As I enter my 19th year of practice, I find myself solidly in midlife—and I’ve noticed my patient population has aged right along with me. Many of my patients who first came to me in their 30s are now in their 50s or 60s. With this shift, my focus has evolved too. One area I pay much closer attention to now is cardiovascular health, especially since heart disease remains the leading cause of death for both men and women worldwide.
My current deep dive into the topic—while studying for a menopause certification—has reinforced just how critical this area is. Much of what I’m sharing here is drawn from the North American Menopause Society’s (NAMS) Menopause Practice Guidebook. My goal is to help you understand why we treat certain risks more aggressively, when lifestyle changes are enough, and when it’s time to consider medication. I believe knowledge is power, especially when it comes to your health.
Cardiovascular Health in Women in Midlife
What Exactly Is Cardiovascular Disease (CVD)?
CVD is a broad term covering many heart and blood vessel conditions, including:
- Arrhythmias (irregular heartbeat)
- Atherosclerosis (narrowed, hardened arteries)
- Congenital heart defects
- Heart failure
- Coronary artery and ischemic heart disease
- Heart attack (myocardial infarction)
- Angina (chest pain)
- Microvascular coronary dysfunction
- High blood pressure (hypertension)
- Stroke and mini-stroke (TIA)
- Valve problems
- Aortic disease
- Blood clots, including pulmonary embolism
At the root of most of these conditions is a common issue: the heart and blood vessels aren’t getting the oxygen and nutrients they need. Problems like plaque buildup, damaged vessel walls, or restricted blood flow can cause serious health issues—from high blood pressure to stroke, or even difficulty walking due to poor circulation.
While most heart disease in women appears after age 55, early menopause—whether natural or surgical—is a known risk factor. Although the direct link between menopause and heart disease is still debated, we do know that right after menopause, LDL (“bad” cholesterol) tends to rise, and insulin resistance can worsen.
Key Risk Factors for Cardiovascular Disease in Women
| Risk Factor | Target / Concern |
| Cigarette Smoking | Strong risk factor at any level |
| Blood Pressure | Ideal: Below 120/80. Treat if consistently above 130/90 |
| Triglycerides | Aim for under 200 mg/dL |
| HDL (Good Cholesterol) | 50–80 mg/dL |
| LDL (Bad Cholesterol) | Ideally under 100 mg/dL (depends on overall risk profile) |
| Obesity | Focus on reducing central belly fat; goal BMI ≤ 25 |
| Diet | Minimize processed foods, excess carbs, and high salt intake |
| Physical Inactivity | Aim for consistent exercise and healthy heart rate recovery |
| Family History of Early Heart Disease | If in a male relative <55 or female relative <65 |
| Metabolic Syndrome | See below |
| Signs of Atherosclerosis | Coronary calcium, carotid plaque, or thickened artery walls |
| Autoimmune Disorders | Lupus, RA, scleroderma, vascular Ehlers-Danlos |
| History of Pregnancy Complications | Includes gestational diabetes, preeclampsia, preterm delivery |
Why Blood Pressure Matters So Much
High blood pressure (hypertension) is one of the strongest predictors of heart problems. Left untreated, it increases the risk of heart failure, stroke, atrial fibrillation, dementia, and more. If lifestyle changes can’t keep your blood pressure under 120/80, medication is usually the safest next step.
What About Cholesterol?
Cholesterol can be confusing. Many patients are unsure when (or if) they should take a statin medication. A common concern I hear is whether pharmaceutical companies are driving statin use unnecessarily. It’s a fair question, given the volume of information (and misinformation) online. However, it’s important to know that the American Heart Association (AHA) and American College of Cardiology (ACC) develop their guidelines through rigorous processes specifically designed to avoid pharmaceutical industry influence.
The AHA and ACC keep their recommendations evidence-based and free from financial conflicts. If you’re interested, you can explore the ACC’s transparency policy here.
To assess your risk, your doctor can use the ASCVD Risk Estimator Plus—a tool that takes into account your age, race, blood pressure, smoking status, and more. Based on your risk, statins may be recommended. Statins lower the risk of heart attacks and strokes by 25–45%.
If you’re prescribed a statin:
- Dosing can vary: There are low, moderate, and high-intensity options.
