Major medical groups issue a new framework for girls’ and women’s heart health

For the first time, four medical societies have joined to create shared guidance linking women’s heart health to key life stages, giving clinicians a clearer way to spot cardiovascular risk earlier and respond sooner.

Submitted by the American Heart Association

The American Heart Association, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine have released a landmark set of publications that reframe heart health in girls and women. Together, the organizations outline four distinct “Female Life Stages,” creating a framework for heart health discussions from puberty through menopause and beyond.

Three papers published in the American Heart Association’s flagship journal, Circulation, form the first coordinated, multi-society effort to prevent, detect and manage cardiovascular disease in girls and women. The publications map out a way to connect care across the specialties that see women throughout their lives.

“Women experience their healthcare across clinical specialties, but it often is fragmented or disconnected,” said Sadiya S. Khan, M.D., M.Sc., FAHA, chair of the collaborative writing group and Magerstadt Professor of Cardiovascular Epidemiology at Northwestern University Feinberg School of Medicine in Chicago. “These reports connect the dots for clinicians, for patients and across health domains so that care is holistic and begins in adolescence, recognizing that women’s heart health is uniquely shaped by biological transitions not experienced by men — periods, pregnancy, perimenopause and menopause.”

According to the American Heart Association, cardiovascular disease, including heart disease and stroke, is the leading cause of death in women, taking more than 400,000 lives in the U.S. each year — more than breast cancer, lung cancer and chronic lung disease combined. Even so, only about 41% of women identify it as their greatest health threat.

“Women make up more than half the population, and their heart health must be part of everyday care across medicine,” said Mariell Jessup, M.D., FAHA, chief science and medical officer of the American Heart Association. “These publications give clinicians and health systems a shared foundation for recognizing risk throughout a woman’s life.”

Why a different approach is needed

Progress in lowering cardiovascular deaths among women has stalled over the past two decades. The new approach treats women’s cardiovascular health as a lifelong process in order to get ahead of risk.

A scientific statement from the American Heart Association projected that if current trends continue through 2050, the share of U.S. women ages 20 and older living with high blood pressure will rise from about 49% in 2020 to 59% in 2050.

At the same time, maternal mortality has increased, and cardiovascular disease has become the leading cause of medical-related deaths during pregnancy. The American Heart Association says cardiovascular conditions account for more than one-third of maternal deaths in the U.S.

“These projections underscore the urgency of making cardiovascular health a priority at every stage of a woman’s life,” Khan said. “This new approach gives clinicians across specialties shared guidance to recognize risk earlier, personalize prevention, and act before a heart attack, stroke or heart failure event.”

A first-of-its-kind Female Life Stage framework

The Female Life Stage framework is grounded in female biology and identifies periods when heart disease and stroke can be prevented or delayed. Each stage is defined by hormonal changes that are uniquely experienced by girls and women, with pregnancy treated as an event that can affect cardiovascular health during any stage or more than one stage:

• Stage 1 perimenarche — the transition around the first menstrual period. Approximate age range: 8 to 15 years.

• Stage 2 ovarian cycling — regular ovulatory and hormone cycles are established, and pregnancy most often occurs. Approximate age range: 15 to 44 years.

• Stage 3 perimenopause — the transition marked by changing cycle length, skipped cycles and hormone shifts. Approximate age range: 45 to 51 years.

• Stage 4 postmenopause — the years after menopause, or 12 months after the final menstrual period. Approximate age: 51 years and older.

• Pregnancy, at any life stage — the time before, during and after pregnancy is described as a biological “stress test” that can reveal previously unrecognized cardiovascular risk.

Across each stage, the framework takes a broad view of women’s heart health by considering cardiovascular, hormonal and emotional health together, Khan said. “For clinicians, this approach underscores that heart health cannot be understood by looking at the heart alone. We need to recognize that women’s heart health is deeply interconnected with hormonal and emotional health.”

The framework also aims to support earlier identification of risk, earlier prevention and better continuity of care beginning in childhood.

“Heart health begins long before adulthood,” said Amanda Marma Perak, M.D., M.Sc., FAHA, vice-chair of the collaborative writing group and a pediatric cardiologist at Lurie Children’s Hospital in Chicago. “As pediatric clinicians, we have the opportunity to help every girl start strong and to ensure that what we learn about her health follows her as she grows.”

Links between heart, hormones and psychosocial health

• Periods can signal heart health. The new publications identify menstrual cycle patterns as a female-specific vital sign. Heavy or irregular menstrual bleeding may be an early marker of cardiovascular risk, including polyendocrine metabolic ovarian syndrome (PMOS), formerly known as polycystic ovary syndrome, or PCOS.

• Perimenopause can mark a cardiovascular turning point. Changes in cholesterol and metabolic health during this stage may be early warning signs of cardiovascular risk, and acting on them may help reduce the chance of disease.

• Postmenopause is a key time for prevention. The years after menopause can account for as much as 40% of a woman’s lifetime. Most heart attacks, strokes and heart failure events occur during this stage, and more than 80% are preventable if action is taken early.

• Psychosocial health matters. Women are more likely to experience anxiety, depression and eating disorders, all of which can contribute to poorer heart health.

• Pregnancy history is heart history. Pregnancy-related changes can reveal cardiovascular risk. Complications such as high blood pressure, preeclampsia, gestational diabetes, preterm birth, small-for-gestational-age infants and stillbirth are recognized as female-specific risk enhancers. The 2026 American Heart Association/American College of Cardiology cholesterol guideline now includes pregnancy-related factors in women’s cardiovascular risk assessment.

• Postpartum care is often missed. Only about 60% of U.S. women who experience high blood pressure-related complications during pregnancy receive follow-up care for high blood pressure within six months of delivery. The American Heart Association and its partner societies are calling for immediate action to close that prevention gap.

“Pregnancy and the postpartum period are important windows into cardiovascular health throughout the life course. An adverse pregnancy outcome can unmask increased cardiovascular risk and that information should guide care well beyond pregnancy,” said William A. Grobman, M.D., MBA, vice-chair of the writing group and professor of obstetrics and gynecology at The Warren Alpert Medical School of Brown University in Providence, Rhode Island. “This multi-society guidance gives clinicians who provide obstetric, gynecologic and cardiovascular care a shared framework for recognizing and acting on that risk.”

Grobman is also a former president of the Society for Maternal-Fetal Medicine and associate dean of clinical research at Brown.

Turning evidence into coordinated care

The societies are calling for a national network of Comprehensive Centers of Excellence for Women's Cardiovascular Care built on four pillars: interdisciplinary clinical care, professional education and training, research and community engagement. Existing tools and therapies can improve cardiovascular health now, while more research is needed to close evidence gaps specific to women by increasing women’s participation in studies, expanding funding for women’s health and turning evidence into action.

“Over the last several decades, research has led to substantive advances in the understanding of female-specific risk of cardiovascular disease,” Khan said. “Today, cardiovascular risk can be identified earlier in women with 10- and 30-year sex-specific risk estimation using the American Heart Association PREVENT equations. The goal is to assess health comprehensively and longitudinally across life stages, identify earlier opportunities for prevention, and close implementation gaps for women.”

“All girls and women deserve more healthy years to live their fullest lives,” Khan said. “Advancing women’s health is a responsibility we all share. This investment improves not only women’s health, but also the health of their families and their communities.”