In menopause, sleep is vitally important for women’s long-term heart health, study finds

PITTSBURGH, July 9, 2025 — During the menopause transition, only 1 in 5 women have optimal scores using the American Heart Association’s health-assessment tool, known as Life’s Essential 8 (LE8). Among the tool’s eight components, four of them — blood glucose, blood pressure, sleep quality and nicotine use — are key in driving future cardiovascular risks, with sleep being particularly crucial for long-term cardiovascular health.

The findings – published today in Menopause – were made by researchers at the University of Pittsburgh, Albert Einstein College of Medicine and Baylor University.

“Previously we’ve shown that the menopause transition is a time of accelerating cardiovascular risk,” said senior author Samar R. El Khoudary, Ph.D., M.P.H., professor of epidemiology at Pitt’s School of Public Health. “This study underscores that it’s also an opportunity for women to take the reins on their heart health.”

The team analyzed health data collected from about 3,000 women who participated in the Study of Women’s Health Across the Nation (SWAN), an ongoing, longitudinal, multi-site, multi-ethnic study of midlife women that began in 1996. The researchers compared the women’s LE8 scores at baseline, around age 46, to their evolving health trajectories over time, from subclinical cardiovascular disease measures, such as increased carotid-artery thickness, to cardiovascular events, including heart attacks and strokes, to mortality of all causes. The team also examined impacts of each of the individual LE8 components: nutrition, physical activity, smoking abstinence, sleep, body mass index, blood lipids, blood sugar and blood pressure.

The analysis showed that four LE8 components — blood glucose, blood pressure, sleep quality and nicotine use — were the most important factors driving the study participants’ future cardiovascular risks.

Above all, sleep emerged as a potential predictor for long-term effects of cardiovascular disease events and all-cause mortality, though it was not linked to the shorter-term effects of carotid-artery thickening. The team found that at midlife, meeting the bar for healthy sleep, defined in Life’s Essential 8 as seven to nine hours on average for most adults, may contribute to women’s heart health and longevity, a hypothesis that should be tested in a future clinical trial, said Ziyuan Wang, Ph.D. candidate at Pitt Public Health and first author.

Low total LE8 scores correlated with increased cardiovascular risk, as expected—however, only 21% of the midlife women studied had an ideal LE8 score.

“With heart disease being the leading cause of death in women, these findings point to the need for lifestyle and medical interventions to improve heart health during and after menopause among midlife women,” said El Khoudary.

Other authors on the study were Ziyuan Wang, M.S., Emma Barinas-Mitchell, Ph.D., Maria M. Brooks, Ph.D., Jared W. Magnani, M.D., M.Sc., and Rebecca C. Thurston, Ph.D., all of Pitt; Carol A. Derby, Ph.D., of Albert Einstein College of Medicine; and Kelly R. Ylitalo, Ph.D., of Baylor University.

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About the University of Pittsburgh School of Public Health
Founded in 1948, the University of Pittsburgh School of Public Health is a top-ranked institution of seven academic departments partnering with stakeholders locally and globally to create, implement and disseminate innovative public health research and practice. With hands-on and high-tech instruction, Pitt Public Health trains a diverse community of students to become public health leaders who counter persistent population health problems and inequities. 

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