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Why this article is important
We regularly visit the gynecologist, go for skin checks and dental cleanings. But for a heart check-up? Unfortunately, this is rarely considered and is not included in health insurance prevention programs.
This is surprising, because: Cardiovascular diseases are the number one cause of death in women. Yet, it often doesn't have to come to that – if one pays attention in time.
The problem: Many women do not know that their heart has its own risk profile. And that typical warning signs look different than in men.
So, it's time to put the heart on the priority list – not just when it falters.
What many don't know – and why prevention is particularly important for women
While men often raise alarms earlier, women with heart risks frequently fly under the radar. Why?
Estrogen protects – but not forever. With hormonal changes during menopause, the risk of high blood pressure, unfavorable blood lipids, and inflammation increases.
Typical risk factors are often overlooked in women. Heart attacks are still perceived more as a "male problem." Because women often have different symptoms than men, these are often not correctly assigned.
There is no special, standardized "heart prevention" as a health insurance benefit.
Values that protect your heart – the sooner you know them, the better
Even if your risk of a heart attack is still low at 30 or 40 – your body remembers everything. A persistently slightly elevated blood pressure, too high an LDL value, too little exercise, or chronic stress: All of this quietly burdens your blood vessels – often for years. This is called lifelong risk: It builds up insidiously, long before symptoms appear. And that's precisely why it's worth taking a look early – not just when your heart starts acting up.
In fact, you should know certain values early on and have them checked regularly:
Your Heart Baseline:
Blood pressure: optimal below 130/80 mmHg
LDL cholesterol: < 116 mg/dl – with increased risk < 100 mg/dl
HDL & Triglycerides: HDL > 50 mg/dl, Triglycerides < 150 mg/dl
Lipoprotein(a): determine once – genetically determined, not influenced by diet
Blood sugar / HbA1c: early detection if metabolism is unbalanced
hs-CRP: inflammatory marker – often underestimated, but insightful
Lp-PLA2: very precise marker for vascular inflammation
Have your values explained and keep them. This way you can compare them over time.
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When is a closer look worthwhile?
If you can answer "yes" to three or more of these questions, you should discuss further examinations with your doctor:
✔ Have there been heart attacks or sudden cardiac deaths in close relatives under 60?
✔ Did you have pregnancy complications such as pre-eclampsia or gestational diabetes?
✔ Is your LDL cholesterol above 116 mg/dl?
✔ Do you have high blood pressure over 140/80 mmHg?
✔ Is there diabetes or pre-diabetes?
✔ Have you been diagnosed with PCOS or an autoimmune disease?
✔ Is your Lipoprotein(a) significantly elevated (> 100 mg/dl)?
✔ Do you smoke or exercise less than 2.5 hours per week?
✔ Is your BMI over 30?
Even if you are still young – these risk factors count. And the earlier you keep an eye on them, the better you can counteract them.
Heart prevention during and after menopause – now it becomes relevant
With the drop in estrogen levels, many things change – also for your heart.
Because estrogen has a vascular protective effect: It keeps the vessel walls elastic, regulates blood pressure, influences fat metabolism, and inhibits inflammation. When this protection diminishes, blood pressure and LDL cholesterol rise, and quietly progressing inflammatory processes accelerate – often unnoticed.
Therefore, the time around menopause is the ideal moment for a targeted heart check-up that clarifies comprehensive risk factors in addition to the values already described and, if necessary, includes targeted imaging examinations.
Why imaging procedures are particularly useful now
In postmenopause, certain examinations become more important because they make visible whether deposits in the blood vessels already exist – and if so, how far advanced they are.
Here are the most important tools:
Carotid duplex sonography:
The carotid artery is examined with an ultrasound probe – a kind of window into vascular health. Thickening or plaques are early signs of arteriosclerosis throughout the body.CT angiography (cardiac CT with contrast agent):
Shows millimeter-precisely whether deposits are already present in the coronary arteries. Particularly helpful if you have elevated Lp(a), high blood lipids, or a family history.Calcium scan:
CT without contrast agent, which measures the amount of calcium in the blood vessels. A score of 0 is ideal – the higher the value, the greater the risk.
(Important to know: Non-calcified plaques are not detected here – so it is often more sensible to have a CT angiography immediately.)Cardiac ultrasound (echo):
Checks if the heart is pumping well, the valves are working, and the wall thickness is correct. Provides important basic information about heart structure.Stress ECG:
Measures ECG and blood pressure under stress (e.g., on a bicycle). Interesting for detecting hidden high blood pressure under stress or circulatory disorders under stress.Cardiac MRI:
Without radiation, with particularly good visualization of the heart muscle – for example, in case of suspected myocarditis or scars.
Conclusion: Your heart prevention summarized
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Heart prevention is not a matter of age – but a matter of attitude.
Knowledge is protection: The earlier you know your values, the more specifically you can intervene.
Perimenopause is a key time: Estrogen drops, risk increases – and you often don't even notice. Many examinations help to set the course early – even if they are not covered by health insurance.
You don't have to do everything at once. But you should know what is possible.
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Questions & Answers
I am slim and sporty – do I still need heart prevention?
Absolutely! Even slim people can have silent risk factors – e.g., a genetically determined high cholesterol level or an unnoticed increase in blood pressure. Your outward appearance says nothing about your vascular health. Therefore: Check your values before your heart makes itself known.XX Antwort XX
Why is Lipoprotein(a) so important – and why isn't an LDL value alone enough?
Lipoprotein(a), or Lp(a) for short, is genetically determined and an independent risk factor – even with otherwise normal cholesterol levels. One measurement is sufficient. If the value is elevated, your heart prevention should be particularly consistent, and all other risks (high blood pressure, overweight, smoking) should be avoided.
What does a heart check-up do for me if I have no symptoms?
A lot! Most heart diseases develop over years – unnoticed. Because deposits in the blood vessels or slightly elevated blood pressure usually don't hurt, but the consequences, namely a heart attack or stroke, are painfully noticeable. Prevention means recognizing risks before diseases even arise. If you know where you stand today, you can specifically counteract and relieve your heart of work in the long term.
Dr. Catharina Hamm
Specialist in Internal Medicine and Cardiology
As a cardiologist, I see daily how often heart health in women is underestimated – especially around menopause. I know how important it is to recognize female risks early and to take symptoms seriously. That's why I want to encourage women to actively shape their heart health – with clarity, responsibility, and the knowledge that prevention is the strongest heartbeat.
