Cardiovascular Risk During Menopause: A Window of Opportunity for Prevention

Cardiovascular disease (CVD) is the leading cause of mortality in women, with one woman dying every 80 seconds from heart disease, surpassing deaths from all cancers combined (Uddenberg et al., 2024). The risk of CVD increases significantly during the menopausal transition, largely driven by declining estrogen levels. Estrogen plays a critical role in maintaining metabolic and vascular homeostasis through its regulation of lipid metabolism, insulin sensitivity, fat distribution, and endothelial function. Its decline contributes to adverse physiological changes, including increased arterial stiffness, dyslipidemia, and central adiposity, which elevate the risk of hypertension, coronary artery disease, and overall cardiovascular morbidity.
Sex-specific differences in cardiometabolic risk become more pronounced during midlife. Although men typically develop cardiovascular risk factors earlier, women experience a more rapid acceleration in risk during and after menopause. Postmenopausal women exhibit a more atherogenic lipid profile, characterized by increased low-density lipoprotein cholesterol and decreased high-density lipoprotein cholesterol, as well as greater central fat accumulation compared to age-matched men (Anagnostis et al., 2023). These changes reduce the cardioprotective advantage observed in premenopausal women.
The menopausal transition represents a critical window for early identification and management of cardiometabolic risk factors. Interventions such as lifestyle modification, routine screening, and individualized risk assessment are essential. Menopausal hormone therapy may provide cardiovascular benefits when initiated early in selected women, though risks must be carefully evaluated. Reframing menopause as a preventive health opportunity may improve long-term cardiovascular outcomes and reduce disease burden.