If you’re going through early menopause, there’s quite a bit that you should be aware of where heart disease is concerned.

As with so many things that affect you when you’re coping with an early menopause or premature ovarian failure, the reason for this increased risk appears to be lower amounts of estrogen. There have been a number of research studies exploring this link between estrogen and heart disease, however the results have not been completely conclusive. It’s a confusing scenario, to be sure. . .

Most recently, the Women's Health Initiative Study (the WHI) halted the arm of the study in which "normal" menopausal women (women aged 50 to 79) were taking Prempro (conjugated equine estrogen and medroxyprogesterone acetate) due to an increase in heart attack and stroke.

In the above case, it appeared that the synthetic progestin (Provera) was the problem where the increase in heart problems were concerned, as those women in another arm of the study who were on estrogen alone didn't show this increase, nor was that aspect of the study discontinued.

Another study (the HERS study) found that post-menopausal women (women of "normal" menopausal age -- that is, older women) with a history of heart disease actually increased their risks of having heart problems for the first two years (after which the risk diminished). But yet another a recent study may have uncovered the reason for this: It appears that a gene defect causes estrogen receptors to stop working -- and so keeps arterial cells from responding to estrogen. This could explain why HRT doesn’t appear to have the same effect on heart disease in women who already have coronary heart disease -- and could signal a way to help prevent heart disease in post- menopausal women.

According to a number of studies, it appears that estrogen decreases LDL (low-density lipoprotein -- the "bad" cholesterol) and increasing HDL (high-density lipoprotein -- the "good" cholesterol). This keeps atherosclerotic plaque from sticking to arteries. It also reduces one form of LDL cholesterol called LP(a) , which can cause stroke if high. And it also appears to help keep your homocysteine levels low. Homocysteine is an amino acid that, at elevated levels, affects the arterial linings and appears to be connected with an increase in heart disease and stroke. Finally, estrogen helps keep your blood vessels elastic, so they can expand when necessary to allow for increased blood flow.

But when you have an estrogen deficiency, your cardiovascular system starts working less smoothly. . . . literally. When your circulating cholesterol changes to higher levels of the bad cholesterol and lower ones of the good, the platelets in your blood get sticky. They build up on your artery walls, clogging them up, and interfering with blood flow. This can lead to heart attack or heart disease in general. In addition, the lower estrogen makes your blood vessels more rigid and more likely to constrict. As a result, you can wind up with high blood pressure -- which also can result in heart disease.

It’s not a great scenario. . . . but it doesn’t have to happen. Premature menopause doesn’t necessarily equal heart disease. The key is getting heart-smart now!

Heart Helpers: What You Can Do To Prevent Heart Disease

Okay, so that’s all the bad news. But premature menopause won’t necessarily lead to heart disease. You can fight back -- and, with diligence, keep your heart healthy. Here are some steps that could help your heart:

• Consider replacing the estrogen you’ve lost.

When it comes to fighting heart disease, estrogen itself appears to be on your side. Yes, there has been a longstanding debate over the pros and cons of estrogen replacement therapy and some concern over the viability of different research studies. However, since 1970, over thirty-two studies have been conducted on the link between estrogen and heart disease. And the results seem quite conclusive: replacing estrogen results in a lower risk of heart disease -- as much as 50 percent if used for fifteen years or longer; a 10 to 30 percent improvement if used for less than three years.

Researchers believe estrogen protects your heart by reversing the rise in LDL after menopause. According to one recent study of women taking estrogen, LDL declined 13.5 percent while HDL increased 22.5 percent. Other studies have also shown that estrogen lowers fibrinogen, a blood-clotting factor and helps your blood vessels respond well to overloading through stress or exercise.

There are a few negatives to negatives to take into consideration however: If you take estrogen and a progestin (a synthetic progesterone such as the widely prescribed Provera), the progestin may block the benefits of estrogen. This is one of the reasons it probably is better to opt for a natural progesterone. In addition, according to a number of studies, oral estrogen increases your level of triglycerides (blood fat), and can increase your risk of blood clots..

