Postmenopausal heart health: what to expect

Experts say it is never too late for women to know their risk factors and take steps to prevent heart disease.
Stream postmenopausal heart healthExperts say it is never too late for women to know their risk factors and take steps to prevent heart disease.

Although maintaining heart health is important for women of all ages, experts at the University of Alabama at Birmingham Division of Cardiovascular Disease say it is especially important after menopause as the risk of heart disease increases. While menopause does not directly cause cardiovascular diseases, certain changes that occur in the body during menopause can impact heart health. Beyond the shift in hormones, blood pressure, “bad” cholesterol and triglycerides — a type of fat that circulates in the blood, can all increase following menopause.

“Prior to menopause, women are relatively protected from developing symptoms related to atherosclerotic heart disease, which occurs when plaque builds up inside your arteries,” said Gretchen Wells, M.D., professor in the UAB Department of Medicine in the Marnix E. Heersink School of Medicine and cardiologist at the UAB Cardiovascular Institute. “Postmenopausal women experience angina, which means decreased blood flow to the heart, and other conditions that may block blood flow to the heart, such as a heart attack.” 

Experts say it is never too late for women to know their risk factors and take steps to prevent heart disease.

“We recommend talking to your doctor to determine your risk factors, such as elevated blood pressure, blood sugar or cholesterol levels,” said Elizabeth Jackson, M.D., professor of cardiology at UAB Hospital. “Your doctor can then help you develop a plan to minimize these factors.”

Stop smoking

According to the Centers for Disease Control and Prevention, smoking is a major cause of heart disease and causes one of every four deaths from heart disease.

Smoking can impact heart health through a number of ways, including the following:

  • Increase triglycerides
  • Lower “good” cholesterol
  • Make the blood more likely to clot, potentially blocking blood flow to the heart and brain
  • Damage the blood vessels
  • Increase buildup of plaque

“There are a number of free resources that can help both women and men to stop smoking,” Wells said.

In 2022, Wells was involved in a paper titled “Contributions of the Women’s Health Initiative to Cardiovascular Research: JACC State-of-the-Art Review.” This paper was the first of its kind summarizing the contributions the Women’s Health Initiative made toward cardiovascular health in postmenopausal women. Read the full paper here.

Below are some resources recommended by the American Heart Association.

Check out UAB Medicine’s resources for smoking cessation at

Get screened

By managing risk factors such as diet, physical activity, blood pressure levels, cholesterol levels and blood glucose levels, women can lower their risk of heart disease. To manage these factors, it is important to maintain regular checkups with a health care professional. AHA recommends these screenings:

  • Cholesterol checked every five years.
  • Blood pressure checked at least every two years.
  • Blood glucose levels checked every three years.
  • Waist circumference checked as needed.
  • Body mass index checked during every regular health care visit.

“There is a free risk calculator on the internet from the American College of Cardiology where you can insert your numbers to determine your 10-year risk of having a cardiac event,” Wells said. “Depending on your numbers, your doctors may prescribe statins that can help lower cholesterol levels and reduce risk of heart attack or stroke.”

Additionally, prioritizing one’s mental health and mental health screenings can also be beneficial as depression is linked to almost double the risk of stroke in middle-aged women, according to AHA. Women who are feeling down, depressed or hopeless or who have lost interest or pleasure in things they do should talk to a health care provider.  

Learn more on why talking to your family about their health history is important here.

Know your history

Heart disease and related conditions such as high blood pressure and high cholesterol can run in the family, which is why knowing one’s family history of these conditions plays an important role in preventing heart disease in the future.

“By looking at your family’s medical history, you can have a better understanding of which heart-related conditions you may be at risk for and use this information to make decisions that can help you maintain good heart health,” Jackson said.

In addition to understanding one’s family medical history, Wells says it is also important to work with a physician to determine how one’s own health history can impact their future heart health.  

