ABSTRACT Menopausal age is a sex-specific risk factor for heart failure (HF). Although prior studies have demonstrated associations of menopausal age with subclinical cardiac dysfunction and HF, the exact mechanisms that link menopausal age and cardiac dysfunction are not known. Obesity is a known HF risk factor that becomes more prevalent after menopause begins. Adipokines, such as leptin and adiponectin, which are released from adipose tissue, have been linked with subclinical cardiac dysfunction and symptomatic HF. We surmised that adipokines play a role in the relationships of menopausal age with cardiac structure and function and subsequently with clinical HF. The overarching goals of this proposal are to examine the influence of serum adipokines on the associations of menopausal age with cardiac structure and function measured by magnetic resonance imaging (MRI) in the Multi-Ethnic Study of Atherosclerosis (MESA). We will also investigate the moderating role of adipokines on the relationship between menopausal age and HF incidence (including HF subtypes), accounting for years post menopause, sex hormone levels and body composition using the MESA data. MESA provides a comprehensive assessment of body composition including body mass index, waist circumference, waist hip ratio, computed tomography measures of subcutaneous adipose tissue and visceral adipose tissue, sex hormone and adipokine data, detailed measures of cardiac structure and function by MRI and incident HF records. This approach illustrates the pathophysiological progression from subclinical cardiac dysfunction to clinical HF. MESA has information on preserved and reduced ejection fraction HF, further allowing us to explore associations according to HF subtypes. The results from this study will be used as pilot data for a future R01 grant aimed at further characterizing HF in postmenopausal women.