Did they take medications for conditions like high cholesterol, high blood pressure or diabetes? 
  
   For women, it is important to take into consideration a history of prior pregnancy-related complications such as:

• gestational diabetes, 
• pregnancy related hypertension 
• pre-term birth

• Menopausal status and symptoms are also important and can influence risk.   
• Most cardiovascular risk factors are well understood and are modifiable. It is estimated that 80% of heart disease is preventable.  If risk factors are modified, one’s risk of cardiovascular disease as well as many other major diseases can be significantly reduced.
• Some markers to consider for testing include:  
• 1. Blood testing
• Standard Lipid panel: includes Total cholesterol as well as LDL, HDL, non-HDL and triglycerides which have optimal ranges depending on your overall cardiovascular risk
• High-Sensitivity C-Reactive Protein (hs-CRP): This can give an indication of inflammation in the body which can contribute to heart disease (although it is a non-specific marker so can be elevated for a large variety of reasons and requires clinical judgement in interpretation)
• Apoliprotein B (ApoB): Measures the number of atherogenic cholesterol-carrying particles, providing a more accurate risk assessment than LDL alone
• Lipoprotein (a) [Lp(a)]: An inherited lipoprotein level which can increase risk if elevated. It is a one-time test.  While Lp(a) cannot be influenced with diet, exercise, or other lifestyle changes, it can help inform your overall risk.  
• HbA1c & Fasting Glucose: These inform blood sugar control issues as well as diabetes risk. Insulin resistance has an important impact on heart health.  
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   Some of these tests may have an extra cost or may not be recommended by your physician, or may not be necessary if they have already been completed within a certain time frame. You can use this list to help inform your discussion with your physician.
• 2. Blood pressure
• Blood pressure of 120(systolic) or less and 80(diastolic) or less is an optimal healthy blood pressure. 
• High blood pressure strains the arteries and increases risk for heart attack, stroke, and can signal other health issues such as kidney, hormone imbalance, and stress related conditions. Moreover, high blood pressure has been shown to impact brain health, increasing risk for dementia. Blood pressure can be easily tracked and monitored either by visiting your physician, certain pharmacies or by purchasing a blood pressure cuff. 
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  3. Body Composition
• We have two main types of fat stores: visceral and subcutaneous fat. Women typically store fat under the skin, usually on the hips and thigh area. This subcutaneous fat is actually cardioprotective. Men on the other hand, do not have as much capacity to store subcutaneous fat and are more prone to visceral fat storage if they gain excess weight. Visceral fat is deep fat that surrounds the organs such as liver and intestines, typically around the abdomen. As women enter into menopause, they become more prone to storage of visceral fat. This is the ‘menopause belly’ that women often complain about. Unfortunately visceral fat has negative metabolic consequences. It releases inflammatory chemical and hormones that can:
• Increase insulin resistance
• Raise blood pressure
• Disrupt cholesterol levels
• Promote chronic inflammation
• Knowing your visceral fat levels can inform your risk of cardiovascular disease, even if you are not overweight. A historic method for indicating body composition health has been the body mass index (BMI) which takes into account one’s height and weight only. This is not a very useful  measure as one could be underweight (with a low BMI) but have high visceral fat. Conversely,  weight (and BMI) could be high in someone with high muscle mass which may characterize them as obese by BMI even though they are healthy. Here are some additional ways to help assess your visceral fat. While MRI is the gold standard, this is seldom done unless for a specific reason. The next most valid measure is a DEXA. Here are some options to consider:
• DEXA (Dual-Energy X-ray Absorptiometry) 
• 📌 What it measures: Fat mass, lean muscle, and bone density.
• 📌 Accuracy: High—precise breakdown of body composition.
• 📌 Pros: Best for measuring visceral fat and muscle imbalances.
• 📌 Cons: Requires a clinic visit and can be costly.
• Bioelectrical Impedance Analysis (BIA) - Quick & Convenient
• 📌 What it measures: Body fat percentage and muscle mass using electrical currents.
• 📌 Accuracy: Moderate—hydration levels can affect readings.
• 📌 Pros: Affordable, widely available in smart scales and handheld devices.
• 📌 Cons: Less reliable for visceral fat measurement
• Waist-to-Hip Ratio & Measuring Tape - Easy at Home
• 📌 What it measures: Fat distribution, especially abdominal fat.
• 📌 Accuracy: Low to moderate—a useful indicator of health risks.
• 📌 Pros: Quick and no equipment needed.
• 📌 Cons: Doesn’t measure muscle or visceral fat precisely
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  The medical system is based on treating already ‘sick’ people. The shift to proactive health prevention is underway but has a long way to go. This means you might experience some resistance in requesting baseline testing and perhaps even dismissal of the need for doing this. Information on health markers, including your heart, allows you to decide what health and lifestyle behaviors you want to invest your time, resources, and commitment to. Moreover, ongoing monitoring of this information informs how impactful your investment in lifestyle health is.
• Check out our Insta Live recording on baseline testing and cardiac health (@pauzhealth) with Dr. Katherine MacGregor!