Women transitioning through menopause are at higher risk for heart disease, according to the Study of Women’s Health Across the Nation (SWAN). This research adds to the growing evidence that menopause is a critical time for changes in cardiovascular health. The study helps to underscore the importance of women and their doctors focusing on heart health during the menopausal transition.

“Midlife is not just a period where women have hot flashes and experience other menopausal symptoms,” said senior author Samar R. El Khoudary, Ph.D., M.P.H., associate professor of epidemiology at Pitt Public Health. “It’s a time when their cardiovascular disease risk is increasing as we see significant changes in multiple clinical measures of their physical health.”

For the study, El Khoudary and her team analyzed data from SWAN Heart, a study that enrolled women from Pittsburgh and Chicago between 2001 and 2003. It included two examinations of early markers of cardiovascular health over time. 339 women were included in the study, 36% were black and the rest white.

The researchers examined the way arterial stiffness changes as women transition through menopause. Arterial stiffness refers to the elasticity of arteries and is measured by looking at how fast blood flows through arteries. Arteries that have become stiff can lead to dysfunction in how well the heart pumps and moves blood, and could potentially damage the heart, kidneys, and other organs.

All participants were tracked for up to 12.5 years, or until they reached menopause, allowing researchers to confidently anchor the arterial stiffness measure to the menopausal transition.

The results published in Arteriosclerosis, Thrombosis, and Vascular Biology show that on average as women go through menopause, their arterial stiffness increases by about 0.9% up to one year before their last menstrual period to about 7.5% within one year before and after their last period. This is a considerable acceleration. The black women in the study were noted as showing a greater increase in arterial stiffness earlier in the transition than white women, more than a year before menopause.

Heart Health during Menopausal Transition

Lead author Saad Samargandy, M.P.H., a Ph.D. student at Pitt Public Health said, “SWAN is a unique source of data on changes in women’s health over several decades, and this is the latest in a long line of research by our team and others that indicate the menopausal transition is a very important time for heart health. While there are limitations to our study, including that a sizeable minority of the women had their arterial stiffness measured at only one time point, we were still able to see that major changes to cardiovascular disease risk happen around menopause.”

This study adds to previous research that has shown a link between menopausal transition and the accumulation of heart fat, inflammation, changes in cholesterol, blood pressure, and coronary artery calcification, among other heart disease risk factors.

“Our study is not able to tell us why we’re seeing these changes during the menopausal transition,” El Khoudary said. “But we speculate that the dramatic hormonal changes accompanying menopause might play a role by increasing inflammation and affecting vascular fat deposition, a hypothesis that we would like to test in future studies.”

More research is needed to test if lifestyle interventions such as diet changes or physical activity, or medications such as statin or hormone replacement therapy, could be beneficial as women go through menopause. But this study does outline the importance of women being made aware that their cardiovascular health is likely to worsen as they go through menopause.