Only 1 in 5 midlife women meet heart health goals—here's the overlooked factor
Industry Buzz
Our work over the course of many years has helped to establish that the menopause transition is really a critical turning point for cardiovascular health.
—Samar R. El Khoudary, PhD, MPH, professor of epidemiology at the University of Pittsburgh School of Public Health
A striking new analysis from the University of Pittsburgh reveals that just 21% of middle-aged women—average age of 46—achieve an ideal score on the American Heart Association’s Life’s Essential 8 (LE8) metric, a comprehensive cardiovascular health index. []
The study followed nearly 3,000 women from the long‑standing Study of Women's Health Across the Nation (SWAN), tracking how their LE8 scores corresponded with long‑term outcomes such as carotid‑artery thickness, cardiovascular events, and all‑cause mortality. []
Related: AHA guidelines for 'Life's Essential 8': Metrics to predict longevity4 LE8 components stand out—especially sleep
Of the eight components—diet, physical activity, tobacco use, sleep, BMI, blood lipids, blood sugar, and blood pressure—four emerged as the strongest predictors of future risk:
Blood glucose
Blood pressure
Nicotine exposure
Sleep quality
Among these, sleep had the most notable correlation with long‑term cardiovascular events and overall mortality, even though it wasn’t tied to intermediate markers like carotid thickening. []
It's worth noting there were study limitations like the included cardiovascular disease events being self-reported. Even still, it's important “to find effective ways to help women adopt healthy habits and stick to them," said Samar R. El Khoudary, PhD, MPH, a professor of epidemiology at the University of Pittsburgh School of Public Health. []
What you can do in practice
For clinicians, midlife—especially the menopause transition—represents a critical window. Hormonal changes often usher in increased visceral fat, metabolic shifts, elevated blood pressure, and disrupted sleep. []
Together, these factors converge to ramp up cardiovascular risk—and yet, this study suggests sleep is a modifiable element that might offer outsized returns when addressed proactively.
“Our work over the course of many years has helped to establish that the menopause transition is really a critical turning point for cardiovascular health,” Dr. El Khoudary said. “From midlife on, it is important that women work to counteract all of those changes to protect their cardiovascular health for the long haul.” []
Here's what you can do as a physician:
1. Screen all midlife women for sleep quality: Begin routine assessment with simple questions: “How many hours do you sleep nightly? Do you feel rested or wake frequently?” Early recognition of sleep issues opens the door to heart‑health counseling.
2. Integrate sleep into risk assessments: When evaluating cardiovascular risk, don’t just check blood pressure or A1c—ask about sleep. Highlight that 7 to 9 hours of quality sleep isn’t just about energy; it’s a heart‑protective behavior in its own right. []
3. Collaborate for sleep interventions: Coordinate care with sleep specialists for insomnia, sleep apnea, or circadian rhythm disorders. For sleep hygiene, offer evidence‑based advice—consistent schedule, screen curfew, bedroom environment.
4. Revisit the LE8 holistically: Use LE8 not just as a metric but a framework. Optimize diet, activity, smoking cessation, blood pressure, glucose—but especially sleep, which may boost long‑term outcomes even when other markers lag.
Related: How 2 common sleep habits increase your risk of death