PERIMENOPAUSAL LINKS TO CARDIOVASCULAR DISEASE (CVD) IN WOMEN / Imaging Solutions

By: Dr. Robert L. Bard     Edited by: L. Goetze, Ed.D / C. R. DeWitt /  G. Davi

One of the most concerning risks associated with menopause is heart disease. Estrogen plays a protective role in maintaining healthy blood vessels and cholesterol levels. Its decline leads to increased LDL (bad cholesterol), reduced HDL (good cholesterol), higher blood pressure, and arterial stiffness, all of which contribute to cardiovascular disease. The risk of heart disease increases substantially for women during and after menopause. Although exact prevalence rates vary, research indicates that nearly 45% of women aged 20 and older are affected by some form of cardiovascular disease. The menopausal transition is marked by significant hormonal shifts, particularly a decline in estrogen, which reduces its cardioprotective effects and heightens the risk of cardiovascular complications. Notably, women who undergo natural menopause at a later age tend to have a lower risk of cardiovascular disease and mortality. Given these factors, it is essential for women experiencing menopause to actively monitor their heart health and adopt preventive strategies.

IMAGING HEART HEALTH

Ultrasound plays a vital role in assessing heart health in premenopausal women by providing a non-invasive, real-time evaluation of cardiac function. Echocardiography offers detailed imaging of the heart’s chambers, valves, and function, aiding in early detection of cardiovascular disease. As estrogen declines during menopause, risks like hypertension, arrhythmias, and reduced arterial elasticity increase. Early ultrasound detection helps guide lifestyle changes and medical interventions to prevent complications.

Carotid ultrasound is also crucial for detecting early atherosclerosis, a key driver of heart disease. By evaluating plaque buildup and arterial thickness, it identifies cardiovascular risks before major events occur.  Since heart disease risk rises post-menopause, early vascular screening allows for timely preventive strategies.

Spasticity: Ultrasound elastography (USE), particularly shear wave elastography (SWE), shows promise as a non-invasive tool for assessing spasticity and monitoring treatment efficacy. While further research is needed to establish its reliability and validity, elastography is a well-established ultrasound imaging technique that measures tissue stiffness or elasticity. It has been widely used for liver fibrosis assessment and is now being explored off-label for other organs. In the context of spasticity, SWE can quantify muscle stiffness, potentially offering a more objective measure than traditional clinical assessments.

Incorporating ultrasound into routine assessments enables early intervention, guiding lifestyle and medical management to reduce heart disease risks. Given that cardiovascular disease is the leading cause of death in women, proactive imaging supports a healthier transition into menopause. Incorporating ultrasound into routine assessments enables early intervention, guiding lifestyle and medical management to reduce heart disease risks. Given that cardiovascular disease is the leading cause of death in women, proactive imaging supports a healthier transition into menopause.

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SLIDE 1: DETECTING SILENT MYOCARDIAL AND CARDIOVASCULAR DISEASE

Many years ago, the Framingham study, conducted for life insurance purposes, identified carotid intima-media thickness (CIMT) as an indicator of decreased life expectancy. Since that study, which is now over 20 years old, further research has shown that the lining of the carotid artery can thicken up to one centimeter. CIMT is now recognized as a key health marker and a measure of longevity.

Advanced imaging techniques, such as super-selective B-flow ultrasound, allow for precise measurement of CIMT. In this case, the ultrasound scan shows a CIMT of 1.2 millimeters. The adjacent image highlights the underlying cause: inflammatory vessels associated with arteritis. These inflamed vessels contribute to arterial wall thickening, even in the absence of significant arterial blockage. A microvascular imaging scan of the same carotid artery further demonstrates the contrast between normal and thickened arterial walls.

Although the artery may not be obstructed, individuals with a CIMT exceeding 1.0 millimeters face an increased risk of stroke. The rightmost image presents an innovative technique for assessing the hardness of arterial plaques. Soft plaques are more prone to embolization and can travel to the brain, whereas calcified plaques are generally more stable. Shear wave ultrasound technology enables early detection of arterial stiffness, providing insight into vascular health before overt disease develops. In addition to measuring arterial inflammation and fibrosis, this method helps evaluate the extent of arterial wall scarring.

During menopause, most myocardial and cardiovascular events occur silently. Women experiencing heart attacks are often misdiagnosed with chest pain, pruritus, or musculoskeletal discomfort. However, a simple one-minute carotid artery scan can help detect silent myocardial and cardiovascular disease, making it a valuable tool for identifying potential serious conditions in asymptomatic menopausal patients.

