Experts warn cardiovascular risk rises during menopause and call for earlier, more intensive cholesterol care.
Cardiovascular disease (CVD) remains the leading cause of death in the Philippines, but for many women, the risk is often underestimated until it is too late.At the 18th Asian-Pacific Society of Atherosclerosis and Vascular Diseases (APSAVD) Congress, experts raised concern over a growing yet underrecognized threat: the sharp rise in cardiovascular risk among women during midlife, particularly through the menopausal transition.“Cardiovascular disease remains the leading cause of mortality and morbidity, but women are often overlooked
because their symptoms are more atypical and they tend to present later,” said Dr.. Louella Santos, president of the Asian-Pacific Society of Atherosclerosis and Vascular Diseases.As women approach menopause, hormonal shifts begin to influence metabolism and cholesterol levels, increasing vulnerability to atherosclerosis, the buildup of plaque in the arteries that can lead to a heart attack or stroke.. What makes this more concerning, experts said, is that these changes often happen quietly, without obvious warning
signs.“By the menopausal transition, women begin to experience hormonal and metabolic changes that significantly increase their cardiovascular risk,” Dr.. Santos added.Yet despite the availability of effective therapies, many patients, particularly those already at high risk, remain undertreated.A persistent gap between treatment and outcomesAcross the region, a significant proportion of patients are still failing to meet recommended cholesterol targets, even with existing treatment options.“Very few high-risk patients are achieving their LDL cholesterol targets, and this remains
a major global and regional problem,” said Dr.. Brian Tomlinson, professor at the Faculty of Medicine at Macau University of Science & Technology.Data presented at the congress showed that many patients remain on single-drug therapy, while others receive no treatment at all, leaving cardiovascular risk largely unaddressed.“The majority of patients are still receiving monotherapy, and some are not receiving any therapy at all,” he said.This gap reflects a combination of delayed treatment intensification and challenges
in long-term adherence, factors that allow risk to accumulate over time and increase the likelihood of serious events such as heart attacks.Why earlier and combination therapy matterExperts emphasized that the future of cardiovascular care lies in acting earlier and more decisively.Lowering LDL cholesterol early in the disease process has been shown not only to slow progression but, in some cases, even reverse plaque buildup.“Greater benefits are observed when LDL cholesterol lowering is started early; this
can delay progression and even regress plaque,” Santos said.This is especially critical following a cardiovascular event, such as a heart attack, when patients face the highest risk of recurrence and complications.To address this, specialists are increasingly recommending combination therapy, particularly the use of statins alongside ezetimibe, to achieve faster and more consistent cholesterol reduction.“Combining statins with ezetimibe is more effective, safer, and allows patients to reach their targets more quickly,” Tomlinson explained.The approach works by
targeting cholesterol through two pathways: statins reduce production in the liver, while ezetimibe limits absorption in the intestine.. Together, they offer a more comprehensive strategy without the need for higher statin doses, which may pose greater risks for some patients.This is particularly relevant for Asian populations, including Filipinos, who may be more susceptible to statin-related side effects.“Asian patients may be at higher risk of statin-related adverse effects because drug levels are higher in the blood,”
Tomlinson noted, cautioning against routine use of high-dose statins.Beyond treatment, experts stressed that prevention remains equally critical.. Lifestyle factors such as poor diet, physical inactivity, smoking, and stress continue to drive the country’s cardiovascular burden, underscoring the need for stronger public health interventions, early screening, and sustained patient education.Ultimately, addressing cardiovascular disease, especially among women, will require more than just access to medicines.. It calls for earlier recognition of risk, timely and appropriate treatment, and
a shift toward more proactive, evidence-based care.Because while the tools to prevent heart disease already exist, experts agree: the real challenge is ensuring they are used, early enough to make a difference.
menopause cardiovascular risk, LDL cholesterol targets, statins ezetimibe, atherosclerosis plaque, heart attack recurrence, Filipinos heart health, APSAVD congress