18 Cardiovascular Risk Factors Menopausal Women Need To Know

Woman with hands in shape of heart as she focuses on heart health

The problem with heart disease is that the first symptom is often fatal.

~ Michael Phelps

Think you’re too young at this point to really worry about cardiovascular disease (e.g., hypertension, heart disease, and stroke)? Wake-up call: heart disease is the #1 cause of death in women+ in the U.S. For context, it’s more fatal than all forms of cancer combined! Yet, awareness of this is dropping among women+, and during the menopause journey your risk goes up as estrogen levels drop. In addition, there are at least 18 factors – like your medical history, weight, menopause symptoms, race and ethnicity, and even where you live  – that can impact your cardiovascular risk. Understanding heart health risk factors can save your life.

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    Heart attack facts for women

    A heart attack usually occurs when there’s a blockage or underlying cardiovascular condition like heart disease. In women+, a heart attack can show up differently than in the stereotypical pictures that are often portrayed in movies and come to mind when you imagine signs and symptoms.

    While chest pain or discomfort are the most frequent symptoms of a heart attack in both men and women, a heart attack in women can present with symptoms like:  

    • pain or discomfort in your arms, back, jaw, neck or stomach
    • shortness of breath
    • a cold sweat
    • nausea or vomiting
    • lightheadedness or fainting
    • extreme fatigue

    Women+, and too often emergency room staff as well, sometimes attribute these symptoms to other conditions like acid reflux.  

    Cardiovascular disease (CVD): #1 Killer in women

    Cardiovascular disease (CVD) includes conditions of the heart or blood vessels. CVD encompasses several conditions, including: 

    • heart disease
    • hypertension (high blood pressure)
    • stroke
    • peripheral artery disesase (PAD)

    Women typically develop cardiovascular conditions 7-10 years later than men, with the fastest growing rates of CVD among 45-64 year old women+. As you may have noticed, that timing aligns with a typical timeframe for perimenopause, menopause onset, and the post-menopause stage of the journey.

    Women are exposed to more estrogen during their lifetime, particularly during the reproductive years, and estrogen offers a protective benefit with regard to CVD. However, once estrogen levels drop during the menopause journey, the risk of CVD goes up.

    Despite CVD  being a leading cause of death, the 2019 National American Heart Association Survey of Women’s Cardiovascular Disease Awareness found awareness of CVD as a leading cause of death had dropped in all races/ethnicities and ages, except in women 65 or older.

    The greatest declines in awareness were seen among Hispanic women and non-Hispanic Black women.

    By learning more about cardiovascular risk factors for women+, you can start taking charge of your heart health as soon as today. And it actually could mean the difference between life and death!

    While our focus in this article is on CVD risks associated with menopause,

    it’s important to note that other circumstances like a family history of CVD, certain medical conditions, and an unhealthy lifestyle also put you at increased risk.

    Cardiovascular risk factors

    Risk factors for CVD run the gamut from menopause symptoms to your medical history. 

    You have the power to take control of your heart health and your menopause journey!

    Ready to learn about the menopause risk factors? You can follow the ones listed below in order or select the ones of most interest to you and jump right to them.

    CVD Risk Factors Menopausal Women Should Consider

    1. Metabolic syndrome

    Have you heard of metabolic syndrome? It’s a group of medical conditions that increase the risk of heart disease, stroke, and type 2 diabetes.

    Metabolic syndrome is diagnosed if a person has at least three of the following five conditions:

    1. excess internal body fat around your organs with a waist circumference ≥ 35 inches in women+ (≥ 31.5 inches if you are Asian)
    2. high blood sugar (glucose)
    3. high blood pressure
    4. a high blood triglyceride (a type of fat that can increase your LDL “bad” cholesterol) level
    5. low HDL cholesterol (“good” ) level

    While each of the medical conditions individually increases risk, when they occur in combination, it can lead to a significantly increased risk of developing cardiovascular disease. So, even if you haven’t been diagnosed with metabolic syndrome, talk to your doctor about managing the conditions that can lead to a diagnosis, especially as the menopuase joureny can increase your risk of each of these conditions.

