Perimenopause Identified as Critical Window for Heart Disease Prevention in Women
A new study reveals that perimenopausal women are twice as likely to have low cardiovascular health scores, highlighting this transition as a key opportunity for early intervention and lifestyle changes to prevent heart disease.
A new analysis of nationwide U.S. data published today in the Journal of the American Heart Association finds that perimenopausal women are twice as likely to have a low cardiovascular health score compared to premenopausal women, underscoring the importance of this transitional period for heart disease prevention. The study, which used the American Heart Association’s Life’s Essential 8™ (LE8) health metrics, suggests that perimenopause—the transition into menopause—offers a "window of opportunity" for women to reassess risk and implement lifestyle changes.
Researchers analyzed data from 9,248 women aged 18 to 80 who participated in the National Health and Nutrition Examination Survey between 2007 and 2020. Participants were categorized as premenopausal (median age 34), perimenopausal (median age 50.5), or postmenopausal (median age 60). The LE8 score, which measures cardiovascular health on a 100-point scale based on diet, physical activity, tobacco use, sleep, blood pressure, cholesterol, body weight, and blood sugar, revealed a clear decline: median scores dropped from 73.3 in premenopausal women to 69.1 in perimenopausal women and 63.9 in postmenopausal women.
After accounting for aging, perimenopausal women were 76% more likely to have a low cholesterol score and 83% more likely to have a low blood sugar score compared to premenopausal women. Diet consistently received the lowest scores across all groups and continued to decline. "Mid-life women should think of the perimenopausal period as a 'window of opportunity.' They should be proactive and not wait until they reach menopause to start checking their blood pressure, cholesterol and blood sugar levels," said Garima Arora, M.D., senior author of the study and professor of medicine at the University of Alabama at Birmingham. "Women should talk with their health care team about their reproductive status and any changes they are experiencing."
The findings align with a 2020 scientific statement from the American Heart Association emphasizing that the menopause transition increases cardiovascular disease risk and is a critical time for early intervention. Fluctuating estrogen levels during perimenopause may contribute to declines in heart health by affecting cholesterol, insulin resistance, blood pressure, and weight.
"Our analysis highlights that perimenopause is the critical time when the increase in cardiovascular risk seems magnified," said Amrita Nayak, M.D., lead author and research fellow at the University of Alabama at Birmingham. "When we compared women’s LE8 scores to the premenopausal baseline, the perimenopausal group was the first to show a significant jump in the odds of having low heart health."
Stacey E. Rosen, M.D., FAHA, volunteer president of the American Heart Association, noted that the research "highlights yet another aspect of the unique factors that increase a woman’s risk of cardiovascular disease throughout the stages of her lifespan." She encouraged women to discuss both traditional and female-specific risk factors with their healthcare teams.
The study’s authors are now planning to follow women over several years to track hormone levels and heart health, aiming to clarify the long-term impact of perimenopause and how lifestyle changes can reduce risk. "We hope these findings encourage clinicians to begin screening for high blood pressure, cholesterol and Type 2 diabetes earlier in the perimenopausal transition," Arora said.
The American Heart Association’s Life’s Essential 8 metrics provide a framework for achieving optimal cardiovascular health. The study’s results underscore the importance of nutrition and exercise, with Arora recommending the DASH diet and regular physical activity as key interventions for perimenopausal women.