, Writer and editor, MyGLP. Sources checked .

Why the risk changes after 50

The British Heart Foundation says women have a lower risk of coronary heart disease than men before the menopause, and the risk rises sharply afterwards. Falling oestrogen is part of the reason. Barts Health NHS Trust sets out what changes: lower oestrogen can shift cholesterol in the wrong direction and let fatty deposits build in the arteries, and the menopause raises the risk of high blood pressure. Barts also notes weight gain around the tummy at this stage. Our menopause weight gain guide covers that part.

The same BHF page reports research showing women having a heart attack are more likely to be misdiagnosed than men, and less likely to get treatments such as stents. This is about evidence and practice catching up with women's bodies. Our guide to heart attack symptoms in women covers what to look for and when to call 999.

The numbers to know

MeasureHealthy level for most adultsWhere to get it checked
Total cholesterolUnder 5 mmol/LGP, NHS Health Check, some pharmacies
Non-HDL ("bad") cholesterolUnder 4 mmol/LSame blood test
HDL ("good") cholesterolOver 1.2 mmol/L for womenSame blood test
10-year heart and stroke risk (QRISK3)Under 10%Worked out by your GP or at a Health Check
Cholesterol levels from the NHS. Your own target depends on your age, health and overall risk. QRISK3 threshold from NICE NG238.

The NHS cholesterol levels page gives these as general guides for healthy adults. Note the HDL figure is higher for women than for men, at over 1.2 mmol/L against over 1.0. If you have not had a cholesterol test and you are over 40, overweight, or have a family history of high cholesterol or heart problems, the NHS says to ask your GP surgery. Most people do not need to fast before the test.

The free NHS Health Check

If you live in England, are 40 to 74 and do not already have a heart or circulation condition, you should be invited for an NHS Health Check every 5 years. It checks:

  • Height, weight, BMI and waist measurement.
  • Blood pressure.
  • Cholesterol, and sometimes blood sugar.
  • Family history, smoking, alcohol and activity.

You come away with a score for your chance of a heart or circulation problem, such as heart disease, stroke, type 2 diabetes or kidney disease, over the next 10 years. If you think you are due and have not been invited, contact your GP surgery. If your surgery does not offer it, contact your local council. You are not eligible if you already have heart disease, high blood pressure, diabetes, kidney disease, atrial fibrillation, or have had a stroke or TIA.

QRISK3 and statins

GPs use a tool called QRISK3 to estimate your 10-year risk of heart attack or stroke. NICE guideline NG238 says to offer a statin, atorvastatin 20mg, to people with a QRISK3 score of 10% or more. It also says a score under 10% should not rule out a statin if you would prefer one or there is concern your risk is underestimated.

NICE warns the risk tools may underestimate risk in people with autoimmune and other inflammatory conditions. QRISK3 includes lupus as a factor. If you have lupus, rheumatoid arthritis or another autoimmune condition, ask your GP to take it into account. Our autoimmune guide explains why these conditions are far more common in women.

HRT and your heart

HRT is a treatment for menopause symptoms, and it should not be started only to protect the heart. NICE reviewed the evidence in its 2023 menopause evidence review on heart disease and stroke. It concluded that for women without existing coronary heart disease, neither combined nor oestrogen-only HRT has been shown to raise the risk of coronary heart disease. Oral HRT started at 60 or over was linked to a higher stroke risk in trials. The evidence did not show a raised stroke risk with oestrogen through the skin, such as a patch or gel. Our HRT in numbers guide sets out the figures.

What the SELECT trial found

SELECT tested semaglutide, the medicine in Wegovy, in 17,604 adults aged 45 or over with existing heart or circulation disease, a BMI of 27 or more, and no diabetes. The results were published in the New England Journal of Medicine in 2023. Over an average of about 40 months, 6.5% of people on semaglutide had a heart attack, stroke or heart death, against 8.0% on placebo. That is a 20% lower risk.

More people stopped semaglutide because of side effects: 16.6% against 8.2% on placebo. In July 2024 the MHRA approved Wegovy to reduce the risk of serious heart problems in adults with established heart disease and a BMI of 27 or more. The trial did not test people without heart disease, so it does not show the same benefit for everyone who takes a weight loss medicine.

SELECT resultSemaglutidePlacebo
Heart attack, stroke or heart death6.5%8.0%
Stopped because of side effects16.6%8.2%
Lincoff et al, New England Journal of Medicine, 2023. Average follow-up about 40 months.

What you can do this year

  1. Find out your blood pressure. Ask at your GP surgery or a pharmacy.
  2. Ask for a cholesterol test if you are over 40 and have never had one.
  3. Book your NHS Health Check if you are 40 to 74 and due.
  4. Ask your GP for your QRISK3 score, and what would bring it down.
  5. Keep moving. Our walking guide is a simple place to start.

Call 999 if you think you or someone else is having a heart attack. Do not wait to see if chest pain or pressure passes. Our heart attack symptoms guide lists the signs women report.

Paying for your own medicine? The lowest first-order prices today, with delivery included: Mounjaro from £89.00, Wegovy from £44.00, Wegovy pill from £52.99, Foundayo from £49.00.

Compare every price Discount codes

Sources

  1. Menopause Mandate unite with BHF on heart risk in menopause (British Heart Foundation, October 2023)
  2. Support your heart health through menopause (Barts Health NHS Trust, October 2023)
  3. Cholesterol levels (NHS)
  4. High cholesterol: getting tested (NHS)
  5. NHS Health Check (NHS)
  6. Cardiovascular disease: risk assessment and reduction (NG238) (NICE)
  7. Menopause (update): evidence review for cardiovascular disease and stroke (NICE, 2023)
  8. Semaglutide and cardiovascular outcomes in obesity without diabetes (SELECT) (Lincoff et al, New England Journal of Medicine, 2023 (open access copy, UCL Discovery))
  9. MHRA approves semaglutide to reduce risk of serious heart problems (MHRA, July 2024)

Sian Anderson

Sian writes the health and nutrition guides on MyGLP. Every clinical claim links to the NHS, NICE, a medical royal college, a regulator or a peer-reviewed paper, and the pages carry no medical advice.