Sleep Problems Can Affect Heart Health in Women Over 45

Sleep habits in middle age may be more important than previously thought. A large-scale study has found that poor sleep, along with high blood pressure and nicotine use, significantly increases the risk of heart problems in menopausal women, yet only one in five women scores well on overall heart health.

How Sleep and Heart Health are Linked

During menopause, only one in five women achieve optimal scores on the American Heart Association’s health assessment tool known as Life’s Essential 8 (LE8). Of the eight components of the tool, four—blood sugar, blood pressure, sleep quality, and nicotine use—are critical for future cardiovascular risk, with sleep being particularly important for long-term cardiovascular health. The results were published in the journal Menopause and were conducted by researchers at the University of Pittsburgh, Albert Einstein College of Medicine, and Baylor University.

“We have already shown that menopause is a time when the risk of cardiovascular disease increases,” said lead author Samar R. El Khoudary, Ph.D., M.P.H., professor of epidemiology at the Pitt School of Public Health. This study underscores that this is also an opportunity for women to take charge of their heart health. The team analyzed health data from approximately 3,000 women who participated in the Study of Women’s Health Across the Nation (SWAN), a multi-ethnic longitudinal study of menopausal women that has been ongoing since 1996 and is conducted at multiple sites. The researchers compared the women’s LE8 scores at the start of the study, when they were around 46 years old, with their health as it developed over time, from subclinical cardiovascular disease such as increased carotid artery thickness to heart attacks and strokes to overall mortality. The team also examined the impact of each individual LE8 component: diet, physical activity, smoking cessation, sleep, body mass index, blood lipid levels, blood sugar, and blood pressure. The analysis revealed that four LE8 components—blood sugar, blood pressure, sleep quality, and nicotine use—were the most important factors for the future cardiovascular risk of the study participants.

Lifestyle Changes and Nedical Interventions

Sleep in particular emerged as a potential predictor of the long-term effects of cardiovascular disease and overall mortality, although it was not associated with the short-term effects of carotid artery thickening. The team found that achieving the threshold for healthy sleep defined in Life’s Essential 8, which is an average of seven to nine hours for most adults, in midlife may contribute to heart health and longevity in women. This hypothesis should be tested in a future clinical trial, according to Ziyuan Wang, a doctoral student at Pitt Public Health and first author of the study. As expected, low overall LE8 scores correlated with increased cardiovascular risk—but only 21% of the women in midlife had an ideal LE8 score. Since heart disease is the leading cause of death among women, the researchers say these findings point to the need for lifestyle changes and medical interventions to improve heart health in middle-aged women during and after menopause.