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There may be a correlation between declining hormone levels during menopause and the prevalence of CVD during midlife. Alterations in the CVD risk profile of women throughout the menopause transition (MT) are multifactorial and include changes to arterial stiffness, endothelial function, lipid metabolism, insulin resistance and adipose fat distribution. Menopausal Hormonal Therapy (THM) is a potential therapy to reduce CVD risk, though clinical trials have shown conflicting results, with some trials reporting an increase in CVD events with THM. A holistic approach to care for women going through the MT could be beneficial to improve their CVD risk profile and quality of life. This would include early identification of risk factors in individual patients and raising public and professional awareness of CVD risk burden in this patient population. Improving the knowledge of healthcare professionals and the public that women going through the MT are at an increased risk of CVD is a key target area to improve cardiovascular health in women. Current risk assessment scores for CVD do not include sex-specific risk factors. Guidelines and National Health Systems are beginning to recognise the importance of reproductive history in women\u2019s cardiovascular health. In this review, we aim to discuss traditional and sex specific risk factors for CVD in menopausal women, current guidelines on THM, gaps in knowledge and strategies to reduce CVD in women.<\/jats:p>","DOI":"10.1136\/openhrt-2026-004200","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T12:06:23Z","timestamp":1786449983000},"page":"e004200","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Role of menopause in the development of cardiovascular disease in women"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-0120-8313","authenticated-orcid":false,"given":"Sophia","family":"Das","sequence":"first","affiliation":[{"name":"University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanqi","family":"Wang","sequence":"additional","affiliation":[{"name":"Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2975-6971","authenticated-orcid":false,"given":"Vijay","family":"Kunadian","sequence":"additional","affiliation":[{"name":"Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"2026091603501606000_13.2.e004200.1","doi-asserted-by":"crossref","first-page":"2690","DOI":"10.1016\/j.jacc.2024.04.028","article-title":"Addressing the Global Burden of Cardiovascular Disease in Women: JACC State-of-the-Art Review","volume":"83","author":"Vervoort","year":"2024","journal-title":"J Am Coll Cardiol"},{"key":"2026091603501606000_13.2.e004200.2","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a009609"},{"key":"2026091603501606000_13.2.e004200.3","doi-asserted-by":"crossref","DOI":"10.1155\/2021\/5523516","article-title":"Protective Effects of Estrogen on Cardiovascular Disease Mediated by Oxidative Stress","volume":"2021","author":"Xiang","year":"2021","journal-title":"Oxid Med Cell Longev"},{"key":"2026091603501606000_13.2.e004200.4","doi-asserted-by":"publisher","DOI":"10.1038\/s41371-022-00771-0"},{"key":"2026091603501606000_13.2.e004200.5","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.110.236687"},{"key":"2026091603501606000_13.2.e004200.6","article-title":"Influence of the Onset of Menopause on the Risk of Developing Alzheimer\u2019s Disease","volume":"16","author":"Briceno Silva","year":"2024","journal-title":"Cureus"},{"key":"2026091603501606000_13.2.e004200.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00684-X"},{"key":"2026091603501606000_13.2.e004200.8","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000912"},{"key":"2026091603501606000_13.2.e004200.9","doi-asserted-by":"crossref","first-page":"4158","DOI":"10.1093\/eurheartj\/ehac321","article-title":"Premature menopause and cardiovascular disease: can we blame estrogen?","volume":"43","author":"Torbati","year":"2022","journal-title":"Eur Heart J"},{"key":"2026091603501606000_13.2.e004200.10","unstructured":"Department of Health and Social Care . 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