Unraveling How the Menopause Is Related To Cardiovascular Risk & Heart Health in Women During and After Menopause

Link between early menopause and heart disease risk

Emerging evidence underscores that an earlier onset of natural menopause serves as a marker for heightened risk for heart problems. Factors like short menstrual cycle length, low parity, smoking, and unfavorable cardiovascular health status during reproductive years contribute to this risk. Additionally, individuals of Black and Hispanic backgrounds face an increased likelihood of experiencing early menopauseuse, magnifying their vulnerability to CVD.

Perimenopause: a window of cardiovascular disease vulnerability

Perimenopause, characterized by intermenstrual cycle irregularities extending up to 12 months after the final menstrual period, signifies a critical period marked by substantial alterations in cardio-metabolic and vascular health parameters. These shifts strongly correlate with future risk for heart attacks, stroke, and other forms of cardiovascular disease, warranting focused attention on mitigating risks during this phase (see key takeaways for women below).

Vasomotor symptoms and cardiovascular health

Vasomotor symptoms such as hot flashes may not be incidental midlife symptoms but in fact may offer insights into women’s future cardiovascular disease risk. These symptoms are associated with adverse cardiovascular risk factor profiles, such as higher LDL (“bad”)-cholesterol, higher blood pressure, and higher blood sugar levels. More frequent or severe hot flashes may signal adverse changes in the underlying vasculature, such as a thickening of vessel walls or accumulation of plaque on the vessel walls, which place women at future risk for heart disease events. Finally, women with more frequent hot flashes, particularly if they persist over midlife, are at elevated risk for heart attacks, strokes, and other cardiovascular disease events as they age. The links between hot flashes and women’s heart health is not accounted for by levels of estrogen in the body.

Linking risk factors to cognitive decline

Cardiovascular risk factors, such as blood pressure or elevated cholesterol, encountered during midlife hold implications that extend far into the future. Recent SWAN research has established a link between midlife cardiovascular risk factors and the rate of adverse changes in cognitive function during midlife.  Greater declines in cognitive function during midlife may increase risk of developing Alzheimer’s disease and related dementias later in life.

While the impact of vascular risk factors on cognitive decline is still emerging, the connection is undeniable. SWAN’s findings point to the critical role of cardiovascular health in shaping cognition, and highlight the importance of managing cardiovascular risk factors in midlife to promote healthy cognition as women age.

Reimagining heart health indicators for women

SWAN’s findings are providing a more nuanced understanding of the risk and indicators of heart disease in women. For example, research is showing that the protective effect of high-density lipoprotein cholesterol (HDL-C, the so-called “good” cholesterol) may diminish as women undergo menopause. Furthermore, studies have  suggested that post-menopausal women have significantly greater volumes of fat around their hearts – a risk factor for heart disease – than their pre-menopausal counterparts.

Impact of early life adversity on heart health

Childhood trauma, particularly experiences of childhood abuse, can cast a lasting impact on cardiovascular well-being later in life. SWAN’s research has revealed that a history mistreatment is associated with a heightened risk of CVD events, such as heart attacks and strokes, in women as they age. SWAN’s research has also found that women who have experienced intimate partner violence have increased risk for CVD events as they age, and that this connection may be due in part due to the increased blood pressure that women experiencing intimate partner violence often have. These findings delve into the complex biological pathways through which traumatic experiences may shape heart health. These findings also suggest potential preventive measures, such as blood pressure control, that may help protect the heart among women who have experienced intimate partner violence.