A nationwide U.S. study published today in the Journal of the American Heart Association reveals that perimenopausal women are twice as likely to have low cardiovascular health scores compared to premenopausal women, underscoring the importance of this transitional period as a critical time for heart disease prevention. The findings, based on data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2020, analyzed 9,248 women and assessed their heart health using the American Heart Association's Life's Essential 8 (LE8) metrics.
Perimenopause, the transition into menopause, is marked by fluctuating estrogen and progesterone levels, irregular menstrual periods, and symptoms such as mood changes, sleep problems, and hot flashes. According to the study, median LE8 scores declined with advancing reproductive stage: 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 overall LE8 score (less than 50 out of 100) compared to premenopausal women. They were also 76% more likely to have low cholesterol scores and 83% more likely to have low blood sugar scores.
“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 and professor of medicine at the University of Alabama at Birmingham. She emphasized that women should discuss reproductive changes with their healthcare team to establish a baseline for heart health.
The study, which defined low LE8 scores as below 50, intermediate as 50-79, and ideal as 80 or higher, found that diet consistently received the lowest scores across all reproductive stages and continued to decline. Sleep duration scores remained high despite reported sleep difficulties, suggesting sleep quality may be more affected. The American Heart Association's 2020 scientific statement on menopause and cardiovascular disease risk already highlighted this transition as an important time for early intervention.
“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, “This research highlights yet another aspect of the unique factors that increase a woman’s risk of cardiovascular disease throughout the stages of her lifespan. 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.”
The researchers urge clinicians to begin screening for high blood pressure, cholesterol, and Type 2 diabetes earlier during perimenopause. “Nutrition can be a central factor for early and proactive intervention,” added Dr. Arora, suggesting regular exercise and a heart-healthy eating plan like the DASH diet with a focus on lowering salt. The study’s next steps involve following women over several years to track hormone levels and heart health, which will help clarify the long-term impact of perimenopause and how lifestyle changes can reduce risk.
Further details and the full manuscript are available online at the Journal of the American Heart Association. Additional resources, including the American Heart Association’s Life's Essential 8 metrics, are accessible through the organization.