- CoQ10 supplementation (30–200 mg daily) is advised to help prevent statin-related side effects.
- Non-statin medications exist but are typically reserved for those who can’t tolerate statins.
Lifestyle improvements absolutely help—but if your high cholesterol is genetic, medication may be unavoidable.
What Is Metabolic Syndrome?
Metabolic Syndrome is a collection of risk factors that, together, significantly increase your chances of heart disease, stroke, diabetes, and vascular disease. You’re diagnosed if you meet three or more of the following:
- Waist size: Over 35 inches (31.5 for South Asian women)
- Triglycerides: Over 150 mg/dL
- HDL cholesterol: Less than 50 mg/dL
- Blood pressure: Over 130/85 mmHg
- Fasting blood sugar: Over 110 mg/dL
How Does Menopause Play Into All This?
After menopause, women often experience:
- Higher LDL cholesterol
- More insulin resistance
- Increased belly fat
It’s unclear if these changes are purely due to hormone loss. But we do know that hormone therapy (HT) may help reduce abdominal fat and possibly lower the risk of developing type 2 diabetes. That said, hormone therapy isn’t for everyone. In women over 60 who have not yet started HT, the risks—such as blood clots, stroke, heart disease, and dementia—may outweigh the benefits. That’s why individualized risk assessment with your doctor is key, rather than relying on trends you see online or on social media.
What Are the Best Strategies to Protect Your Heart?
Lifestyle modification is powerful. The key is to meet yourself where you’re at and build from there. Sometimes we need to address mental or physical barriers first, and that’s where working with your naturopathic doctor, nutritionist, personal trainer, or even supportive friends can help.
- Quit smoking: You’ve heard this before, but here’s a reminder—women who smoke are 2 to 6 times more likely to have a heart attack. The more you smoke, the higher your risk.
- Move your body: Aim for 150 minutes of moderate aerobic activity weekly, or 75 minutes of vigorous activity. Include both dynamic resistance (like weight lifting) and isometric exercises (like planks, wall sits, or squats).
- Eat for heart health: Focus on:
- 4+ cups of fruits and vegetables daily
- Whole grains
- High-fiber foods
- Reduced saturated fats
- Avoiding trans fats
- Sodium below 1,500 mg/day
- The DASH diet and Mediterranean diet are excellent choices. Low-carb, high-protein, vegetarian, and vegan diets also show benefits.
- Weight management: While weight isn’t everything, reaching an ideal weight matters for heart health. For every 2.2 pounds lost, blood pressure typically drops by 1 point (mmHg). Lose 10 pounds and your BP may drop 5 points.
What About Supplements?
Supplements can be a helpful tool, especially when tailored to your personal health picture. Always check with your naturopathic doctor, especially if you’re on prescription medications, as interactions can occur. Here are some options I often recommend:
- Magnesium glycinate complex: 200–400 mg daily
- Carditone (Ayush Herbs): May lower blood pressure by ~10 points
- NBI Health NattoPine: Supports healthy blood flow and clotting (Nattokinase and Pine Bark extract)
- Berberine: 500–1,500 mg daily; helps lower triglycerides, LDL, and insulin resistance
- NiaVasc (Xymogen): 750 mg of sustained-release Niacin twice daily may help regulate cholesterol
- Bergamot extract: Shown to lower LDL, triglycerides, and raise HDL; anti-inflammatory and antioxidant benefits
- Red Yeast Rice: Natural statin-like effect; always pair with CoQ10
- ProOmega200 (Nordic Naturals): High-quality omega-3 fish oil for heart, brain, and hormone health
- Herbal options: Hawthorne berry, hibiscus, motherwort, garlic, cayenne, cinnamon, and rosemary commonly appear in herbal formulas for cardiovascular support
My Philosophy: Supplements are tools—just like medications—to help support your body, especially while you’re working on foundational diet and lifestyle habits. Ideally, the more progress you make with lifestyle changes, the fewer supplements you’ll need over time.
Ready for Personalized Support?
If you’re struggling with heart or metabolic health and want individualized guidance, please don’t hesitate to reach out to our skilled team of naturopathic doctors in Olympia, Washington. Together, we can develop a strategy that fits your life and supports your long-term health.