However, most doctors -- even those who have argued against the use of HRT for normal menopausal women -- believe that women in premature menopause would benefit from the use of HRT to prevent heart disease. . . . at least until they reach the age of 50, the age at which their bodies would "normally" have experienced an estrogen drop.

To restate a point that I keep saying again and again: The key thing to remember here is that, unlike women who are taking estrogen in their 50s, when you’re in premature menopause, you’re taking it in your 20s, 30s or 40s -- the years in which your body would normally have had this estrogen anyway. You’re replacing what the average woman your age has -- and so, regaining the protection against heart disease that you usually would have had at this age.

All in all, then, HRT probably makes sense to reduce heart disease risks from early menopause and premature ovarian failure. Of course, though, this isn’t a decision to make lightly. Your best course of action is to learn more about HRT, then make an informed decision.

• If you can’t -- or won’t -- take HRT, you can still get the benefit of estrogen through alternative methods.

First, you can replace estrogen by upping your intake of phytoestrogens, estrogens found naturally in certain foods, such as soy. A 1998 study found that phytoestrogens appear to be as effective in preventing stroke as Premarin (a commonly prescribed conjugated estrogen). The study is part of an ongoing program funded by the National Heart Lung and Blood Institute that is exploring the benefits of soy phytoestrogens. You can get soy and other phytoestrogens through your diet, or by taking supplements such as soy isoflavones or ground flaxseed.

You also can look into taking tamoxifen or raloxifene. Both are so-called "designer-estrogens" or SERMs (selective estrogen receptor modulator), that take the place of estrogen in your body. These seem to offer some cardiovascular benefits, however they appear to be less effective than regular estrogen. A recent study of raloxifene found that it lowered LDL by 11 percent compared to 13 percent with HRT, lipoprotein (a) levels by 4 percent compared to 16 percent with HRT, and had no significant effect on HDL, whereas HRT raised HDL by 11 percent. Even so, some prevention is better than none -- so raloxifene or tamoxifen may make sense for you if you are unable to take estrogen. Again, talk to your doctor.

• Exercise!

You’ve heard it before: Regular exercise is good for your heart. It keeps your blood pressure down, increases the level of good cholesterol in your blood, helps you cope with stress, keeps your weight under control, and helps prevent diabetes. . . . and these are only the benefits connected to your heart! It also keeps your lungs working well, tones your muscles, and builds bone. Quite a list of positives. . . .

To get any benefit for your heart, you must exercise at least thirty minutes a day. The good news is that, contrary to what was believed in the past, you don’t have to get those thirty minutes of exercise at one time. As long as you get your heart rate up for a total of thirty minutes, you’re getting the protection you need. Walk up stairs instead of taking an elevator or escalator. Park farther from the mall and walk a few extra yards. Just get active!

• Start eating for your heart’s sake.

Opt for a low fat diet -- one that gets 20 percent or less of its daily calories from fat. Include a small amount of polyunsaturated fats (such as Omega-3 fats, in fatty fishes like salmon) and Omega-6 fats (in vegetable oils), as well as monounsaturated fats.

Try to eat foods high in Vitamin E (such as nuts, vegetable oils, whole grains, and wheat germ), which were recently found to lower the "bad" cholesterol, LDL.

Up your fiber intake. It’s a good idea to get about 25 to 35 grams of fiber a day -- to help reduce cholesterol, protect against diabetes, and keep blood sugar levels stable.

Finally, try to cut down on sugar and empty calories. You’ve probably heard this advice before, but for good reason: It works!

• If you smoke, quit. If you don’t smoke, don’t start.
  Smoking is one of the leading causes of heart disease -- and one that we have control over. Smoking can raise your homocysteine levels, increase your blood pressure and much more.

• Cut down on alcohol.
  Yes, some studies have shown that drinking can be good for your heart, but excessive drinking is still considered a no-no

• Consider taking certain vitamins, herbs and other supplements for your heart’s sake.
  Certain vitamins and other supplements can help your heart. Heart-healthy supplements include: A, carotenoid complex, B-complex, (including folic acid) calcium, copper, chromium, magnesium, manganese, selenium, zinc and CoQ10. In addition, studies have shown that garlic helps lower cholesterol and prevent arterial build-up.