How Estrogen Affects a Woman's Heart

Prior to menopause, natural estrogen production helps decrease the risk of a heart attack. After menopause, though, estrogen levels fall, and by age 60 to 65, men and women have approximately the same risk of developing heart disease.

As estrogen levels decline and stay low with age, recent data suggests women over the age of 75 may surpass men of the same age when it comes to heart disease risk.​

Maintains Healthy Cholesterol Levels

The majority of estrogen’s protective effects are likely to come from its influence on regulating cholesterol levels. Estrogen acts on the liver to cause an overall reduction in the total amount of cholesterol in the body, an increase in the amount of high-density lipoprotein (HDL) good cholesterol. and a decrease in the amount of low-density lipoprotein (LDL) bad cholesterol.

Over time, bad cholesterol can accumulate as deposits in your blood vessels. This can lead to blockages that interfere with the delivery of blood to your heart. Decreasing your level of bad cholesterol reduces the likelihood of these blockages forming.

Good cholesterol, on the other hand, is actually an anti-blockage type of cholesterol. Good cholesterol reduces both the amount of bad cholesterol present in the body and makes bad cholesterol less able to accumulate into the types of deposits that cause blockages.

Influences the Immune Response

There is some evidence that estrogen also has an effect on the immune system, which further decreases the danger posed by deposits of bad cholesterol.

Once bad cholesterol has deposited in the blood vessels, a complicated immune system reaction causes the affected vessel to become inflamed. This inflammation leads to further blockage while increasing the risk that a part of the deposit may break off and travel downstream to a narrow area of your vessel. Here it can lodge and cause a heart attack or stroke.

Reduces Fibrosis

Estrogen may also have a protective effect against cardiac fibrosis, a condition where the heart muscle develops scar tissue in response to acute or chronic damage. Cardiac fibrosis may occur as a result of a heart attack, high blood pressure, heart failure, heart inflammation, and more.

Research suggests that estrogen can inhibit the activation of cardiac fibroblasts—cells that create and maintain connective tissue in the heart.

Enhances Vascular Health

Research suggests that estrogen can stimulate new blood vessel formation, also known as angiogenesis, which may help with conditions like heart failure. Estrogen can also help relax blood vessels in the heart and throughout the body; this may improve blood flow, lower blood pressure, and reduce the risk of heart disease.

Improves Heart Metabolism and Reduces Oxidative Stress

Studies performed in a lab suggest that estrogen may exert a protective effect on the heart (against ischemia-reperfusion injury and a high-fat diet) by improving mitochondrial function. Mitochondria, often referred to as the "powerhouses'" of the cell, play an important role in the energy metabolism of the heart.

Additionally, estrogen may reduce oxidative stress in the heart muscle by decreasing the production of reactive oxygen species (ROS). ROS are highly reactive molecules containing oxygen that can easily react with other molecules in a cell—potentially causing damage. In the heart, ROS are often a byproduct of mitochondrial metabolism.

How To Prevent Heart Disease

Regardless of your age or estrogen level, you can lower your risk of heart disease through lifestyle adjustments. One of the best things you can do for your heart is to stop smoking. If you smoke, talk to your healthcare provider about quitting; your healthcare provider can give you tips, resources, and medications that can make quitting easier.

Regular exercise and maintaining a healthy diet are also greatly beneficial for heart health. If you want to adopt a healthier lifestyle, but aren't sure where to begin, talk to a nutritionist about your diet and work with a personal trainer to identify which workouts are best for your body and activity level.