Menopause is often a turning point for women's health worldwide. Increasing knowledge from experimental data and clinical studies indicates that cardiometabolic changes can manifest at the menopausal transition, superimposing the effect of ageing onto the risk of cardiovascular disease. The menopausal transition is associated with an increase in fat mass (predominantly in the truncal region), an increase in insulin resistance, dyslipidaemia, and endothelial dysfunction. Exposure to endogenous oestrogen during the reproductive years provides women with protection against cardiovascular disease, which is lost around 10 years after the onset of menopause. In particular, women with vasomotor symptoms during menopause seem to have an unfavourable cardiometabolic profile. Early management of the traditional risk factors of cardiovascular disease (ie, hypertension, obesity, diabetes, dyslipidaemia, and smoking) is essential; however, it is important to recognise in the reproductive history the female-specific conditions (ie, gestational hypertension or diabetes, premature ovarian insufficiency, some gynaecological diseases such as functional hypothalamic amenorrhoea, and probably others) that could enhance the risk of cardiovascular disease during and after the menopausal transition. In this Review, the first of a Series of two papers, we provide an overview of the literature for understanding cardiometabolic changes and the management of women at midlife (40–65 years) who are at higher risk, focusing on the identification of factors that can predict the occurrence of cardiovascular disease. We also summarise evidence about preventive non-hormonal strategies in the context of cardiometabolic health.

更年期通常是全球女性健康的转折点。越来越多的实验数据和临床研究表明，心脏代谢变化可以在绝经过渡期表现出来，将衰老的影响叠加到心血管疾病的风险上。更年期过渡与脂肪量增加（主要在躯干区域）、胰岛素抵抗、血脂异常和内皮功能障碍增加有关。在生育期暴露于内源性雌激素可为女性提供预防心血管疾病的保护，这种疾病在绝经开始后大约 10 年就会消失。特别是，绝经期间有血管舒缩症状的女性似乎有不利的心脏代谢特征。早期管理心血管疾病的传统危险因素（即，高血压、肥胖、糖尿病、血脂异常和吸烟）是必不可少的；然而，重要的是要在生殖史中识别出女性特有的疾病（即妊娠高血压或糖尿病、卵巢早衰、一些妇科疾病，如功能性下丘脑性闭经，以及可能的其他疾病），这些疾病可能会增加女性患心血管疾病的风险。和更年期过渡后。在这篇评论（两篇系列论文中的第一篇）中，我们概述了了解心脏代谢变化和中年（40-65 岁）高风险女性管理的文献，重点是确定影响心脏代谢的因素。可以预测心血管疾病的发生。