Cardiovascular disease is the number one threat to healthspan and longevity. But, aging in women doesn’t follow the same trajectory as it does in men. Alongside perimenopause, as the protective effects of estrogen wane, dyslipidemia, metabolic dysregulation, and weight gain arrive in a rush. This transition still catches even our healthiest patients (and their clinicians) off guard. The downstream effects are vast–brain, bone, microbiome, joints, and barriers (including intestinal and endothelial) all become compromised. Cardiovascular risk can skyrocket.