Menopause Transition and CVD: A Window of Opportunity

JoAnn E. Manson, MD, DrPH


December 28, 2020

This transcript has been edited for clarity.

Hello. This is Dr JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women's Hospital.

I'd like to talk with you about a recent report in Circulation, an American Heart Association Scientific Statement on the Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention.

Heart disease is a leading cause of death in women, yet only about half of women are aware of this fact. The menopause transition period, beginning about 2 years before the final menstrual period, is the stage of life during which there is accelerated cardiovascular disease (CVD) risk and adverse changes in CVD risk factors. The purpose of this report is to highlight a window of opportunity for helping women to reduce their risk factors and lower their CVD risk. I'd like to acknowledge that I'm a coauthor of this report.

Several longitudinal cohort studies have looked at the role of menopause transition and the entire perimenopause (which includes 1 year after the final menstrual period). This is the stage of life when estrogen levels, although fluctuating, are substantially declining and follicle-stimulating hormone levels are increasing.

Researchers have tried to disentangle the changes in risk factors that are due to ovarian aging as opposed to chronological aging in cohorts of women. They've identified some of the risk factors linked to ovarian aging, including increases in LDL cholesterol and apolipoprotein B, and changes in the quality of HDL cholesterol (such that HDL may not be as protective or its function changes). Others include changes in body composition, such as increased central and visceral adiposity and ectopic fat distribution (including pericardial fat), as well as a reduction of lean body mass and increased prevalence of metabolic syndrome. Some risk factors, such as changes in blood pressure and glucose tolerance, are more closely linked to chronological aging.

During this time, women — especially those who experience premature (onset before age 40) or early (onset between age 40 and 45) menopause — can be at particularly high risk for CVD. The report discusses the appropriate use of estrogen, which may be of particular relevance in women with premature or early menopause but also in women who have significant vasomotor or other menopausal symptoms, especially those that interfere with sleep and quality of life.

This report focuses on lifestyle modification (physical activity, heart-healthy diet, Life's Simple 7) and the tremendously important role that lifestyle modification can have in lowering CVD in women and improving risk factor status during this period, as well as, in some cases, pharmacologic management of elevations in blood pressure or lipids.

Although, we need much more research on the relationship between the menopause transition and CVD risk in women. There already is a critical mass of actionable information that can be used to help women to improve their CVD risk factor status, especially during this period of accelerated risk, and ultimately lower their risk for CVD.

Thank you so much for your attention. This is JoAnn Manson.

Dr JoAnn Manson is a professor of medicine at Harvard Medical School and chief of the Division of Preventive Medicine at Brigham and Women's Hospital in Boston, Massachusetts.

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