- Cardiovascular disease is the leading cause of death for women globally.
- A woman’s heart disease risk increases after menopause.
- A new study found that, during perimenopause, women are twice as likely to have a low cardiovascular health score, especially when it comes to diet.
- Researchers believe this offers women a ‘window of opportunity’ during perimenopause to make lifestyle changes that may help lower their heart disease risk in the future.
According to the World Heart Federation, cardiovascular disease is the leading cause of death for women around the globe, accounting for about 30% of all deaths.
While a woman can develop heart disease at any age, past studies show that a woman’s risk for cardiovascular issues increases after menopause, which is generally around the age of 52.
“Heart disease is still the leading killer of women, and yet for decades, the research, the clinical trials, the risk calculators were built almost entirely on men,” Garima Arora, MD, Professor of Medicine in the Division of Cardiovascular Disease at the University of Alabama at Birmingham, told Medical News Today.
“We’ve definitely made progress, but we’re still playing catch-up. Women’s cardiovascular risk doesn’t follow the same trajectory as men’s. It’s tied up with reproductive hormones, with pregnancy history, with life stages that men simply don’t go through,” Arora added.
She is the senior author of a new study published in the
Researchers believe this gives women a “window of opportunity” during perimenopause to make lifestyle changes that may help lower their heart disease risk in the future.
Based on question responses, study participants were categorized as either premenopausal with an average age of 34, perimenopausal with an average age of 50.5, or postmenopausal with an average age of 60.
Arora said that she and her team decided to examine how different menopause stages might impact a woman’s heart disease risk partly because she kept seeing the disconnect between what the literature keeps telling us and what women are actually experiencing.
“Patients come in during perimenopause feeling like their bodies have shifted: being unable to lose weight, feeling like their energy is gone, not being able to sleep well, and cardiovascular risk isn’t really part of the conversation yet,” she explained.
“The consensus has always been to just revisit this in a few years,“ she told us. “But what if those few years are exactly when it matters most? That question drove a lot of this work.”
During the study, researchers examined how well study participants continued to adhere to the AHA’s Life’s Essential 8 — eight key measures to help improve and preserve cardiovascular health, such as eating a healthy diet, quitting smoking, maintaining a healthy weight, and being physically active.
Scientists discovered that perimenopausal women were twice as likely to have an overall low Life’s Essential 8 score when compared to premenopausal women, especially when it came to diet.
“To me, the significance [of this finding] is really about timing,” Arora said. “If we’ve been directing our attention and our resources only toward postmenopausal women when it comes to cardiovascular prevention, and it turns out the highest relative risk is earlier, during perimenopause, then we’ve been showing up late.“
According to her, “having twice the odds of poor cardiovascular health compared to premenopausal women after accounting for age is a clinically meaningful signal that tells us we should be starting these conversations sooner.”
“Perimenopause is not a waiting room for postmenopause: It’s a high-stakes window for cardiovascular health in its own right, and we need to start treating it that way. The time to pay attention to a woman’s heart health is during the transition, not after it.”
– Garima Arora, MD
MNT had the opportunity to speak with Jennifer Wong, MD, a board-certified cardiologist and medical director of Non-Invasive Cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA, about this study and why perimenopausal women may be twice as likely to have a low cardiovascular health score compared to women with regular menstrual cycles.
“These physiologic shifts contribute to an elevated cardiovascular risk profile and may partially explain the higher prevalence of low cardiovascular health scores in this population,” she told us..
“Estrogen plays a significant role in cardiovascular physiology,” Wong further explained. “During the early menopausal transition, estrogen is associated with more favorable lipid profiles, improved insulin sensitivity, and enhanced endothelial function, contributing to vascular flexibility. Declining estrogen levels during menopause may therefore contribute to increased cardiovascular risk.”
Middle age, particularly during the perimenopausal transition, Wong said, represents a critical window for cardiovascular risk modification.
“Perimenopause should be recognized as a pivotal period for cardiovascular risk assessment and preventive care,” she noted. “Adoption of heart-healthy behaviors during this stage can significantly improve long-term cardiovascular outcomes and overall health.”
As diet consistently received the lowest Life’s Essential 8 scores among perimenopausal women, and continued to decline through further menopause stages, Monique Richard, MS, RDN, LDN, a registered dietitian nutritionist and owner of Nutrition-In-Sight, shared her top tips on how to improve diet scores when transitioning to perimenopause, menopause, and postmenopause.
“The fluctuations and decrease in estrogen, bone density, muscle composition, thyroid function, as well as changes in insulin sensitivity can affect multiple systems at once and so we want to support the whole-body and address specific needs identified,” Richard said.
“One of the most important things I tell women is that it is not the time to ‘eat less,’ but to eat more strategically. As with all stages of life, if we want to flourish, we must nourish,” she emphasized.
Richard encouraged women to think about building a plate that nourishes hormones, muscles, bones, brain, and the microbiome all at once, and made the following recommendations for prioritizing nutritional needs during perimenopause and menopause:
- adequate hydration and electrolytes
- calcium– and vitamin D-rich foods for bone health
- colorful fruits and vegetables rich in polyphenols and antioxidants
- fermented foods with probiotics such as yogurt, kefir, kimchi, or miso
- flaxseed for lignans and cardiovascular support
- omega-3-rich foods like salmon, walnuts, chia, and flax
- prebiotic fibers obtained from foods such as beans, oats, onions, garlic, asparagus
- protein at consistent intervals to support muscle mass and metabolic health
- soy foods for naturally occurring protecting isoflavones.
“We’re really working to lift the ‘taboo’ related to perimenopause and menopause, and redirect understanding and care,” Richard said.
“It is not simply an ‘estrogen issue,’ or ‘woman’s problem,’ to deal with alone. It’s a whole-body transition that benefits from a whole-person approach, in addition to empathy, humanity, and updated tools that offer support and care. The right nutritional plan will help be foundational to any additional complementary interventions necessary. Midlife is not the beginning of decline but a ‘rebirth’ and ‘refresh’ for a vibrant next several decades of health.”
– Monique Richard, MS, RDN, LDN
