08/10/2026
Most heart attacks happen below the knee.
A woman’s hormonal life from her first period all the way through menopause changes cardiovascular health risk.
Estrogen is cardioprotective. It helps keep blood vessels flexible, supports the lining of your arteries, and helps hold LDL cholesterol down.
As estrogen declines through perimenopause and menopause, you lose some of that protection. LDL tends to rise, body fat shifts toward the middle, and insulin resistance often increases.
The plaque narrowing the arteries feeding your heart is narrowing the arteries feeding your feet at the same time.
In diabetes, the small vessels below the knee are often where it shows up first, sometimes years before anything happens in your chest.
Diabetes can also quiet the nerves in your feet, so the usual warning sign of poor circulation, aching legs when you walk, may never arrive. The first clue ends up being a sore that will not close.
At your next appointment, ask for a PAD screen. Pulses in both feet, skin color when your leg is raised and when it hangs down, and whether your legs get tired when you walk. It takes about two minutes.