Perimenopause Identified as Key Window for Heart Disease Prevention in Women

A nationwide U.S. study published today in the Journal of the American Heart Association found that perimenopausal women are twice as likely to have low cardiovascular health scores compared to women still having regular menstrual cycles. The findings underscore perimenopause as a critical 'window of opportunity' for early intervention to prevent heart disease.

The analysis, based on data from the National Health and Nutrition Examination Survey (2007-2020), included 9,248 women aged 18 to 80. Using the American Heart Association's Life's Essential 8 (LE8) metrics, which assess diet, physical activity, tobacco use, sleep, blood pressure, cholesterol, blood sugar, and body weight, researchers found that median LE8 scores declined 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 twice as likely to have a low LE8 score (below 50 out of 100) compared to premenopausal women.

Dr. Garima Arora, senior author and professor of medicine at the University of Alabama at Birmingham, emphasized the importance of proactive health checks during perimenopause. '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,' she said. The study found that low scores were largely driven by significantly higher cholesterol and blood sugar levels, with perimenopausal women 76% more likely to have a low cholesterol score and 83% more likely to have a low blood sugar score.

Fluctuating estrogen levels during perimenopause may contribute to these declines by negatively affecting cholesterol, insulin resistance, blood pressure, and weight management. Lead author Dr. Amrita Nayak noted that perimenopause is the first stage where a significant jump in cardiovascular risk occurs. '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,' she said.

Dr. Stacey E. Rosen, volunteer president of the American Heart Association, who was not involved in the study, highlighted the importance of addressing both traditional and female-specific risk factors. 'Significant health changes during pregnancy, perimenopause and menopause make it particularly important to pay close attention to increases in health risk factors during those times,' she said. The study also revealed that diet scores were consistently the lowest among all LE8 components and continued to decline across reproductive stages. Dr. Arora recommended focusing on heart-healthy habits such as regular exercise and the DASH diet, which emphasizes lowering salt intake.

The researchers hope these findings will encourage clinicians to begin screening for high blood pressure, cholesterol, and Type 2 diabetes earlier during the perimenopausal transition. The study's next steps include following women over several years to track hormone levels and heart health, clarifying the long-term impact of perimenopause and how lifestyle changes can reduce risk. Limitations of the study include reliance on self-reported menstrual history and lifestyle factors, as well as incomplete data on ovary removal or hormone replacement therapy use.