Only 1 in 5 Women Meet Heart Health Targets at Midlife, and These 4 Factors Matter Most

Fewer than 1 in 4 women in midlife maintain optimal cardiovascular (CV) health during the menopause transition, according to a new analysis of data from the Study of Women’s Health Across the Nation (SWAN). The findings, published in Menopause, linked higher scores on the American Heart Association’s Life’s Essential 8 (LE8) CV health framework to better vascular health, fewer CV disease events, and lower all-cause mortality.¹

The study, which included nearly 3000 women, also identified 4 LE8 components particularly influential in shaping long-term CV outcomes: blood glucose, blood pressure, sleep quality, and nicotine use.¹

Samar R El Khoudary, PhD, MPH

Courtesy of University of Pittsburgh School of Public Health

“Previously we’ve shown that the menopause transition is a time of accelerating cardiovascular risk. This study underscores that it’s also an opportunity for women to take the reins on their heart health.”

“Previously we’ve shown that the menopause transition is a time of accelerating cardiovascular risk,” senior author Samar R El Khoudary, PhD, MPH, professor of epidemiology at the University of Pittsburgh School of Public Health, said in a statement. “This study underscores that it’s also an opportunity for women to take the reins on their heart health.”²

The cohort of 2924 chosen for the analysis by El Khoudary et al had a median age of 46 years at baseline, according to the study. The team reported that just 21% of participants achieved an ideal LE8 score (80 or greater) during follow-up.¹

Women with higher baseline scores and greater improvements over time in total LE8 metrics had more favorable outcomes across all measures, including subclinical markers such as carotid intima-media thickness and plaque presence and pulse wave velocity. There were 213 CVD events that included myocardial infarction, stroke, heart failure, and revascularization and 161 deaths over a median 19 years of follow-up.¹

Among individual LE8 components, favorable baseline or improving scores for glucose, blood pressure, and nicotine exposure were consistently associated with reduced risk for all outcomes. Sleep quality also emerged as a notable factor, with better baseline or improved sleep associated with lower risk of CVD events and mortality, although not linked with subclinical measures such as carotid thickness.¹

In 2022, the AHA added healthy sleep as an essential component of CV health to the association's original Life's Simple 7, for the current LE8 elements. The addition at the time reflected the increasing body of evidence showing that both insufficient and excessive sleep are linked to increased risks of CVD, including hypertension, obesity, type 2 diabetes, stroke, and heart attack.³

Achieving the LE8 recommendation for 7 to 9 hours of sleep per night may be a key modifiable factor in women's long-term CV health, lead author Ziyuan Wang, a PhD candidate at Pitt Public Health, noted in the press statement, although further research is needed to confirm causality.² According to the authors, their findings may be more conservative in terms of sleep health alone, as well as the total LE8 scores, because they used a multidimensional sleep measure that captures a range of sleep-related issues rather than focusing solely on sleep duration.²

Among the study's limitations that could affect the ability to generalize their findings the authors acknowledged reliance on self report for several of the CVD outcomes and the potential for residual confounding. Still, they emphasized that the results underscore menopause as a critical window for intervention. Starting in midlife women have an opportunity to work against the common changes in LE8 components, such as an increases in visceral fat, elevated LDL-C, and the tendency toward hypertension, they noted. Sleep disruption during menopause is a well-known problem with deleterious effects that can also be modified to support long-term cardioprotection.¹

“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," El Khoudary concluded.²

References

1. Ziyuan W, Barinas-Mitchell E, Brooks MM, et al. Prospective associations of American Heart Association Life’s Essential 8 with subclinical measures of vascular health, cardiovascular disease events, and all-cause mortality in women traversing menopause: The Study of Women’s Health Across the Nation study. Menopause. 2025;32(8):758-768. doi:10.1097/GME.0000000000002549

2. Lloyd-Jones DM, Allen NB, Anderson CAM, et al on behalf of the American Heart Association. Life’s Essential 8: Updating and Enhancing the American Heart Association’s Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association. Circulation. 2022;146(5). doi:10.1161/CIR.0000000000001078

3. In menopause, sleep is vitally important for women’s long-term heart health, study finds. News release. University of Pittsburgh. July 9, 2025. Accessed August 4, 2025. https://www.eurekalert.org/news-releases/1090493