SLIDE 2: HASHIMOTO’S / THYROIDITIS

One incidental benefit of scanning the thyroid for tumors or inflammatory disease is the ability to assess nearby structures, including lymph nodes—where cancer may spread—and the carotid artery, which supplies blood to the brain. In this case, the arrow indicates plaque in the carotid artery, measuring 1.3 millimeters in thickness. Since the normal threshold is 1.0 millimeter, this finding suggests an early potential cardiovascular issue. This discovery is relevant to both thyroid and heart disease. Additionally, the scan reveals an incidental thyroid cyst and an abnormal, non-homogeneous thyroid.

SLIDE 3: AORTIC ADVENTITIAL PLAQUE

When scanning for aortic aneurysms or aortic adenopathy to assess whether breast cancer has spread to the lymph node chain, we typically observe the aorta as a midline vessel. In this case, during scanning, we detected abnormal echoes in the peri-aortic region. To further investigate, a Doppler blood flow scan was performed, which ruled out an aneurysm. Subsequently, an aortic scan with blood flow analysis was conducted to assess abnormal arterial activity, revealing that the thickened area had no discernible arterial inflammatory blood flow. However, the elastogram on the far right indicated abnormal fibrosis of the aortic wall, which could weaken the structure and potentially lead to rupture.

SLIDE 4: THYROID SCAN WITH POINT OF CARE ULTRASOUND

Portable high-resolution thyroid scanning is clinically available. In the labeled scan, the thyroid tissue appears milky white, while a dark area represents a cyst. We can confirm this is a cyst because, to its left, the carotid artery—filled with blood—also appears dark. A magnified scan (third image) reveals that this is not a simple cyst. The cyst wall contains internal micro-calcifications, and a follow-up study indicates inflammation. The presence of red arterial flow suggests irritation of the cyst wall. I could tag the middle image, which clearly shows the carotid artery.

ABOUT THE AUTHOR-

ROBERT L. BARD, MD, PC, DABR, FASLMS - Advanced Imaging & Diagnostic Specialist

Having paved the way for the study of various cancers both clinically and academically, Dr. Robert Bard co-founded the 9/11 CancerScan program to bring additional diagnostic support to all first responders from Ground Zero. His main practice in midtown, NYC (Bard Diagnostic Imaging- www.CancerScan.com) uses the latest in digital Imaging technology has been also used to help guide biopsies and in many cases, even replicate much of the same reports of a clinical invasive biopsy. Imaging solutions such as high-powered Sonograms, Spectral Doppler, sonofluoroscopy, 3D/4D Image Reconstruction and the Spectral Doppler are safe, noninvasive, and does not use ionizing radiation. It is used as a complement to find anomalies and help diagnose the causes of pain, swelling and infection in the body’s internal organs while allowing the diagnostician the ability to zoom and ‘travel’ deep into the body for maximum exploration.

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SUPPLEMENTAL

The Many Faces of Heart Disease and Cardiovascular Disease

By: Lennard Goetze, Ed.D and Graciella Davi

Heart disease and cardiovascular disease (CVD) are umbrella terms encompassing a wide range of conditions that affect the heart and blood vessels. These conditions can lead to serious complications, including heart attacks, strokes, and even death. Understanding the various types of heart disease can help individuals recognize symptoms early, seek appropriate treatment, and take preventative measures to maintain heart health.

1) CORONARY ARTERY DISEASE (CAD) is one of the most common types of heart disease. It occurs when the coronary arteries, which supply oxygen-rich blood to the heart, become narrowed or blocked due to plaque buildup (atherosclerosis). This can lead to chest pain (angina), shortness of breath, and heart attacks. Lifestyle changes, medications, and procedures such as angioplasty or bypass surgery can help manage CAD.

2) HEART FAILURE, also known as congestive heart failure (CHF), occurs when the heart cannot pump blood effectively to meet the body’s needs. It can result from conditions such as CAD, high blood pressure, or cardiomyopathy. Symptoms include fatigue, shortness of breath, and fluid retention. Treatment includes medications, lifestyle changes, and in severe cases, devices like pacemakers or heart transplants.

