Abstract Body (Do not enter title and authors here): Background:
An accelerated increase in cardiometabolic risk has been observed in women during the perimenopausal period, likely due to hormonal fluctuations that affect cardiovascular health (CVH) indicators such as blood pressure and lipid levels. However, CVH during this transition remains insufficiently described. The Life’s Essential 8 (LE8) score provides a comprehensive framework for assessing CVH. In this study, LE8 scores were characterized in perimenopausal women, temporal trends were evaluated, and comparisons were made across pre-, peri-, and post-menopausal stages.

Methods:
Data from NHANES cycles 2007–2020 were used. Women aged 18–80 were included. Those who were pregnant, breastfeeding, had prior cardiovascular disease or hysterectomy, did not undergo a physical exam, or had missing data were excluded. Menopausal status was classified as pre-, peri-, or post-menopausal. LE8 scores were calculated as the mean of eight component scores (range: 0–100) and categorized as poor (<50), intermediate (50–79), or ideal (≥80). NHANES analytical guidelines were followed. Adjusted linear regression models were used to assess temporal trends.

Results:
A total of 9,248 women were included in the final sample. Median LE8 scores declined with advancing reproductive stage: 73.3 (pre-menopause), 69.1 (perimenopause), and 63.9 (post-menopause). Diet consistently received the lowest component score, while sleep received the highest. Across all stages, diet scores declined over time (P for trend <0.001). Worsening BMI scores were observed in pre- and post-menopausal women (P <0.001), while lipid and sleep scores improved in these groups (P <0.001) (Figure). In comparison to pre-menopausal women, perimenopausal women were found to have higher odds of poor overall LE8 (OR 2.01, 95% CI: 1.19–3.39), poor lipid score (OR 1.79, 95% CI: 1.13–2.18), and poor glucose score (OR 2.06, 95% CI: 1.21–3.51).

Conclusion:
A progressive decline in CVH, as assessed by LE8, was observed from pre- to post-menopause, with a marked deterioration during perimenopause. Significantly poorer LE8, lipid, and glucose scores were identified in perimenopausal women. These findings highlight perimenopause as a critical period for monitoring and targeting CVH in women.