Role of menopause in the development of cardiovascular disease in women.

Cardiovascular disease (CVD) is the most common cause of death in women. Early identification of CVD risk factors in women is often overlooked by physicians leading to delays in diagnosis and treatment of CVD with subsequent morbidity and mortality. There may be a correlation between declining hormone levels during menopause and the prevalence of CVD during midlife. Alterations in the CVD risk profile of women throughout the menopause transition (MT) are multifactorial and include changes to arterial stiffness, endothelial function, lipid metabolism, insulin resistance and adipose fat distribution. Menopausal Hormonal Therapy (THM) is a potential therapy to reduce CVD risk, though clinical trials have shown conflicting results, with some trials reporting an increase in CVD events with THM. A holistic approach to care for women going through the MT could be beneficial to improve their CVD risk profile and quality of life. This would include early identification of risk factors in individual patients and raising public and professional awareness of CVD risk burden in this patient population. Improving the knowledge of healthcare professionals and the public that women going through the MT are at an increased risk of CVD is a key target area to improve cardiovascular health in women. Current risk assessment scores for CVD do not include sex-specific risk factors. Guidelines and National Health Systems are beginning to recognise the importance of reproductive history in women's cardiovascular health. In this review, we aim to discuss traditional and sex specific risk factors for CVD in menopausal women, current guidelines on THM, gaps in knowledge and strategies to reduce CVD in women.