“We want women with a history of gestational diabetes, hypertensive disorders of pregnancy and pre-term deliveries to be aware that they may have an increased risk of heart disease,” Wells said. “Your doctor can work with you to make a plan to minimize your risk of heart disease.”

Eat a heart-healthy diet

When it comes to heart health, diet matters. Wells and Jackson say wholesome nutrition is a major factor in combating plaque buildup in the arteries that can lead to heart disease. Focus on a diet that consists of an abundance of fruits and vegetables, foods high in fiber, and healthy sources of protein, such as plant-based protein, fish and seafood.

“Try to incorporate vegetables with a variety of colors, such as spinach, avocados, bell peppers, sweet potatoes, carrots and zucchini,” Jackson said. “Fruit options include strawberries, blueberries, blackberries and raspberries, which are full of antioxidants that can help minimize your risk of heart disease.” 

Foods that are high in fiber play a large role in protecting against heart disease, diabetes, diverticulitis, inflammatory bowel syndrome, obesity and colorectal cancer. Fiber maintains gut health, stabilizes blood sugar and helps people stay fuller longer.

Whole grains are good sources of fiber and other nutrients that help regulate blood pressure and maintain heart health. Choosing whole wheat bread instead of white bread or whole wheat pasta instead of egg noodles are examples of how to incorporate whole grains into one’s diet.

Fish, seafood and plant-based proteins including beans, peas, lentils and nuts are heart-healthy sources of protein. Although it is best to limit one’s consumption of red meat like beef, pork and lamb due to the amount of saturated fat in these items, when consuming poultry, pork, beef or other meat, choose lean meat, skinless poultry and unprocessed forms.

Learn more about how to maintain a heart-healthy diet here.

Inside PM HHPhysical activity is vital to maintaining good heart health.Move

Physical activity is vital to maintaining good heart health. Women should aim for at least 150 minutes of physical activity per week.

“Studies have shown that women who exercised 30 minutes a day for five days a week reduced their risk of a heart attack by 50 percent,” Jackson said. “We recommend trying to get at least 30 minutes in a day, but any movement is better than none.” 

Some examples of activities include walking, water aerobics, dancing, gardening, hiking and playing sports. The AHA says the simplest way to begin moving is walking, because it is free, easy and can be done anywhere. For those who are unable to do 30 minutes of activity at once, breaking it up into short bouts of activity during the day works too. Even a few small five- to 10-minute walks throughout the day add up.

For those with chronic conditions or disabilities, it is important to talk with a health care provider about what types and amounts of physical activity are right for them.

“No matter where you are with your heart health, it is important to find a doctor who will listen to your concerns,” Wells said. “Women’s heart programs have developed in most areas of the country and focus on the unique risk factors and differences in presentation between women and men regarding heart disease. Many of these programs have a research component as well as community involvement.”  

Women have unique risk factors and symptoms and may benefit from cardiac care designed to address their particular needs. The Women’s Heart Health Clinic at the Kirklin Clinic of UAB Hospital is directed by an experienced team of UAB cardiac experts, including hypertension specialists and interventional cardiologists, who can evaluate and manage the health of women with all types of heart disease. Learn more at

Learn more

In 2022, Wells was involved in a paper titled “Contributions of the Women’s Health Initiative to Cardiovascular Research: JACC State-of-the-Art Review.” This paper was the first of its kind summarizing the contributions the Women’s Health Initiative made toward cardiovascular health in postmenopausal women.

From 1993-1998, the WHI enrolled 161,808 racially and ethnically diverse postmenopausal women ages 50-79 years. Through clinical trials, the WHI evaluated three interventions — menopausal hormone therapy, diet modification, and calcium/vitamin D supplementation — and their role in preventing major chronic disease such as heart disease in postmenopausal women. Twenty-five years later, the WHI findings are still being leveraged to develop insights about heart disease prevention and healthy aging in women. Read the full paper about WHI findings and their contributions toward postmenopausal heart health here.