Perimenopause, or menopause transition (MT), is a critical life stage that encompasses significant physiological, emotional, and psychosocial changes that impact women’s cardiovascular health and quality of life. The decline in estrogen during MT induces adverse metabolic changes that increase the risk of dyslipidemia, obesity, insulin resistance, atherogenesis, and poor downstream outcomes such as diabetes, hypertension, stroke, and other adverse changes. Concurrently, stress plays an important role in shaping overall cardiovascular well-being during MT and long-term heart health post-menopause. In addition, nontraditional risk factors—particularly social determinants of health (SDoH) such as economic well-being, access to health care, built environment, social support, and others—are key upstream determinants of cardiovascular disease in women during perimenopause. Coordinated efforts are needed to screen, identify, and address the primary SDoH for optimal heart health in the clinically vulnerable MT patient population. Patient-centered care pathways that focus on assessing social needs and connecting socially vulnerable patients with available community resources are much needed for holistically addressing patient needs. Community-centered efforts are key to addressing persistent inequities in women’s cardiovascular health via navigation and connection to community resources that may help address SDoH barriers.