Cardiovascular Risk Assessment and VMS Management in Menopausal Care

In "Cardiovascular Risk Assessment and VMS Management in Menopausal Care," our panel explores the inadequacies in current cardiovascular risk assessment practices for menopausal women and presents a comprehensive, guideline-informed framework for improving that care.

Dr. Erin Michos introduces the PREVENT score, the American Heart Association's updated risk calculator, which improves upon prior tools by incorporating kidney function, social determinants of health, and more diverse population data. Critically, the PREVENT score estimates both 10-year and 30-year cardiovascular risk — the latter being especially relevant for younger and perimenopausal women who may appear low-risk in the short term but carry significant lifetime risk. Updated risk thresholds are outlined, with 10-year risk categories ranging from low (under 3%) to high (above 10%).

Beyond the calculator itself, Dr. Erin Michos highlights guideline-recommended risk enhancers not captured in standard scoring, including adverse pregnancy outcomes such as preeclampsia and gestational diabetes, polycystic ovary syndrome, preterm delivery, and early menopause before age 45. A class one guideline recommendation for one-time lipoprotein(a) testing in all adults is also discussed, given its genetic basis and absence from standard lipid panels.

For cases where risk remains uncertain, coronary artery calcium scoring is presented as a useful adjunct tool to guide decisions around statin therapy and menopausal hormone therapy. Calcium score ranges are discussed in the context of shared decision-making around hormone therapy eligibility for VMS management.

Both panelists converge on the importance of a personalized, multifactorial approach — one that integrates reproductive history, cardiometabolic profile, and menopause status — and stress that cardiovascular risk assessment must be an ongoing, dynamic process rather than a one-time evaluation, particularly as women age beyond 10 years post-menopause or past age 60.

Our next episode, "Hormonal and Non-Hormonal Treatment Options in VMS," provides a comprehensive overview of both hormonal and non-hormonal treatments available for vasomotor symptoms, from menopausal hormone therapy and its evidence base to newly FDA-approved pharmacologic options for women who cannot or choose not to use hormones.