Understanding the Role of Perimenopause in Coronary Heart Disease and Innovative Intervention Strategies

Perimenopause, the phase of life just before and after menopause, significantly affects women’s health, particularly their cardiovascular well-being. During this period, women experience a gradual decline in ovarian function, leading to diminished estrogen levels and various associated symptoms. Experts agree that cardiovascular disease is the leading cause of death among women, and perimenopause exacerbates these risks. This article delves into the connection between perimenopause and coronary heart disease, exploring risk factors and innovative intervention strategies to mitigate these risks.

The Intersection of Perimenopause and Coronary Heart Disease

Perimenopause is characterized by a decline in ovarian function, which results in reduced estrogen levels and a cascade of changes in the body. These changes can lead to impaired lipid metabolism, increased blood pressure, and higher glucose levels—all significant risk factors for coronary heart disease. A study by the American Heart Association highlights that cardiovascular disease poses the most significant threat to women’s lives, emphasizing the importance of addressing heart health during perimenopause.

The “Chinese Women’s Cardiovascular Disease Prevention Expert Consensus” identifies menopause as a distinct and independent risk factor for coronary heart disease in women. This consensus underscores the high incidence of coronary heart disease in perimenopausal women, highlighting the critical need for targeted interventions to reduce risk factors and prevent adverse events.

Risk Factors Affecting Perimenopausal Women with Coronary Heart Disease

Research reveals several risk factors associated with coronary heart disease in perimenopausal women, including body mass index (BMI), hypertension, diabetes, smoking, a family history of heart disease, depression, and hormonal factors such as follicle-stimulating hormone and luteinizing hormone. While certain factors like family history and hormonal changes are uncontrollable, lifestyle factors such as BMI, exercise, and diet are modifiable.

Despite the recognition of these risk factors, limited literature addresses specific intervention measures for perimenopausal women with coronary heart disease. Current guidelines often recommend lifestyle changes as the primary means to manage and reduce risk factors in this population.

Cardiac Rehabilitation and the Health Action Process Approach

Cardiac rehabilitation is a comprehensive program designed to help patients with cardiovascular disease improve their physical and mental health. It includes five major components: medication management, exercise, nutrition, psychosocial support, and cessation of smoking and alcohol use. The goal is to enhance patients’ quality of life, reduce the risk of recurrent cardiovascular events, and promote a faster return to normal activities.

The Health Action Process Approach (HAPA) is a theoretical framework that explains how individuals adopt and maintain healthy behaviors. It proposes that behavior change occurs in three stages: pre-intentional, intentional, and action stages. During the pre-intentional stage, individuals recognize the dangers of unhealthy behaviors and consider the benefits of positive changes. They then move to the intentional stage, where they set goals and develop action plans. Finally, in the action stage, individuals implement their plans and continue healthy behaviors through self-monitoring and self-regulation.

This study applies the HAPA model to develop an intervention program for perimenopausal women with coronary heart disease. The program aims to guide women in adopting and maintaining healthy behaviors to manage their risk factors effectively.

Development of the Intervention Program

The intervention program was developed through multiple stages, including research team establishment, literature review, qualitative interviews, and expert consultations using the Delphi method. The research team comprised healthcare professionals with expertise in cardiology, nursing, and rehabilitation, ensuring a well-rounded approach to the program’s design.

The Delphi method, an iterative process involving expert consensus, was used to refine the intervention program. Experts were invited to rate the importance of various components of the program on a 5-point Likert scale. Their feedback was used to modify and improve the program’s content in successive rounds, leading to a final version based on expert agreement.

Expert Consensus

The Positivity of Experts: A total of 11 experts participated in the Delphi process, with a 100% response rate in both rounds. Experts made valuable suggestions, and their opinions converged over the two rounds, indicating high levels of agreement.

Expert Familiarity and Authority: The credibility of experts was assessed using the coefficient of authority (Cr), which combines the experts’ basis for judgment (Ca) and their familiarity (Cs) with the content. In this study, Cr was 0.960, suggesting a high level of confidence in the experts’ judgments.

Degree of Concentration and Harmony: The degree of consensus among experts was measured using statistical parameters like mean, standard deviation, coefficient of variation (CV), and Kendall’s coefficient of concordance (Kendall’s W). Results showed high levels of agreement across different elements of the program, indicating well-defined intervention strategies.

Table 2 Risk factor intervention programs for perimenopausal patients with coronary heart disease based on health action process orientation theory

Discussion

The intervention program developed for perimenopausal women with coronary heart disease is grounded in evidence and practical application. By drawing on scientific literature, clinical expertise, and patient feedback, the program addresses the unique challenges faced by this population.

The program’s importance is underscored by the high prevalence of coronary heart disease among perimenopausal women. Estrogen decline during perimenopause disrupts lipid metabolism, blood glucose regulation, and cardiovascular function, contributing to the development of heart disease. Comprehensive interventions focusing on diet, exercise, and mental health can help women navigate this challenging phase more effectively.

Several lifestyle modifications are recommended for perimenopausal women with coronary heart disease. These include:

• Educating patients on the disease and providing psychological support through activities like meditation and yoga.
• Encouraging aerobic and resistance exercises to manage weight, blood pressure, and cholesterol levels.
• Adopting a balanced diet rich in estrogen-containing foods and reducing sodium and saturated fat intake.
• Supporting smoking cessation and avoiding exposure to secondhand smoke.

The HAPA model is particularly useful in guiding these interventions. It acknowledges the individual stages of behavior change and addresses each stage with tailored strategies. For example, pre-intentional patients are educated about the risks of unhealthy behaviors, while action-stage patients receive ongoing support to maintain positive changes.

Conclusion

This study demonstrates the feasibility and importance of developing a structured intervention program for perimenopausal women with coronary heart disease. By leveraging the Health Action Process Approach and cardiac rehabilitation principles, the program aims to reduce risk factors and improve patients’ quality of life. While this study lays the groundwork for the program’s implementation, further clinical research is needed to validate its effectiveness.

The intervention program is designed to be a comprehensive guide for healthcare providers, empowering them to offer targeted, evidence-based care to women at risk of coronary heart disease during perimenopause. By addressing the unique needs of this population, we can enhance heart health outcomes and improve overall well-being.

Call to Action

We invite healthcare professionals, researchers, and patients to engage with this article and provide feedback. Your insights can help us refine and expand on these intervention strategies. Share your thoughts in the comments below, or follow us on social media to stay updated on the latest research and developments in women’s health.