    For example:

    • The loss of estrogen during the menopause journey can impact your lipid levels like cholesterol. So, get regular lab work.
    • Many women gain weight during the menopausal transition, and it’s common to have a greater distribution of weight in the waist area instead of the hips or thighs. That excess internal body fat around your organs is a risk factor. So, consider exercises designed for menopausal women+ and eat foods, rich with the nutrients you need.
    • A recent study found that women+ who experience severe hot flashes are at a potentially greater risk of developing both hypertension and metabolic syndrome.
    Woman standing on scale worried about weight gain

    2. Obesity and visceral abdominal fat 

    In a pausitive health survey, weight gain was the top complaint from women+ on the menopause journey. So, what’s the impact on CVD?

    • Being 20 pounds or more overweight can increase the risk of high blood pressure, which is an additional risk factor for heart disease and stroke.
    • Excess visceral (internal around the organs rather than just under the skin) abdominal fat — the type most common during menopause — is particularly linked to increased (by 27%) CVD risk. It sets up an inflammatory process, which can also increase the risk of blood clots and diabetes.

    So, why do women gain weight during the menopause journey?  

    • A drop in estrogen levels can cue your body to gain weight in the abdomen versus on the thighs or hips. In fact, in post-menopausal women, belly fat accounts for 15 to 20% of their total body weight, compared with 5 to 8% in premenopausal women.
    • What’s more, the loss of muscle mass that tends to occur as we age can lead to a slower metabolism. And if the onset of menopause is early, a recent study of Korean women found an increased risk of muscle loss in the senior years, as measured by handgrip strength.
    • Even if you haven’t noticed it, you may be less active than you once were.
    • Symptoms like hot flashes, night sweats, aches and pains – the musculoskeletal syndrome of menopause, depression, and anxiety can lead to sleep issues, which in turn impact the levels of hormones like leptin and ghrelin, which can result in increased appetite and food cravings.

    Because of its relationship to CVD, it’s critical to pay attention to your weight during the menopause journey. Focus on foods packed with nutrients a woman needs on the journey. Exercise can also help with weight loss/maintenance, with the added bonus of also helping to boost energy, maintain/build muscle mass, and reduce the risk of osteoporosis. 

    3. Cholesterol and an abnormal lipid profile

    When was the last time you had lab work done? In most cases, the only way to know if your cholesterol or other lipids are abnormal is to have them checked. 

    Importantly, menopause can contribute to abnormal lipid profiles. Lipids are fats that circulate in your blood.

    One of these is cholesterol. It’s a waxy substance that’s made by your liver. There’s good (HDL) and bad (LDL) cholesterol.

    Another type of lipid is triglycerides. They can build up to unhealthy levels from foods you eat and when you eat more calories than you burn.

    If blood levels of some of these lipids are either too high or too low, it can lead to an increased risk of heart disease, stroke, or heart attack.

    During the menopause journey, the dramatic drop in estrogen levels can cause good cholesterol (HDL) levels to drop and bad (LDL) cholesterol and triglyceride levels to rise.

    When you have too much LDL (bad) cholesterol in your blood, it may be deposited in the lining of the arteries. These fatty deposits narrow your arteries, including those that carry blood to your heart, which can eventually lead to coronary artery disease.. On the other hand, having a low level of HDL (good) cholesterol has been associated with a higher risk of CVD.

    An abnormal lipid profile is of concern for all women+, but especially so for Black women+, who are at higher risk of both cardiovascular disease and an abnormal lipid profile.

    You can monitor cholesterol and triglycerides with lab work. 

     

    By taking action, like eating healthy foods (especially ones packed with nutrients needed for menopause), exercising regularly, and maintaining a healthy weight, you reduce the risk of developing an abnormal lipid profile and the likelihood of needing to take medication to do so.

