Heart Health in Midlife: What Changes and What to Measure
Atherosclerosis Explained: How Plaque Builds Up — and What You Can Do About It
When I go for a run or hike in the mountains, it’s rarely my legs that complain first. More often it’s my heart. When I push a little, I can feel out of breath and my pulse racing faster than my pace. It’s a humbling reminder that our most important muscle is often the one we think about the least… until it asks for our attention.
A healthy heart is more than a “strong beat.” It’s a whole-body system working smoothly.
Physiologically, it means your heart can fill and pump efficiently, delivering nutrient and oxygen-rich blood to every cell. It also means your heart can adapt to everyday demands like walking uphill, a stressful day, poor sleep, or exercise without feeling strained.
A healthy heart also relies on healthy blood vessels. They stay flexible, and their inner lining acts like a protective coating that helps vessels widen or tighten so blood flows easily through the body.
The Slow Build: How Plaque Starts Long Before Symptoms
Over time, that protective lining in our arteries can become less functional, and less able to support smooth blood flow and healthy vessel responses. Factors like high blood pressure, blood sugar swings, smoking, and high levels of LDL (“bad”) cholesterol over time contribute to an unfavourable environment for our arteries. Patterns that raise blood pressure, blood sugar, and inflammation over time, including chronic stress and poor sleep, can add to that overall load. When this happens, blood vessels can become less flexible and less able to respond smoothly. Inflammation can quietly build, and the conditions for plaque to form begin.
This is where the slow, silent process behind most heart disease often starts: atherosclerosis, meaning the gradual build-up of plaque in the artery walls.
So when we talk about “heart health,” we’re usually talking about preventing, or slowing, plaque formation and plaque instability, ideally long before symptoms show up. Genetics plays a role, but for most of us, daily choices shape the path far more than we realise.
Why does heart health shift in peri/menopause?
During the menopause transition, oestrogen levels fluctuate and eventually decline, and this is linked to shifts in several key areas that influence cardiovascular risk:
Blood fats can shift: LDL cholesterol and triglycerides often move in a less heart-friendly direction.
Visceral fat can increase: more fat stored around the organs, which is strongly linked to disease risk.
Insulin resistance can rise: the body may need more insulin to manage the same foods than it did when you were younger.
Blood pressure can creep up: sometimes quietly, and earlier than you expect.
Low-grade inflammation can increase: a subtle “background fire” that can accelerate plaque formation.
Reference: American Heart Association Scientific Statement on menopause and cardiovascular disease risk factors.
Based on the above, peri/menopause is often described as a window where risk factors can speed up. But it’s not that our bodies are failing. They’re adjusting to a new internal reality.
In this life stage, many women need a new nutrition and lifestyle strategy, and new metrics, to promote health and minimise risk.
Markers of cardiometabolic and nutritional health for women
If you haven’t had a thorough health assessment done before midlife, now is the time. Even if you feel perfectly healthy, it’s valuable to establish a baseline for the second half of your life.
Get your tests done, save the results, and use them as reference points as the years pass. What matters most isn’t a single number on a single day. It’s the pattern and trend over time.
And here’s the empowering, hopeful part: whatever your tests show, midlife is a powerful opportunity to take ownership of your health. In many cases, nutrition and lifestyle changes can positively shift these markers more than you might expect.
What can we do ourselves?
We can do a lot. A helpful framework comes from the American Heart Association: Life’s Essential 8 for Women; nutrition, movement, nicotine exposure, sleep, weight, blood lipids, blood sugar, and blood pressure.
Translated into practical, midlife-friendly action, it can look like this:
Establish a baseline
Get your blood tests done. Talk to your medical doctor about potential menopause symptoms and solutions. Check if you need any other tests.
Eat in a way that lowers ApoB and reduces insulin demand
For many women this means more fibre and plant-based protein, fewer ultra-processed foods, improved fat quality, and carbs matched to activity, sleep, and stress levels.
Maintain a healthy body composition
Strength training isn’t just aesthetic. It improves insulin sensitivity, supports metabolic health, and protects you as you age.
Walk as a mode of transportation
Daily walking supports blood pressure, triglycerides, stress regulation, and helps reduce visceral fat.
Treat sleep like a supplement you can’t replace
Sleep affects blood sugar, hunger hormones, blood pressure, inflammation, and recovery. It’s one of the fastest ways risk factors creep up.
Manage stress, not perfectly, but consistently
Chronic stress can push glucose and blood pressure up and makes supportive habits harder to sustain. Find your ways to downshiift and relax.
Track your blood pressure
Whenever you pass a pharmacy, visit a preventive care unit, or go to the doctor, check your blood pressure and keep track of your numbers. A few readings now and then can, over time, give you powerful, actionable insight.
Know your personal “risk enhancers”
Pregnancy history matters, preeclampsia, gestational diabetes, hypertensive disorders, as do early menopause and family history. These can justify earlier, more proactive prevention.
Adjustment for Life, Not Just a Finish Line
This year, I’m investing in my heart health by building stamina for a half marathon with one of my sons. Some days, getting outside in the cold and wet is the last thing I feel like doing, but the bigger goal isn’t the finish line.
It’s the energy, hanging out with my son, and a feeling of freedom. A heart, and body, that can keep up with the life I want to live long-term.
Is there a reason you’d like to support your heart more this year, and what’s one small step you could start with? I’d love to hear from you.
For more support, guidance and tools, you can also explore our services, including our One-to-One consultations or find heart friendly recipes in our resources.
With health and happiness,
Dr. Malin Garemo
Registered Dietitian (MSc), PhD (Nutrition)
