Last week was the Menopause Society meeting in Orlando, and while I couldn't attend in person due to getting sick, I spent the weekend watching all the sessions remotely from bed. What struck me most were the cardiovascular sessions.

Recording this on the eve of my mother's one-year death anniversary from a massive heart attack, I want to talk about the real changes that happen when estrogen leaves the chat and why cardiovascular disease awareness among women has actually dropped from 65% to 44% in recent years.

I talk through the key cardiovascular takeaways including why white coat hypertension isn't benign, how the 2025 American Heart Association guidelines changed what's considered normal blood pressure, and why perimenopause is a time of accelerated cardiovascular risk when cholesterol and blood pressure can spike suddenly.

The most fascinating session covered invisible heart disease: INOCA (ischemia with no obstructive coronary arteries) and microvascular dysfunction. This is when women have chest pain, get full cardiac workups showing wide-open arteries, yet still have reduced blood flow to the heart through tiny vessels that don't show up on standard angiograms.

I discuss mental stress ischemia, a hidden killer where emotional stress causes measurable damage and reduced perfusion to the heart even when exercise stress tests are normal. How many women were told they had panic attacks when they actually had coronary microvascular dysfunction?

The mind-heart connection is real, and the sympathetic nervous system surge during high stress can constrict small vessels cutting off microcirculation. I share practical steps including finding preventative cardiologists, getting CT angiograms if you have family history, understanding your blood pressure parameters, and why stress reduction isn't just self-care, it's cardiovascular medicine.

Highlights:

• Why awareness that heart disease is the #1 killer in women dropped from 65% to 44%.
• How white coat hypertension is NOT benign and leads to cardiovascular events.
• New 2025 blood pressure guidelines: normal is now less than 120/80.
• Why perimenopause causes accelerated cardiovascular risk with sudden cholesterol spikes.
• What INOCA and microvascular dysfunction mean for women with chest pain and normal angiograms.
• How mental stress ischemia causes measurable heart damage even with normal stress tests.

If this episode helped you understand cardiovascular risks in menopause and why symptoms like chest pain deserve thorough evaluation beyond standard testing, please share it with women who need this information. Subscribe and leave a review to help more people discover these critical discussions about heart health in midlife.

Resources:

Microvascular Network

INOCA

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