Cardiovascular risk management in women in peri- and postmenopause: a global health challenge (literature review)
https://doi.org/10.69964/BMCC-2025-2-1-10-20
Abstract
According to WHO, cardiometabolic disorders have remained the leading cause of death in the world for 20 years. Heart diseases account for 16% of deaths worldwide today, reaching 47% in Russia. Unfortunately, awareness of CVD as a leading cause of death remains insufficient among both women and physicians. The risk of CVD in middle-aged women remains underestimated and certainly requires timely interdisciplinary attention. The aim of the study was to conduct a literature review of databases in the context of studying the problem of cardiovascular risk realization in peri and postmenopausal women. Research methods. An analysis of evidence published in 2015-2025 in the Cochrane Library, PubMed, ELibrary, Science Direct, Scopus, Web of Science, Google Scholar electronic libraries was conducted using the keywords cardiovascular diseases, cardiovascular risk, peri and postmenopause, menopausal hormone therapy. Results of the study. The review presents the main determinants of the implementation of cardiometabolic and cardiovascular risks in women in peri and postmenopause both in terms of aging and in terms of the influence of menopausal hormone therapy. Conclusion. The presented data convincingly indicate that in order to prevent the implementation of cardiovascular risk in women in peri and postmenopause, it is necessary to create a personalized pathogenetically substantiated strategy of therapeutic and preventive measures based on the concept of preventive medicine.
About the Authors
O. A. MinyailoRussian Federation
Olga A. Minyailo — PhD, Assistant of the Department of Cardiology
Address: st. 8 Marta, 78a, Ekaterinburg, 620144
Phone: +79122863062
O. A. Melkozerova
Russian Federation
Oksana A. Melkozerova — МD, docent, Deputy
of Director for Science
Address: st. Repina, 1, Ekaterinburg, 620028
Phone: +7 (922) 219 45 06, +7 (343) 371 24 27
Yu. A. Semenov
Russian Federation
Yuri A. Semenov — Doctor of Medical Sciences,
Honored Doctor of the Russian Federation, Director
Address: st. Repina, 1, Ekaterinburg, 620028
Phone: + 7 (343) 371 87 68
Ya. L. Gabinsky
Russian Federation
Yan L. Gabinskiy — MD, PhD, Professor, Honored
Doctor of the Russian Federation, Head of the
Department of Cardiology of the Federal State
Budgetary Educational Institution of Higher
Education “Ural State Medical University” of the
Ministry of Health of the Russian Federation, Chief
Physician
Address: st. 8 Marta, 78a, Ekaterinburg, 620144
A. A. Mikhelson
Russian Federation
Anna A. Mikhelson — MD, docent, Head of
department reproductive functions preservation,
Head of the Department of Gynecology
Address: st. Repina, 1, Ekaterinburg, 620028
Phone: +7 (343) 371 24 27
References
1. Stuenkel C.A. Do we have new preventive strategies for optimizing cardiovascular health in women? Climacteric. 2019;22(2):133–139. https://doi.org/10.1080/13697137.2018.1561665
2. Cushman M., Shay C., Howard V. et al. Ten-year differences in women’s awareness related to coronary heart disease: results of the 2019 American Heart Association National Survey: a special report from the American Heart Association. Circulation. 2021;143(7):239–248. https://doi.org/10.1161/CIR.0000000000000907
3. Wenger N.K., Lloyd-Jones D.M., Elkind M.S.V. et al. Call to action for cardiovascular disease in women: epidemiology, awareness, access, and delivery of equitable health care: a presidential advisory from the American Heart Association. American Heart Association. Circulation. 2022;145:1059–1071. https://doi.org/10.1161/CIR.0000000000001071
4. Bello N.A., Merz C.N.B., Cheng S. A scientific imperative as seen through a sharpened lens: sex, gender, and the cardiovascular condition. Circ. Res. 2022;130:433–435. https://doi.org/10.1161/CIRCRESAHA.122.320825
5. Luu J.M., Wei J., Shufelt C.L. et al. Clinical Practice Variations in the Management of Ischemia With No Obstructive Coronary Artery Disease. J. Am. Heart Assoc. 2022;11:022573. https://doi.org/10.1161/JAHA.121.022573
6. Shaw L.J., Min J.K., Nasir K. et al. Sex differences in calcified plaque and long-term cardiovascular mortality: observations from the CAC Consortium. Eur. Heart J. 2018;39(41):3727–3735. https://doi.org/10.1093/eurheartj/ehy534
7. Ibanez B., James S., Agewa S. et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardialinfarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur. Heart J. 2018;39(2):119–177. https://doi.org/10.1093/eurheartj/ehx393
