Perimenopause May Be the Ideal Time for Cardiovascular Risk Prevention

• A recent study suggests that perimenopause offers a “window of opportunity” for females to reassess cardiovascular risk and prompt lifestyle changes. 
• The findings show that perimenopausal females may be two times more likely to have lower cardiovascular health scores.
• According to the study authors, lower cardiovascular health scores may be largely due to high cholesterol and blood sugar levels. 

Perimenopause is considered the transitional period leading up to menopause. During this time, the ovaries begin to gradually produce fewer hormones, particularly estrogen. 

According to a nationwide analysis, U.S. females experiencing perimenopause are twice as likely to have a low cardiovascular health score than those who are still regularly menstruating. 

The findings of this study were recently published in the Journal of the American Heart Association, a peer-reviewed journal of the American Heart Association (AHA).

“From a cardiovascular standpoint, perimenopause is a very important time in which there are changing hormone levels, specifically with a declining estrogen level, which can have not only an impact on how one may feel but also on how one’s cardiovascular system is impacted and responds,” said Jossef Amirian, MD, a board certified cardiologist with Manhattan Cardiology in New York. Amirian wasn’t involved in the study.  

“The end result is potentially a change in body fat distribution, cholesterol and blood glucose levels, blood pressure, and this can all have an impact on blood flow and circulation as well,” he told Healthline.

How perimenopause impacts cardiovascular health

The analysis included data from 9,248 females ages 18 to 80 who participated in the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2020. 

The researchers used the AHA’s Life’s Essential 8 (LE8) metrics to measure participants’ cardiovascular health scores, along with other factors.

The LE8 scores are scientifically based measures of cardiovascular health as defined by the AHA. The recommendations comprise health behaviors and health factors, including: 

• diet
• physical activity
• tobacco use
• sleep
• blood pressure
• blood sugar levels
• cholesterol levels
• body weight

Using the LE8 scores, an average of all eight factors on a 100-point scale, the researchers assessed participants’ heart health. 

The average LE8 score among the participants declined with menopausal status:

• Premenopausal females (average age of 34): average score of 73.3 
• Perimenopausal females (average age of 50.5): average score of 69.1 
• Postmenopausal females (average age of 60): average score of 63.9.

After taking into account the effects of aging, the results showed that perimenopausal females were 76% more likely to have a low cholesterol score, meaning they had higher cholesterol levels.

Perimenopausal females were also 83% more likely to have a low score for blood sugar, meaning they had higher glucose levels, when compared to premenopausal females.

“During perimenopause, women commonly experience adverse metabolic changes, including worsening lipid profiles, increased insulin resistance, and greater accumulation of visceral adiposity,” said Jennifer Wong, MD, a board certified cardiologist and medical director of noninvasive cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA. Wong wasn’t involved in the study. 

“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 Healthline.

Perimenopause: A ‘window of opportunity’ for heart health

The transitional period of perimenopause marks the beginning of many changes in the female body.

It’s also an opportunity to focus on assessment, intervention, and prevention of cardiovascular risk factors. 

“Perimenopause is considered a ‘window of opportunity’ because during this time of changing hormones and a changing body, we have an opportunity such that if we reverse modifiable risk factors and improve our blood glucose, blood pressure, and cholesterol panels, we have an opportunity to lower our risk of cardiovascular disease and as such, mitigate our risk of heart attack and stroke,” said Amirian. 

Adapting heart-healthy behaviors during perimenopause can significantly improve long-term cardiovascular outcomes and overall health.

“Proper and adequate sleep, heart-healthy eating habits, and an exercise regimen focused on aerobic activity and strength training are key, especially at this time in one’s life,” said Amirian.