Among midlife women, only about 21% reached ideal cardiovascular health scores at baseline, per the American Heart Association’s Life’s Essential 8 (LE8) tool.
Glucose levels, blood pressure, nicotine exposure, and sleep quality emerged as key drivers of risk for future heart disease or mortality.
Improvements in LE8 scores over time corresponded with more favorable vascular markers and lower rates of cardiovascular events and death.
As women move through the menopause transition — typically in their late 40s and early 50s — they face important shifts in heart health that often go unnoticed.
A recent study published in Menopause dives into how lifestyle and biological metrics grouped under the American Heart Association’s “Life’s Essential 8” (LE8) checklist during this phase can predict long‑term cardiovascular outcomes.
"Previously we've shown that the menopause transition is a time of accelerating cardiovascular risk," senior author Samar R. El Khoudary, Ph.D., M.P.H., professor of epidemiology at Pitt's School of Public Health said in a news release. "This study underscores that it's also an opportunity for women to take the reins on their heart health."
The study
The team analyzed data from nearly 2,924 women, average age 46, who were part of the Study of Women’s Health Across the Nation.
At baseline and follow-up visits, women received scores on the LE8 components: diet, physical activity, nicotine exposure (smoking), sleep, body mass index, cholesterol, blood sugar (glucose), and blood pressure.
They tracked how each woman’s total LE8 score — and changes in that score over time — related to:
Subclinical vascular health markers, such as carotid artery thickness, plaque presence, and arterial stiffness.
Actual cardiovascular events, including heart attack, stroke, heart failure, or procedures like revascularization (n=213 events).
All‑cause mortality, with 161 deaths recorded.
Statistical models adjusted for age and other potential influences to isolate the effect of LE8 scores and changes in scores.
The results
Ultimately, the researchers identified a link between women who had better LE8 scores and overall better health outcomes.
Only about 21% of these midlife women maintained ideal LE8 scores (a total score ≥ 80) across visits.
Women with higher baseline LE8 scores, and those whose scores improved over time, showed healthier arteries, reduced plaque, and less arterial stiffness. They also had lower rates of cardiovascular events and death.
Of the eight LE8 components, blood glucose, blood pressure, and nicotine exposure were most strongly linked with risks across vascular and event outcomes.
Crucially, sleep quality stood out: better baseline sleep and improvements in sleep score were associated with lower cardiovascular events and mortality, suggesting sleep uniquely contributes to heart health during menopause.
"With heart disease being the leading cause of death in women, these findings point to the need for lifestyle and medical interventions to improve heart health during and after menopause among midlife women," Dr. El Khoudary said.