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During the menopause transition, only 1 in 5 women have optimal scores using the American Heart Association’s health-assessment tool, known as Life’s Essential 8 (LE8). Among the tool’s eight components, four of them-blood glucose, blood pressure, sleep quality and nicotine use-are key in driving future cardiovascular risks, with sleep being particularly crucial for long-term cardiovascular health.

The findings-published today in Menopause-were made by researchers at the University of Pittsburgh, Albert Einstein College of Medicine and Baylor University.

“Previously we’ve shown that the menopause transition is a time of accelerating cardiovascular risk,” said senior author Samar R. El Khoudary, Ph.D., M.P.H., professor of epidemiology at Pitt’s School of Public Health. “This study underscores that it’s also an opportunity for women to take the reins on their heart health.”

The team analyzed health data collected from about 3,000 women who participated in the Study of Women’s Health Across the Nation (SWAN), an ongoing, longitudinal, multi-site, multi-ethnic study of midlife women that began in 1996. The researchers compared the women’s LE8 scores at baseline, around age 46, to their evolving health trajectories over time, from subclinical cardiovascular disease measures, such as increased carotid-artery thickness, to cardiovascular events, including heart attacks and strokes, to mortality of all causes. The team also examined impacts of each of the individual LE8 components: nutrition, physical activity, smoking abstinence, sleep, body mass index, blood lipids, blood sugar and blood pressure.

The analysis showed that four LE8 components-blood glucose, blood pressure, sleep quality and nicotine use-were the most important factors driving the study participants’ future cardiovascular risks.

Above all, sleep emerged as a potential predictor for long-term effects of cardiovascular disease events and all-cause mortality, though it was not linked to the shorter-term effects of carotid-artery thickening. The team found that at midlife, meeting the bar for healthy sleep, defined in Life’s Essential 8 as seven to nine hours on average for most adults, may contribute to women’s heart health and longevity, a hypothesis that should be tested in a future clinical trial, said Ziyuan Wang, Ph.D. candidate at Pitt Public Health and first author.

Low total LE8 scores correlated with increased cardiovascular risk, as expected-however, only 21% of the midlife women studied had an ideal LE8 score.

“With heart disease being the leading cause of death in women, these findings point to the need for lifestyle and medical interventions to improve heart health during and after menopause among midlife women,” said El Khoudary.

Reference:

Wang, Ziyuan MS1; Barinas-Mitchell, Emma PhD1; Brooks, Maria M. PhD1; Derby, Carol A. PhD2; Magnani, Jared W. MD, MSc1,3; Thurston, Rebecca C. PhD1; Ylitalo, Kelly R. PhD4; Bertolet, Marnie PhD1; El Khoudary, Samar R. PhD, MPH1. Prospective associations of American Heart Association Life’s Essential 8 with subclinical measures of vascular health, cardiovascular disease events, and all-cause mortality in women traversing menopause: The Study of Women’s Health Across the Nation study. Menopause ():10.1097/GME.0000000000002549, July 8, 2025. | DOI: 10.1097/GME.0000000000002549.

Dry eyes can cause significant discomfort, and the symptoms become more common as we age. However, until now, it was unclear what proportion of the population suffered from the condition, with estimates ranging from 5-50%.

In fact, research presented today (Monday) at the 43rd Congress of the European Society of Cataract and Refractive Surgeons (ESCRS) , found that more than half of the general population in the USA and Europe experience dry eyes, yet only 20% of European patients and 17% of US patients were diagnosed, and they can wait years for professional help.

Dr Piotr Wozniak, refractive surgeon and dry eye specialist at Optegra Eye Clinics in Warsaw, Poland, and a lecturer and clinical instructor at Cardinal Stefan Wyszyński University in Warsaw, told the Congress: “Results from our studies reveal a substantial group of patients suffering without help. The European questionnaire explored why people don’t seek treatment. Many see dry eye as a normal part of ageing and something to endure. As a medical doctor, I find this particularly concerning because a simple eye drop could offer significant relief – but many people aren’t even asking for help.”

Dr Wozniak presented findings from a survey of 2,003 adults in the US conducted in April 2024, and from an ongoing, international arm of the study conducted by Bausch and Lomb with over 5,000 adults in the UK, France, Germany, Poland, and Saudi Arabia: the ‘Needs Unmet in Dry Eye: Symptoms, Treatment and Severity’ (NESTS) study. In June 2025, the NESTS international arm surveyed 2,580 adults in the general population and 2,572 dry eye sufferers.