    4. Diabetes

    Here’s what we know about diabetes and CVD:

    • Individuals with type 1 or type 2 diabetes are twice as likely to have heart disease at a younger age than those without diabetes.
    • The longer you have diabetes, the more likely you are to have heart disease. This occurs because high blood sugar can damage blood vessels and the nerves that control your heart.

    Because being overweight raises your risk of type 2 diabetes, weight gain during menopause may be responsible for the association between diabetes and menopause. Additionally, if you experience premature (age younger than 40) or early (between age 40 and 45) menopause, you are also at a greater risk of type 2 diabetes.

    You should have your doctor check your glucose levels at least every three years. These levels measure your blood sugar, which could help identify diabetes.

    5, Polycystic ovary syndrome (PCOS)

    There is also a connection between diabetes and polycystic ovary syndrome (PCOS), another risk factor for CVD. 

    PCOS is a condition affecting 5 – 10% of women in which the ovaries produce excess androgens (male hormones that women have in small amounts).

    If you were diagnosed with PCOS during your reproductive years, you may be at an increased risk of a future cardiovascular event.

    In fact, studies suggest that women with PCOS are twice as likely to have a heart attack or stroke.

    While there is no single criterion for diagnosing PCOS, possible symptoms include missed or irregular periods, ovarian cysts, excess body hair, acne, weight gain, and infertility.

    Many risk factors seen in people with cardiovascular disease, such as being overweight or having insulin-resistant diabetes, are also linked to PCOS. While the connection between diabetes and PCOS is not entirely understood, higher androgen levels are also a risk factor for diabetes.

    Many women with PCOS are insulin resistant, which can make it difficult to maintain normal blood glucose levels. In fact, 35% of women with PCOS have prediabetes, and 10 percent go on to develop diabetes by age 40.

    6. Hot flashes 

    Do you have hot flashes, night sweats, or heart palpitations? These are known as vasomotor symptoms.

    There is some evidence hot flashes can be an indicator of heart health, but the connection is not clear. Like so many other things with menopause, research is ongoing, and we’re learning more each day.

    Here’s what the research currently tells us:

    Research indicating heart health and hot flashes may be connected:

    • If hot flashes continue into the post-menopause stage and are severe, one study found women are more likely to develop metabolic syndrome and high blood pressure.
    • Hot flashes are also closely linked to poor CVD health metrics. These metrics, identified by the American Heart Association, help someone establish good cardiovascular health. In relation to hot flashes, women+ had higher blood pressure and body mass index, as well as abnormal lipids. At normal levels, all three are better for your heart health.

    Research showing there is not a link:

    • Another study found women+ with two or more moderate to severe menopausal symptoms had an increased risk of CVD, but vasomotor symptoms were not one of those symptoms.

    Remember, hot flashes are one potential risk factor for cardiovascular disease. Given the research is conflicting, there is even more reason to talk to your doctor about next best steps to manage VSMs and CVD risks.

    Also, hot flashes can impact your quality of life, which is another risk factor you can also learn about in this article. You may also want to learn about ways to manage hot flashes, so in addition to possibly helping heart disease, they don’t also impact your quality of life as much.

    Woman suffering from insomnia awake at night

    7. Insomnia

    For women on the menopause journey, sleepless nights are common. Aches and pains, night sweats, and palpitations can lead to problems with falling asleep, staying asleep, and getting enough good quality sleep. And the result includes fatigue, problems with focus and concentration, weight gain, and an increased risk of cardiovascular disease.

    If these issues occur 3 or more nights a week, last more than 3 months, and cannot be fully explained by another health problem, a diagnosis of chronic insomnia can be made. 

    Experienced by about 10 – 15% of people in the U.S., insomnia occurs when your day-to-day feelings and functioning are impacted by poor or insufficient sleep despite having an adequate opportunity to sleep.

    Insomnia increases the risk of cardiovascular disease in several ways:

    • increased inflammation and stress
    • a causal connection to obesity, diabetes, and depression
    • excessive daytime sleepiness
    • negative impact on lifestyle habits, leading to behaviors like unhealthy eating, being sedentary, and self-medicating with alcohol

    Besides heart disease, insomnia also impacts the likelihood of having a stroke. Compared to those who don’t have trouble sleeping, those with insomnia have close to a 51% higher risk of stroke, especially in people younger than 50.

