Women’s cardiovascular changes may begin nearly 20 years before menopause: Study

Changes linked to future heart disease in women may begin nearly two decades before menopause, a new study suggests, challenging the long-held belief that menopause is the main trigger for age-related cardiovascular changes.

The research, published in Hypertension on September 14, found that pulse pressure — the difference between the top and bottom numbers in a blood pressure reading — begins rising in women in their late 30s, about a decade earlier than in men. This has traditionally been attributed to menopause and the decline in estrogen levels. However, the new research suggests the process may begin years before menopause starts.

The study’s authors analysed data from more than 6,500 women and more than 3,000 men participating in the Framingham Heart Study, one of the world’s longest-running cardiovascular research projects. Participants underwent three health assessments over a 14-year period.

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Researchers found that pulse pressure reached its lowest point and then began rising about a decade earlier in women than in men. Among women, the shift occurred in the late 30s, while among men, it occurred in the late 40s. The pattern remained the same regardless of whether women experienced menopause early, late or at the typical age. By around age 60, women consistently had higher pulse pressure than men, the researchers found.

“To our huge surprise, our results suggest that factors other than the timing of the final menstrual period were likely involved in the accelerated increase in pulse pressure in women after midlife,” noted Gary F Mitchell, an investigator with the Framingham Heart Study.

Pulse pressure is closely linked to the stiffening of the aorta, the body’s largest blood vessel. The aorta carries oxygen-rich blood from the heart to the rest of the body. As its walls become stiffer and less elastic with age, the heart has to work harder to pump blood through the circulatory system.

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The study explains that widening pulse pressure is increasingly recognised as an important marker of cardiovascular health. Elevated pulse pressure is linked to a higher risk of heart disease, dementia and kidney disease. It may also make high blood pressure harder to control because some medications are less effective when arteries become stiff.

The findings of the new study suggest that changes affecting blood vessel health may begin much earlier in women than previously understood. Researchers said the results highlight the importance of paying closer attention to women’s cardiovascular health well before midlife and suggest that monitoring pulse pressure may help identify future heart risks earlier.