Heart Health
Heart disease is the #1 killer of women — and risk rises sharply after menopause. Most women don't know this. Here's what you need to know.
#1
Cause of Death in Women
More than all cancers combined
1 in 3
Women Will Die of Heart Disease
Yet only 44% know it's their biggest risk
2-3x
Risk Increase After Menopause
Protective effects diminish
80%
Is Preventable
With lifestyle and monitoring
The Hidden Cliff
Before menopause, women have significantly lower heart disease rates than men. After menopause, that gap narrows substantially — and women's risk approaches men's within 10 years. Many women are unaware of this shift.
This isn't about scaring you. It's about empowering you. Cardiovascular disease is largely preventable. But you can't prevent what you don't know about. Understanding the menopause-heart connection — and taking action now — could save your life.
Why Risk Increases at Menopause
Estrogen isn't just a reproductive hormone — it plays an important role in cardiovascular health. When it declines, several protective effects diminish.
What Estrogen Did for Your Heart
Kept Arteries Flexible
→ Arteries stiffen
Balanced Cholesterol
→ LDL rises, HDL falls
Reduced Inflammation
→ Inflammation increases
Supported Blood Pressure
→ BP tends to rise
Cardiovascular Risk Over Time
Age 30 — Lower risk
Age 65+ — Equal to men
Risk accelerates 10-15 years after menopause. The window to intervene is now.
Early menopause = earlier risk: Women who experience menopause before age 45 have significantly higher cardiovascular risk. If this is you, aggressive prevention and monitoring should start immediately.
Menopause is one factor among many. Traditional cardiovascular risk factors remain crucial: smoking, family history, high blood pressure, diabetes, obesity, physical inactivity, and unhealthy diet. Menopause adds additional risk — it doesn't replace these fundamentals. Focus on what you can control.
What Changes After Menopause
Four key cardiovascular markers typically shift in unfavorable directions. All are measurable and modifiable.
Cholesterol Profile
Estrogen decline is associated with LDL ("bad") cholesterol rising and HDL ("good") falling. Total cholesterol often increases 10-15%.
LDL rises an average of 10-15 mg/dL
HDL drops an average of 4-6 mg/dL
Triglycerides often increase
→ Get a lipid panel annually. Know your numbers.
Blood Pressure
Blood pressure tends to rise after menopause. Hypertension rates in women over 65 exceed those in men.
Target: Below 120/80 mmHg
Elevated: 120-129 / <80
High: 130+/80+
→ Monitor at home. Check at every doctor visit.
Blood Sugar & Insulin
Insulin sensitivity decreases after menopause. Risk of type 2 diabetes rises, and diabetes dramatically increases heart risk.
Fasting glucose target: Below 100 mg/dL
HbA1c target: Below 5.7%
Prediabetes: A1c 5.7-6.4%
→ Annual fasting glucose. A1c if risk factors present.
Body Composition
Fat redistributes to the abdomen (visceral fat). This metabolically active fat increases inflammation and heart risk more than other fat.
Waist circumference: Keep below 35 inches
Waist-to-hip ratio: Below 0.85
BMI: 18.5-24.9 ideal
→ Measure waist, not just weight. Strength training helps.
Warning Signs — Women Are Different
Heart attack symptoms in women often differ from the "classic" male presentation. Women are more likely to be misdiagnosed or delay seeking care.
Heart Attack Symptoms: Men vs. Women
Classic (More Common in Men)
- Crushing chest pain
- Pain radiating to left arm
- Cold sweat
- Sudden onset
Women May Also Experience
- Pressure, squeezing, or fullness (not always "pain")
- Pain in neck, jaw, back, or stomach
- Shortness of breath without chest pain
- Nausea, vomiting, or indigestion-like symptoms
- Unusual fatigue (even days before)
- Lightheadedness or dizziness
- Anxiety or sense of doom
Trust your instincts: Women often dismiss symptoms as stress, indigestion, or fatigue. They wait longer to seek help than men. If something feels wrong, get it checked. It's better to be wrong than dead.