8. Maas A.H.E.M., Rosano G., Cifkova R. et al. Cardiovascular health after menopause transition, pregnancy disorders, and other gynaecologic conditions: a consensus document from European cardiologists, gynaecologists, and endocrinologists. Eur. Heart J. 2021;42:967–984. https://doi.org/10.1093/eurheartj/ehaa1044
9. Maas A.H.E.M. Maintaining cardiovascular health: an approach specific to women. Maturitas. 2019;124:68–71. https://doi.org/10.1016/j.maturitas.2019.03.021
10. Konst R.E., Elias-Smale S.E., Lier A. et al. Different cardio vascular risk factors and psychosocial burden in symptomatic women with and without obstructive coronary artery disease. Eur. J. Prev. Cardiol 2019;26(6):657–659. https://doi.org/10.1177/2047487318814298
11. Visseren F.L.J., Mach F., Smulders Y.M. et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur. Heart J. 2021;42(34):3227–3337. https://doi.org/10.1093/eurheartj/ehab484
12. Couto C.P., Policiano C., Pinto F.J. et al. Endometriosis and cardiovascular disease: A systematic re view and meta-analysis. Maturitas. 2023;171:45–52. https://doi.org/10.1016/j.maturitas.2023.04.001
13. Zhao L., Zhu Z., Lou H. et al. Polycystic ovary syndrome (PCOS) and the risk of coronary heart disease (CHD): a meta-analysis. Oncotarget. 2016;7(23):33715–33721. https://doi.org/10.18632/oncotarget.9553;7:33715-21
14. Cho L., Davis M., Elgendy I. et al. Summary of updated recommendations for primary prevention of cardio vascular disease in women: JACC state-of-theart review. J. Am. Coll. Cardiol 2020;75(20):2602–2618. https://doi.org/10.1016/j.jacc.2020.03.060
15. Lia M., Zhub Y., Weid J. et al. The global prevalence of premature ovarian insufficiency: a systematic review and meta-analysis. Climacteric. 2023;26(2):95–102. https://doi.org/10.1080/13697137.2022.2153033
16. Santoro N., Roeca C., Peters B.A., Neal-Perry G. The menopause transition: signs, symptoms, and manage ment options. J. Clin. Endocrinol. Metab. 2021;106(1): 1–15. https://doi.org/10.1210/clinem/dgaa764
17. Harlow S.D., Gass M., Hall J.E. et al. Executive sum mary of the Stages of Reproductive Aging Workshop +10: addressing the unfinished agenda of staging re productive aging. Climacteric. 2012;15(2):105–114. https://doi.org/10.3109/13697137.2011.650656
18. El Khoudary S.R., Greendale G., Crawford S.L. et al. The menopause transition and women’s health at midlife: a progress report from the Study of Women’s Health Across the Nation (SWAN). Menopause. 2019;26(10):1213–1227. https://doi.org/10.1097/GME.0000000000001424
19. Bacon E.R., Mishra A., Wang Y. et al. Neuroendocrine aging precedes perimenopause and is regulated by DNA methylation. Neurobiol. Aging 2019;74:213–224. https://doi.org/10.1016/j.neurobiolaging.2018.09.029
20. Carson M.Y., Thurston R.C. Vasomotor symp toms and their links to cardiovascular disease risk. Curr. Opin. Endocr. Metab. Res 2023;30:100448. https://doi.org/10.1016/j.coemr.2023.100448
21. Thurston R.C. Symptom reporting, cardiovascular dis ease, and mortality as women age: it is more than menopause. Menopause. 2022;29(12):1355–1356. https://doi.org/10.1097/GME.0000000000002121
22. Юренева С.В., Аверкова В.Г. Вазомоторные симптомы в менопаузе: центральные триггеры, эффекторы и новые возможности патогенетической терапии. Российский вестник акушера-гинеколога 2018;5:43–48. [Yureneva S.V., Averkova V.G. Vasomotor symptoms in menopause: central triggers, effectors and new possibilities of pathogenetic therapy. Russian Bulletin of Obstetrician-Gynecologist 2018;5:43–48.] https://doi.org/10.17116/rosakush20181805143
23. El Khoudary S.R., Aggarwal B., Beckie T.M. et al. Menopause transition and cardiovascular dis ease risk: implications for timing of early prevention: a scientific statement from the American Heart Association. Circulation. 2020;(25);142:506–532. https://doi.org/10.1161/CIR.0000000000000912
24. Nappi R.E., Siddiqui E., Todorova L. et al. Prevalence and quality-of-life burden of vasomotor symptoms associ ated with menopause: A European cross-sectional sur vey. Maturitas. 2023;167:66–74. https://doi.org/10.1016/j.maturitas.2022.09.006
25. Miller V.M., Kling J.M., Files J.A. et al. What’s in a name: are menopausal ‘‘hot flashes’’ a symptom of menopause or a manifestation of neurovascular dysregulation? Menopause. 2018;25(6):700–703. https://doi.org/10.1097/GME.000000000000106
26. Thurston R.C., Carroll J.E., Levine M. et al. Vasomotor symptoms and accelerated epigenetic aging in the Women’s Health Initiative (WHI). J. Clin. Endocrinol. Metab. 2020;105(4):1221–1227. https://doi.org/10.1210/clinem/dgaa081
