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

Pulse pressure is lower in women than men early in life but becomes significantly higher in women after middle age

Cardiovascular changes linked to heart disease in women may begin almost two decades before the menopause, a study suggests, challenging the long-held belief that hormonal shifts are the main trigger for midlife heart decline.

New research published in Hypertension on September 14 suggests the process may begin years before menopause starts. (Unsplash/Representative Image)

Pulse pressure, the difference between the top and bottom numbers in a blood pressure reading, is lower in women than men early in life but becomes significantly higher in women after middle age. This has traditionally been attributed to menopause and the decline in estrogen levels.

However, new research published in Hypertension on September 14 suggests the process may begin years before menopause starts.

The study’s authors analysed data from more than 6,500 women and 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 14 years.

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,” said the study’s investigator Gary F Mitchell.

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.

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 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.