3) ARRHYTHMIAS are irregular heartbeats that can be too fast (tachycardia), too slow (bradycardia), or erratic. These abnormal rhythms can interfere with the heart’s ability to pump blood effectively. Causes range from heart disease and electrolyte imbalances to stress and medications. Treatments include medications, lifestyle modifications, and procedures such as ablation or the implantation of pacemakers.

4) HEART VALVE DISEASE occurs when one or more of the heart’s valves do not function properly, leading to issues such as stenosis (narrowing of the valve) or regurgitation (leakage of blood backward). Common symptoms include fatigue, chest pain, and swelling in the legs. Treatment options vary from medication management to surgical repair or replacement of the affected valve.

5) CARDIOMYOPATHY refers to diseases of the heart muscle that make it harder for the heart to pump blood efficiently. Types include dilated, hypertrophic, and restrictive cardiomyopathy. Symptoms often include breathlessness, swelling in the legs, and irregular heartbeats. Treatment depends on the type but may involve medications, lifestyle changes, and in severe cases, heart transplants.

6) CONGENITAL HEART DISEASE (CHD) refers to structural heart abnormalities present at birth. These defects can range from minor to severe and may involve holes in the heart, abnormal connections between blood vessels, or improperly formed valves. Some cases require surgical correction, while others may be managed with medications and ongoing monitoring.

7) DEEP VEIN THROMBOSIS (DVT)

is the formation of blood clots in deep veins, usually in the legs. If untreated, these clots can break loose and travel to the lungs, causing a pulmonary embolism. Risk factors include prolonged immobility, surgery, and clotting disorders. Treatment includes anticoagulant medications, compression stockings, and lifestyle changes.

8) PERIPHERAL ARTERY DISEASE (PAD) occurs when arteries outside the heart, particularly in the legs, become narrowed due to atherosclerosis. This can lead to pain, numbness, and even tissue damage in severe cases. PAD increases the risk of heart attack and stroke. Treatment focuses on lifestyle changes, medications, and procedures to restore blood flow.

9) AORTIC DISEASE affects the body’s main artery, the aorta. Conditions such as aortic aneurysm (a bulging or weakened area in the aorta) or aortic dissection (a tear in the artery’s wall) can be life-threatening. Symptoms include severe chest or back pain, dizziness, and difficulty breathing. Treatment ranges from monitoring to emergency surgical repair.

10) RHEUMATIC HEART DISEASE is caused by rheumatic fever, an inflammatory disease that can damage heart valves. It often develops from untreated or inadequately treated strep throat infections. Symptoms include breathlessness, fatigue, and irregular heartbeats. Prevention through early treatment of strep infections is crucial, and management includes medications and sometimes valve surgery.

11) STROKE occurs when blood flow to the brain is disrupted, either due to a blocked artery (ischemic stroke) or a ruptured blood vessel (hemorrhagic stroke). This can cause brain damage, disability, or death. Symptoms include sudden weakness, confusion, trouble speaking, and loss of coordination. Treatment involves clot-busting drugs, surgery, and rehabilitation.

12) PULMONARY EMBOLISM (PE) occurs when a blood clot, usually from a DVT, travels to the lungs, blocking blood flow. This can be life-threatening, causing sudden shortness of breath, chest pain, and rapid heart rate. Immediate treatment with anticoagulants, thrombolytics, or surgery is necessary to prevent fatal complications.

 

Conclusion

Heart disease and cardiovascular disease manifest in many forms, each with its own causes, symptoms, and treatment options. Early detection, lifestyle modifications, and appropriate medical intervention are key to managing these conditions and improving overall heart health. Regular check-ups, maintaining a balanced diet, engaging in physical activity, and managing stress can significantly reduce the risk of developing these life-threatening diseases.

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RELATED ARTICLE 

Understanding Thyroid Health: Key Insights on Hormones, Longevity, and Wellness

Thyroid health plays a critical role in nearly every physiological process of the body, influencing metabolism, brain function, heart health, and more. Yet, despite its significance, the nuances of thyroid function remain elusive for many. As we age, maintaining optimal thyroid function is an essential component of overall well-being, and understanding the balance of thyroid hormones can help prevent future health challenges.  See Dr. Angela Mazza's full report on Thyroid Health @ this season's MenoNews.

For more information on this article, or to explore diagnostic imaging related to cardiovascular health, visit: www.menoscan.org or www.BardDiagnostics.com. You can also contact our editorial team at: 516-522-0777, or email us at: editor.prevention101@gmail.com

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