27. Muka T., Oliver-Williams C., Colpani V. et al. Association of vasomotor and other menopausal symptoms with risk of cardiovascular disease: a systematic re view and meta-analysis. PLoS One. 2016;11:0157417. https://doi.org/10.1371/journal.pone.0157417
28. Vogel B., Acevedo M., Appelman Y. et al. The Lancet women and cardiovascular disease commission: reducing the global burden by 2030. Lancet. 2021;397(10292): 2385– 2438. https://doi.org/10.1016/S0140-6736(21)00684-X
29. Samargandy S., Matthews K.A., Brooks M.M. et al. Trajectories of blood pressure in midlife women: does menopause matter? Circ. Res. 2022;130: 312–322. https://doi.org/10.1161/CIRCRESAHA.121.319424
30. Cifkova R., Pitha J., Krajcoviechova A., Kralikova E. Is the impact of conventional risk factors the same in men and women? Plea for a more gender-specific approach. Int. J. Cardiol. 2019;286:214–219. https://doi.org/10.1016/j.ijcard.2019.01.039
31. Cifkova R., Pitha J., Krajcoviechova A., Kralikova E. Is the impact of conventional risk factors the same in men and women? Plea for a more gender-specific approach. Int. J. Cardiol. 2019;286:214–219. https://doi.org/10.1016/j.ijcard.2019.01.039
32. Samargandy S., Matthews K.A., Brooks M.M. et al. Arterial stiffness accelerates within 1 year of the final menstrual period: the SWAN Heart Study. Arterioscler. Thromb. Vasc. Biol. 2020;40:1001–1008. https://doi.org/10.1161/ATVBAHA.119.313622
33. Hildreth K.L., Ozeme C., Kohrt W.M. et al. Vascular dysfunction across the stages of the menopausal transition is associated with menopausal symptoms and quality of life. Menopause. 2018;25(9):1011–1019. https://doi.org/10.1097/GME.0000000000001112
34. Thurston R.C., Karvonen-Gutierrez C.A., Derby C.A. et al. Menopause versus chronologic aging: their roles in women’s health. Menopause. 2018;25: 849–854. https://doi.org/10.1097/GME.0000000000001143
35. Ding M., Manson J.E. HDL-C and arterial calcifica tion in midlife women: does an HDL paradox exist? Menopause. 2021;28(3):231–233. https://doi.org/10.1097/GME.0000000000001734
36. Kronenberg F., Mora S., Stroes E.S.G. et al. Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. Eur. Heart J. 2022;43(39):3925–3946. https://doi.org/10.1093/eurheartj/ehac361
37. DePree B., Houghton K., Shiozawa A. et al. Treatment and resource utilization for menopausal symptoms in the United States: a retrospective review of re al-world evidence from US electronic health records.Menopause. 2023;30(1):70–79. https://doi.org/10.1097/GME.0000000000002095
38. Mehta J., Kling J.M., Manson J.E. Risks, benefits, and treatment modalities of menopausal hormone therapy: current concepts. Front. Endocrinol. 2021;12:564781. https://doi.org/10.3389/fendo.2021.564781
39. Manson J.E., Aragaki A.K., Rossouw J.E. et al. Menopausal hormone therapy and long-term all-cause and cause-specific mortality: the Women’s Health Initiative randomized trials. JAMA. 2017;318:927–938. https://doi.org/10.1001/jama.2017.11217
40. Miller V.M., Naftolin F., Asthana S. et al. The Kronos Early Estrogen Prevention Study (KEEPS): what have we learned? Menopause. 2019;26(9):1071–1084. https://doi.org/10.1097/GME.0000000000001326
41. Faubion S.S., Crandall C.J., Davis L. et al. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767–794. https://doi.org/10.1097/GME.0000000000002028
42. El Khoudary S.R., Venugopal V., Manson J.E. et al. Heart fat and carotid artery atherosclerosis progression in re cently menopausal women: impact of menopausal hor mone therapy: the KEEPS trial. Menopause. 2020;27:255– 262. https://doi.org/10.1097/GME.0000000000001472
43. Slopien R., Wender-Ozegowska E., Rogowicz-Frontczak A. et al. Menopause and diabetes: EMAS clinical guide. Maturitas. 2018;117:6–10. https://doi.org/10.1016/j.matu-ritas.2018.08.009
44. Gambacciani M., Cagnacci A., Lello S. Hormone replace ment therapy and prevention of chronic conditions. Climacteric. 2019;22(3):.303–306. https://doi.org/10.1080/13697137.2018.1551347
45. Dinger J., Bardenheuer K., Heinemann K. Drospirenone plus estradiol and the risk of serious cardiovascular events in postmenopausal women. Climacteric. 2016;19(4):349– 356. https://doi.org/10.1080/13697137.2016.1183624
Review
For citations:
Minyailo O.A., Melkozerova O.A., Semenov Yu.A., Gabinsky Ya.L., Mikhelson A.A. Cardiovascular risk management in women in peri- and postmenopause: a global health challenge (literature review). Bulletin of maternal and child care. 2025;2(1):10-20. (In Russ.) https://doi.org/10.69964/BMCC-2025-2-1-10-20