Chrisandra Shufelt, MD, on cardiovascular risk assessment and menopause care

Chrisandra L. Shufelt, MD, MS, FACP, MSCP, professor and chair of the Division of General Internal Medicine and associate director of the Women’s Health Research Center at Mayo Clinic in Jacksonville, Florida, joined Contemporary OB/GYN at The Menopause Society Annual Meeting 2026 in San Diego, California, to discuss how cardiovascular risk can play a role in menopause care and hormone therapy consideration.

Building on her discussion of the cardiovascular risk factors that rise during menopause, Shufelt described a new tool to help determine who is an appropriate candidate for hormone therapy in patients with noted and increased cardiovascular risk.

A risk score for hormone therapy candidacy

Shufelt and colleagues are publishing an algorithm in the journal Menopause that uses a score to identify women at high risk for cardiovascular disease, benchmarked against the PREVENT Risk Calculator developed by the American Heart Association and the American College of Cardiology.

That calculator, which guides decisions about starting cholesterol-lowering medication, has now been incorporated into an effort to determine who is, and is not, an appropriate candidate for hormone therapy, Shufelt said.

For women at high cardiovascular risk, defined by multiple uncontrolled risk factors or a personal history of blood clots or heart attack, Shufelt said clinicians should consider nonhormonal, neurokinin (NK)-based medications for hot flashes and potentially avoid hormone therapy.

Because these evaluations can be time-consuming in the office, she recommended partnering with a primary care physician or preventive cardiologist, and referring patients with a family or personal history of cardiovascular disease for further evaluation around the time of menopause.

Hormone therapy and heart disease

“The take-home message is that we are not using menopausal hormone therapy to prevent heart disease. We have much better tools for that,” Shufelt said, pointing to statins, other lipid-lowering medications, and GLP-1 medications with established cardiovascular benefits.

For women at or around menopause with well-controlled cardiovascular risk factors, hormone therapy is appropriate for treating menopause symptoms, Shufelt said, though it has not been shown to provide the same cardiovascular benefit as cholesterol- and blood pressure-lowering therapies.

“We know that hormones don’t cause heart disease, but we need to be selective about whom we treat with hormone therapy during and around the time of menopause,” Shufelt said.