    Insomnia health disparities

    As with many conditions, health disparities are observed with insomnia. Even before menopause, women report experiencing insomnia more often than men.

    White adults are more likely to have trouble falling asleep than Hispanic, Black, and Asian adults.

    Do you know what’s interrupting your sleep? Learn more about potential contributory factors besides dropping estrogen levels. And then get into a sleep routine as well as try techniques like binaural beats and cognitive behavioral therapy (CBT). 

    8. Moderate-to-severe menopausal symptoms

    How many menopause symptoms do you have? Now, how many are moderate-to-severe?

    If you have two or more moderate-to-severe symptoms, researchers found your CVD risk goes up, including an increase in the risk of stroke. 

    In the trial, women+ who had these moderate-to-severe symptoms had a higher risk of CVD:

    • dizziness
    • heart racing
    • restlessness
    • feeling tired
    • difficulty concentrating
    • forgetfulness
    • headaches or migraines

    Remember, you have options. Talk to your healthcare practitioner about hormonal and non-hormonal medications and techniques to manage symptoms.

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    9. Quality of life during menopause

    What’s your quality of life like during menopause?

    Menopause symptoms can impact the quality of your life, even if symptoms are mild. Perhaps you have multiple mild symptoms or other life challenges that can make it difficult to manage everything.

    In a Korean study about menopausal quality of life, researchers looked at 29 areas in four domains. Some of the symptoms on the questionnaire included:

    1. Vasomotor

      • hot flashes
      • night sweats
      • palpitations

    2. Psychosocial

      • dissatisfaction with life
      • anxiety and depression 
      • impatience
      • accomplishing less than usual
      • poor memory
      • a desire to be alone

    3. Physical

      • bloating, flatulence (gas)
      • tiredness, difficulty sleeping
      • drying skin
      • stress incontinence

    4. Sexual

      • intimacy avoidance
      • changes in sexual desire
      • vaginal dryness during intercourse

    How many of these quality-of-life boxes describe your menopause journey? The study found a higher prevalence of CVD when women+ had symptoms in all 4 areas.

    Having your day-to-day quality of life negatively impacted is definitely another reason to reach out to your healthcare practitioner to discuss the many options available to help manage symptoms.

    10. Stage of menopause

    The risk for CVD goes up as you progress through the stages of menopause, and estrogen levels continue to fall to a new low baseline in post-menopause.

    Post-menopausal women are at higher risk than perimenopausal women.

    It can take up to 10 years to move through the stages of menopause, particularly if you are a Black woman+.  Knowing where you are in the journey can help determine risk and any potential next steps. But developing healthy lifestyle habits is always a good place to start, both now and for your future health and well-being. 

    A new test, Clearblue, is now available which reportedly indicates your stage of menopause. Since global menopausal testing of all women+ is not recommended, it would be a good idea to speak with your doctor to determine if testing would be of value in your particular situation.

    11. Premature and early menopause

    When did you start menopause? Knowing if it’s “premature” or “early” is important because the timing can put you at higher risk for certain conditions for a longer time, including cardiovascular disease.

    Early menopause (age 40-45) and premature menopause (age <40) means the drop in estrogen levels occurs sooner during a person’s lifespan, and the associated increased risk of several chronic conditions lasts for a longer period of time.

    Both premature and early are linked to elevated risks of CVD, specifically heart failure and atrial fibrillation (a type of abnormal heart rhythm that increases the risk of stroke).

    Here’s what the research shows:

    Learn about the causes of premature and early menopause, and what to do if menopause happens overnight.

    12. High blood pressure during pregnancy

    When you hit menopause, you may think you’ve said goodbye to your reproductive years, but if you have been pregnant in the past, events during your pregnancy can also impact you during menopause.

    Gestational hypertension — defined as high blood pressure that first occurs after 20 weeks of pregnancy — is linked to an increased risk of heart disease later in life.

