Women living in disadvantaged neighborhoods face worse heart health and experience a faster decline as they approach menopause, according to a long-term study led by the Harvard Pilgrim Health Care Institute, published on July 17.
Researchers tracked 1,200 women in eastern Massachusetts for over 20 years, following them from pregnancy into midlife. The study measured heart health at five different points using a score based on eight factors: blood pressure, cholesterol, sleep, diet, physical activity, and other lifestyle elements.
The findings show that women residing in the most socially vulnerable neighborhoods scored about 6 to 10 points lower on heart health throughout more than two decades of follow-up compared with those living in the least disadvantaged areas. These differences appeared as early as three years after enrollment and persisted into midlife. The data also revealed that these women experienced steeper declines before menopause—a period associated with rising cardiovascular risk.
Socioeconomic factors such as lower income, less education, or identifying as Non-Hispanic Black were also linked to lower heart health scores throughout the study period. Researchers noted that even modest differences in these scores could have significant consequences; prior research suggests small decreases are associated with higher risks of cardiovascular disease and mortality.
"Our study shows that heart health in midlife is shaped by more than personal choices. Income, education, and neighborhood conditions may all play a role," said senior author Izzuddin Aris of Harvard Medical School at the Harvard Pilgrim Health Care Institute. Aris added, "The years before and around menopause may be an important time to support women's heart health. This is especially true for women living in under-resourced neighborhoods."
Neighborhood conditions continued to affect outcomes even after accounting for income and education levels. The researchers suggest their findings highlight opportunities to improve access to healthy food options, safe spaces for physical activity, and quality healthcare so women can better protect their cardiovascular well-being over time.
