Why our 40s and 50s define our longevity

For decades, we’ve been told that heart disease is a “man’s problem.” The reality? It’s the leading cause of death for women globally, and the menopausal transition is the most critical window for intervention.

A silent shift in our vessels

Heart health in midlife is less about age and more about a steep drop in estrogen. Estrogen is a powerful vasodilator and keeps the lining of our blood vessels (the endothelium) flexible and smooth. When estrogen levels decline in perimenopause and menopause, this protective shield disappears. Vessels can lose elasticity and become more prone to the chronic low-grade inflammation that triggers plaque buildup. This is why risk factors can climb in our 40s and 50s, even if we’ve never had heart-related health problems before.

Why “standard” screenings don’t tell the whole story

Often the more traditional focus on LDL (bad cholesterol) can miss the mark. Relying on basic cholesterol panels fails to capture insulin resistance and inflammation, which are the true drivers of midlife heart risk.

To get a more accurate picture of your heart health, Coral recommends looking at advanced markers, including:

• ApoB and Lp(a): These provide a much more accurate measurement of plaque-causing particles than a standard cholesterol test.
• Calcium Scoring (CAC): A specialized scan that shows calcium deposits in the arteries—an indicator of plaque. This is data that “predictive” models often miss.

The MHT/HRT window of opportunity

In the case of hormone therapy, timing is everything. When started within 5 years of menopause, HRT has been shown to decrease the risk of coronary heart disease by approximately 30% to 50%. While Coral doesn’t prescribe HRT solely for heart disease prevention, the “side effect” of treating your hot flashes, mood swings, and other symptoms is often a significant improvement in vascular health and lipid profiles.

Your proactive protocol

1. Prioritize VO2 max:

Your aerobic fitness is one of the strongest predictors of longevity. We advocate for a mix of steady-state “Zone 2” cardio and high-intensity intervals to keep your heart resilient.

2. Build “metabolic armor”:

Strength and resistance training isn’t just about aesthetics; muscle mass absorbs excess blood sugar, lowering the insulin spikes and reducing the chronic inflammation that can damage your arteries.

3. The 5-year window:

Starting hormone therapy within the first five years of menopause can decrease heart disease risk by roughly 30%.

Disclaimer: The information provided here is for informational purposes only. It is not intended as medical advice. Always consult with your doctor or healthcare provider to determine what is best for your individual health needs.