Cardiometabolic risk factors have worsened in the US population over the past 2 decades, with more pronounced deterioration in women than men. The 2020 Scientific Statement of the American Heart Association recognized the menopause transition as a stage of accelerating cardiovascular disease risk, given the adverse alteration in cardiometabolic health during this period. Although cardiovascular disease risk in women increases after menopause to a level comparable to that of men, women are often undertreated for cardiovascular risk factors compared with men. A comprehensive understanding of how cardiometabolic risk factors worsen over the menopause transition will help clinicians identify high-risk women. This chapter reviews changing patterns of traditional (blood pressure, lipids and lipoproteins, body composition, type 2 diabetes, and metabolic syndrome), novel (inflammatory biomarkers, liver steatosis and enzymes, and kidney function), and psychosocial (sleep health and depression) cardiometabolic risk factors. For each cardiometabolic risk factor, this chapter summarizes sex differences in age-related changes, reviews changes over the menopause transition and related racial/ethnic differences, and distinguishes the effects of ovarian aging from those of chronological aging. Future research should continue to explore menopause-specific deterioration in cardiometabolic risk factors and evaluate the potential benefits of implementing early intervention targeting these changes.