    High blood pressure disorders during pregnancy increase the likelihood of severe menopause symptoms like hot flashes and night sweats. In turn, those symptoms may impact your risk of CVD.

    If you’ve been pregnant before, think back to your experiences during pregnancy to assess whether they might be affecting both your menopause symptoms and cardiovascular risks now and discuss with your healthcare practitioner.

    13. Hysterectomy

    After Cesarean section, hysterectomy is the most common surgery performed in women in the US.

    A 2023 study found hysterectomy performed in women+ younger than age 50 were at increased risk of CVD. The incidence of stroke was also significantly higher.

    Typically, the removal of the ovaries during a hysterectomy leads to the immediate onset of menopause and, therefore the loss of heart-protective estrogen levels. However, in the study, the increased risk of CVD was present even in those whose ovaries were preserved, suggesting something related to the uterus itself is also heart-protective.

    14. Hormone therapy (HT)

    Hormone therapy (HT) can help relieve symptoms, like hot flashes. But there are risks to using it. Many of the HT risks you’ve probably heard about are connected to breast cancer, but there are heart disease concerns too.

    Even though HT usually includes estrogen, it doesn’t necessarily provide the same heart-protective benefits as estrogen that’s naturally found in the body.

    If you take estrogen hormone pills to relieve symptoms, you may be more likely to develop high blood pressure than women+ using other forms of the medication, according to new research.

    Why? Estrogen ingested orally must be processed first through the liver and is associated with factors that can raise blood pressure.

    How can you minimize this risk?

    Talk to your doctor about other forms of HT which pose fewer cardiovascular risks. For example, low-dose, non-oral estrogen, like estradiol in transdermal or vaginal forms, poses a lower risk of hypertension. If you have additional risk factors or a family history of CVD, exploring these alternative options becomes even more important.

    Consider HT in the early stages of menopause. Research has found that starting menopausal hormone therapy early in the menopause journey in women+ with menopausal symptoms may have cardiovascular benefits—though not in the late stages, according to the 2020 AHA scientific statement. The latest position statement from The Menopause Society also indicates that CVD events happen less often in younger women taking HT.

    It is important to note that taking HT solely as a preventive measure (rather than for symptoms) is not indicated.

    woman running with her dog in a field

    15. Where you live

    Did you know that where you live could impact your risk of CVD?

    A Mayo Clinic study found the prevalence of coronary heart disease (CAD) and stroke to be highest in the southern U.S., and the best cardiovascular health index (CVHI) scores were seen in the West. (The CVHI considers 7 cardiovascular health parameters – blood pressure, blood glucose, cholesterol, body-mass index, physical activity, healthy diet, and smoking behavior.)

    As you can see, the 7 factors are, thankfully, all health parameters and:

    • are ones over which you have a significant degree of control.
    • include many that a healthy lifestyle, which is helpful to pursue during the menopause journey to manage symptoms better, will help address.
    • are ones for which taking action will reduce the risk of conditions like diabetes, cancer, and cardiovascular disease (all of which figure more prominently during the hormonal transition and the years beyond)

    In the study, geographic locations where the population experiences higher degrees of insecurity – financial, housing, and food – had greater rates of heart disease.

    16. Race | Ethnicity

    Race is another risk factor for CVD. Women+ of color (WOC+) are more at risk for both CVD and their complications from heart disease than those who are white. In general, WOC+ are also at a greater risk of conditions which can contribute to the development of CVD, such as hypertension and diabetes. Some factors thought to be root causes of this disparity include exposure to racism/bias/discrimination and social determinants of health (SDOH), like socioeconomic status, environmental exposures, and degree of difficulty in living a healthy lifestyle. 

    Possible reasons include:

    • higher blood sugar levels
    • higher cholesterol levels
    • greater likelihood of experiencing:
      • lack of access to healthcare
      • environment – limited green space, safe walking areas
      • food deserts and less access to quality grocery stores

    The last two factors can make maintaining a heart-healthy diet and regular physical activity much more difficult to accomplish.

