Cardiovascular disease (CVD) is the leading cause of death in women, who have a notable increase in the risk for this disease after menopause and typically develop coronary heart disease several years later than men. This observation led to the hypothesis that the menopause transition (MT) contributes to the increase in coronary heart disease risk. Over the past 20 years, longitudinal studies of women traversing menopause have contributed significantly to our understanding of the relationship between the MT and CVD risk. By following women over this period, researchers have been able to disentangle chronological and ovarian aging with respect to CVD risk. These studies have documented distinct patterns of sex hormone changes, as well as adverse alterations in body composition, lipids and lipoproteins, and measures of vascular health over the MT, which can increase a woman’s risk of developing CVD postmenopausally. The reported findings underline the significance of the MT as a time of accelerating CVD risk, thereby emphasizing the importance of monitoring women’s health during midlife, a critical window for implementing early intervention strategies to reduce CVD risk. Notably, the 2011 American Heart Association guidelines for CVD prevention in women (the latest sex-specific guidelines to date) did not include information now available about the contribution of the MT to increased CVD in women. Therefore, there is a crucial need to discuss the contemporary literature on menopause and CVD risk with the intent of increasing awareness of the significant adverse cardiometabolic health–related changes accompanying midlife and the MT. This scientific statement provides an up-to-date synthesis of the existing data on the MT and how it relates to CVD.

Objective Evaluate the prospective relationship between low social support and adherence to diet in a cardiovascular disease (CVD) lifestyle intervention trial. Design Prospective sub-study of participants enrolled in a randomized controlled trial. Setting and Participants Blood relatives/cohabitants of hospitalized cardiac patients enrolled in NHLBI FIT Heart (n = 458; 66% female, 35% non-white, mean age 50) who completed a 1-year follow-up. Main Outcome Measures Non-adherence to diet using the validated MEDFICTS tool; social support using the ENRICHD Social Support Instrument. Analysis Logistic regression models were adjusted for confounders. Results Significant predictors (p < .05) of non-adherence to diet recommendations at 1-year included low social support, increased BMI and waist size, lower physical activity, depression, pre-action stages of change, assignment to the control group, and being male. Those with low social support at baseline were 2.7 times more likely to be non-adherent to diet at 1-year vs. those with higher social support (95% CI = 1.1 – 6.4); there was no interaction by group assignment. Conclusion and Implications Low social support at baseline was independently associated with non-adherence to diet at 1-year in family members of cardiac patients, suggesting that individuals with low social support may be at heightened CVD risk due to poor dietary adherence.

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