🔴 Symptoms That Need Evaluation
See a doctor if you experience:
- New or worsening shortness of breath
- Chest discomfort with exertion
- Heart palpitations (especially with dizziness)
- Unexplained fatigue that's new or severe
- Swelling in legs or ankles
- Rapid or irregular heartbeat
💗 Menopause Palpitations vs. Heart Problems
Palpitations are common in menopause (40% of women). Most are benign. But get evaluated if they:
- Occur with chest pain or pressure
- Cause dizziness or fainting
- Last more than a few minutes
- Are accompanied by shortness of breath
- Happen frequently or worsen over time
What to Test and When
Cardiovascular health is measurable. These tests give you a clear picture of your risk — and whether interventions are working.
Essential Cardiovascular Tests
Test
Optimal
Borderline
High Risk
Total Cholesterol
<200 mg/dL
200-239
240+
LDL Cholesterol
<100 mg/dL
100-159
160+
HDL Cholesterol
60+ mg/dL
40-59
<40
Triglycerides
<150 mg/dL
150-199
200+
Blood Pressure
<120/80
120-139/80-89
140+/90+
Fasting Glucose
<100 mg/dL
100-125
126+
HbA1c
<5.7%
5.7-6.4%
6.5%+
📋 Advanced Tests to Consider
- Lp(a): Genetic risk factor. Test once in lifetime. If elevated, more aggressive prevention needed
- ApoB: Better predictor than LDL for some people. Measures actual particle number
- hs-CRP: Inflammation marker. Elevated levels add to risk assessment
- Coronary calcium score (CAC): CT scan showing calcified plaque. Excellent for risk stratification
- Carotid ultrasound: Checks for plaque in neck arteries
📅 Testing Schedule
- Blood pressure: Every doctor visit + home monitoring
- Lipid panel: Annually (more often if on treatment)
- Fasting glucose: Annually
- HbA1c: Every 1-3 years depending on risk
- Lp(a): Once (it's genetic, doesn't change)
- CAC scan: Consider at 50+ or earlier if family history
Prevention: What Actually Works
The good news: cardiovascular disease is largely preventable. Here's what the evidence says matters most.
Don't Smoke
Smoking is the single biggest modifiable risk factor
Highest Impact
Exercise
150 min/week moderate activity reduces risk 30-40%
Highest Impact
Heart-Healthy Diet
Mediterranean-style eating lowers CVD events by 25%+
Highest Impact
Healthy Weight
Especially reducing visceral (belly) fat
Quality Sleep
7-8 hours reduces cardiovascular risk
Stress Management
Chronic stress raises BP and inflammation
Know Your Numbers
Monitor BP, cholesterol, glucose regularly
Medication If Needed
Statins, BP meds are proven life-savers when indicated
Limit Alcohol
No amount is cardioprotective; less is better
On HRT and heart health: When started within 10 years of menopause, hormone therapy does not increase cardiovascular risk and may be protective for some women. Started later, risks may outweigh benefits. This is individualized — discuss with your doctor.
When to Seek Emergency Care
Know the signs. Act fast. Every minute matters during a heart attack.
🚨 Call Emergency Services Immediately If You Experience
Chest Symptoms
- Chest pain, pressure, squeezing, or fullness
- Pain lasting more than a few minutes
- Pain that goes away and returns
Other Warning Signs
- Pain in jaw, neck, back, arm, or stomach
- Sudden shortness of breath
- Cold sweat, nausea, or lightheadedness
- Sudden severe fatigue
Don't drive yourself. Call emergency services. Chew an aspirin (325mg or 4 baby aspirin) if not allergic. Time = heart muscle. Act fast.
✓ Your Heart Health Action Plan
✓ Get a complete lipid panel — know your LDL, HDL, triglycerides
✓ Check blood pressure — at home and at appointments
✓ Measure your waist — keep below 35 inches
✓ Get fasting glucose and HbA1c tested
✓ Ask about Lp(a) — one-time genetic test
✓ Consider a CAC scan if 50+ or high risk
✓ Exercise: 150 min/week minimum, include strength
✓ Know the warning signs — especially women's symptoms