“In the NESTS study, we found that 58% of the general population reported experiencing dry eye symptoms, yet only one in five have received a formal diagnosis from a healthcare provider,” he said. “The large size of this study makes these results robust.

“The study explored the patient journey in detail. What stood out was that up to one-third of patients had experienced symptoms for more than five years before seeking professional help. NESTS also found that around half of sufferers experience symptoms every single day. The delay in seeking treatment is concerning, especially since dry eye is a progressive disease and early intervention can prevent a vicious cycle of inflammation.”

Other results from NESTS showed that 60% of dry eye sufferers waited at least four months before seeking help and 20% waited more than a year before talking to health care provider about their symptoms. Many sufferers stopped driving at night (17%), no longer wore makeup (14.8%), or reduced their use of heat or air conditioning (15.2%) due to their uncontrolled dry eye symptoms. One in three sufferers (34%) reported that their symptoms had worsened in the past year and only 9% said there had been an improvement.

Lubricating eye drops were the first and most common treatment, chosen either by the patient or by an eye or health care provider. Yet only 25% believed their current treatment was specifically tailored to their needs.

Dr Wozniak said: “NESTS also examined patient-provider interactions, revealing national differences. For example, in France fewer than half of dry eye sufferers had planned follow-up visits, while in Saudi Arabia, the majority, 84%, were proactively followed up by their providers.”

In the US study, eye dryness frequently affected 50% of survey respondents, and 80% experienced symptoms such as fatigue, itchy or watery eyes, but only 17% had a diagnosis from an eye care provider. Between 35-75% of people were very or extremely bothered by dry eyes, with reading, using electronic devices or driving being the most common activities to be disrupted; 70% lacked knowledge of treatment options; 40% were unaware that untreated dry eyes can cause other eye problems and vision loss; only about 25% visited an eye care provider every two years or more frequently; 67% of people with dry eyes waited six months or more to see an eye care provider, and 31% waited two or more years.

Dr Wozniak said: “These findings highlight the widespread impact of dry eye disease on quality of life, showing a large number of people suffering silently.

“We need to educate patients and the public on the causes, consequences and treatment options for dry eyes, as well as the importance of regular eye checks. In addition, we must support healthcare professionals in distinguishing between different types of dry eye and matching treatments appropriately. One person’s ‘dry eye’ can be very different from another’s.”

Diagnosis of dry eye often involves a combination of patient-reported symptoms, medical history and clinical tests. However, some patients are diagnosed only on the basis of symptoms and a standard eye examination, for instance with a microscope. Specific diagnostic tools include looking at the time it takes for a dry spot to appear on the cornea after a blink, using dye to stain the surface of the eye, measuring the concentrations of salts and other particles in tears, or an assessment of the Meibomian gland, which is responsible for producing the oily part of tears.

Left untreated, dry eyes can be very uncomfortable, can cause inflammation and a condition called blepharitis when eyelids become sore and inflamed. Symptoms include a sandy or gritty feeling, soreness, uncomfortable and painful eyes, itching or burning sensation, short-term blurred vision, and watery eyes. Dry eyes are more common in people over the age of 50 because the glands that make tears, particularly the oily component, become less effective, causing the tears to dry up too quickly and the front of the eye to become dry and irritated. The condition may also affect the outcome of nearly every ophthalmological surgery, including cataract and refractive procedures, making its diagnosis and management important, even before surgery takes place.

Dry, dusty, windy and cold conditions can also make eyes feel dry, as can air-conditioning, central heating, smoking and certain medical conditions such as autoimmune diseases and hormonal conditions.

ESCRS President, Dr Filomena Ribeiro, who is Head of the Ophthalmology Department at Hospital da Luz, Lisbon, Portugal, was not involved in the research. She commented: “These findings reveal the true extent of dry eye disease in the general population. It is concerning that such a small proportion of sufferers seek help for the condition, especially as it can make a real difference to the outcomes of ophthalmological surgery and also to their quality of life. Eye and health care professionals need to discuss this with patients when they see them and encourage people to have regular eye care checks.”

Reference:

Dry eyes affect over half the general population, yet only a fifth receive diagnosis and treatment, European Society of Cataract and Refractive Surgeons, Meeting: 43rd Congress of the European Society of Cataract and Refractive Surgeons