    And of course, the experience of racial discrimination in and of itself can also have detrimental health effects. For example, higher levels of perceived discrimination have been linked to elevated blood pressure.

    Black women+

    Black adults are diagnosed with more CVD risk factors such as hypertension and obesity than other racial groups.

    They’re also dying at disproportionate rates, particularly at younger ages (35 – 64 years old). While white women+ are more likely to be diagnosed with CVD, they are less likely than those who are Black to die from it. This disparity points to the barriers to quality healthcare that women+ of color face more often.

    African-American women in particular, have a higher prevalence of heart failure than any other intersection of race and sex in the country.

    Hispanic women+/Latinas

    Hispanic women+ of color also have a higher prevalence of heart failure than their white peers.

    Native women+

    Native women+ are 1.5 times more likely to be diagnosed with coronary artery disease (CAD).

    Asian women+

    While heart disease rates differ among Asian ethnicities, they are rising faster overall than rates among white adults. For example, Filipino Americans experienced the greatest increase in CVD, about twice as high as their white counterparts, during the study period from 2007-2018. The exception is among the Japanese, whose lower cardiovascular risks may be due to greater intake of traditional Japanese diets, which are more heart-healthy. Chinese people have been found to have the lowest prevalence of CVD.

    For Hmong women+, an ethnic group primarily from mountainous areas in Laos, China, Vietnam, and Thailand, a first stroke tends to occur at a much younger age than their white counterparts, recent research has found. Additionally, intracerebral hemorrhage—a type of stroke that often causes fatal brain bleeding—was twice as common in Hmong adults compared to white patients.

    Hawaiian and Pacific Islander women+

    Non-Hawaiian Pacific Islanders have been found to have a greater rate of coronary artery disease than Native Hawaiians.

    17. Risks for the LGBTQIA+ community

    LGBTQIA+ individuals can also face unique risks for cardiovascular disease. According to a small study, sexual and gender minorities may have a higher risk for stroke at a younger age than their heterosexual counterparts – the average age for LGBTQIA+ patients was 55 compared to 69 for their heterosexual peers. Lesbian, gay, bisexual, transgender or non-binary individuals were also potentially more likely to have another stroke.

    In addition to the elevated stress that comes with facing stigma and discrimination as risk factors, sexual and gender minority patients were also more likely to have HIV and a current or previous history of syphilis and hepatitis C as risk factors, contributing to inflammation and damage to blood vessels thereby increasing stroke risk.

    Transgender-specific risks

    In addition to the elevated stress that prejudice can cause, trans women undergoing gender-affirming hormone therapy have an increased risk for stroke, blood clots, and heart attacks.

    The risks for stroke and blood clots were highest with estrogen pills, shots, or patches and lower in individuals who took medication such as spironolactone to reduce testosterone.

    Additionally, chronic stress increases the risk of both hypertension, a risk factor for heart disease, and cardiovascular events. The stress of discrimination and transphobia has been linked to greater rates of heart disease in the transgender community.

    18. Disabilities and heart health

    In the U.S. approximately 42.5 million people are estimated to live with some form of disability (defined as persistent conditions of abnormal functioning that limit activities or restrict participation.) While not all disabilities are linked to an increased risk of cardiovascular conditions, physical disabilities are linked to the development of coronary heart disease.

    In addition, disabilities caused by coronary heart disease are more likely to result in death than disabilities from other causes.

    You can improve your heart health

    Menopausal risks are just one part of CVD. Factors like your lifestyle and a family history of cardiovascular disease can also contribute to an increased risk.

    These other factors include:

    • smoking and second-hand smoke exposure
    • sedentary lifestyle
    • family history
    • alcohol
    • unhealthy eating – diet high in saturated fats, trans fat, and cholesterol

    Talk to your doctor about your risk factors and consider a cardiovascular check-up. Watch the video below to learn more about the menopause journey and heart health.

    Whatever risks factors you may have for heart disease, remember there are many ways to improve your cardiovascular health, reduce the risk of complications, and make a change for the better. Take action now.

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