Shared framework aims to redefine heart health for girls and women

The American Heart Association, American Academy of Pediatrics, American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine have released a publication that redefines heart health in girls and women. The organizations together outline four distinct “Female Life Stages” offering women and health care professionals a chance to have heart health conversations from puberty through menopause and beyond.

Three manuscripts published in Circulation, are the first coordinated, multisociety framework to prevent, detect and manage cardiovascular disease among girls and women. The publications outline a path to connect care across the clinical specialties that see women throughout their lives.

“Women experience their health care across clinical specialties, but it is often fragmented or disconnected,” said Sadiya S. Khan, chair of the collaborative writing group and Magerstadt professor of cardiovascular epidemiology at Northwestern University Feinberg School of Medicine in Chicago.

“Specifically, 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, which includes heart disease and stroke, is the leading cause of death in women, claiming more than 400,000 lives in the U.S. each year—more than breast cancer, lung cancer and chronic lung disease combined. Yet only about 4 in 10 (41%) women recognize it as their greatest health threat.

“Women make up more than half the population, and their heart health must be a part of everyday care across medicine,” said Mariell Jessup, 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 new approach is needed

Progress has stalled in preventing cardiovascular deaths among women over the past two decades. To get ahead of risk, the new approach to women’s cardiovascular health views it as a lifelong process.

A 2026 American Heart Association scientific statement that forecast women’s health and risk factors concluded that if trends continue through 2050, the proportion of U.S. women ages 20 and older living with high blood pressure will increase from approximately 49% in 2020 to 59% in 2050.

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

“These projections underscore the urgency of making cardiovascular health a priority at every stage of a woman’s life,” said Khan. “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 based on female biology and offers windows of opportunity to prevent heart disease and stroke. Each life stage is defined by a change in hormones that is uniquely experienced by girls and women, with pregnancy identified as an event affecting cardiovascular health that may occur at any or multiple life stages:

• Stage 1 perimenarche—This stage represents the transition around the first menstrual period. Approximate age range is 8–15 years.
• Stage 2 ovarian cycling—This stage is when regular ovulatory and hormone cycles are established and pregnancy typically occurs. Approximate age range is 15–44 years.
• Stage 3 perimenopause—This stage represents the transition to variable cycle length, skipped cycles and hormone changes. Approximate age range is 45–51 years.
• Stage 4 postmenopause—This stage represents the years that begin after menopause or 12 months after the final menstrual period. Approximate age is 51 years and older.
• Pregnancy, in any life stage—The time before, during and after pregnancy is highlighted as a biological “stress test” that can identify cardiovascular risks that may have been previously unrecognized.

Within each life stage, the framework takes a holistic approach to 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 allows for earlier recognition of risk, earlier prevention, and better continuity of care beginning in childhood.

“Heart health begins long before adulthood,” said Amanda Marma Perak, 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.”

Heart, hormonal and psychosocial health connections

• Periods can be a marker of heart health. The new publications recognize menstrual cycle patterns as a female-specific vital sign. Specifically, heavy or irregular menstrual bleeding can serve as early markers of cardiovascular risk, such as polyendocrine metabolic ovarian syndrome (PMOS, formerly known as polycystic ovary syndrome, or PCOS).
• Perimenopause is a cardiovascular inflection point. Changes in cholesterol and metabolic health during the perimenopause stage can be early signs of cardiovascular risk. Identifying risk early and acting on it may reduce the risk of cardiovascular disease.
• Postmenopause is an important time for cardiovascular disease prevention. The years after menopause can represent up to 40% of a woman’s lifetime. Most heart attacks, strokes and heart failure events occur in this stage, and they are more than 80% preventable if action is taken early.
• Psychosocial health is important for heart health. Women are more likely to experience anxiety, depression and eating disorders, each of which can contribute to poor heart health.
• Pregnancy history is heart history. Changes in pregnancy can unmask cardiovascular disease risk. Pregnancy 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 cardiovascular risk assessment for women.
• Postpartum care is often a missed opportunity. Only about 60% of U.S. women with high blood pressure-related complications during pregnancy receive follow-up care for their high blood pressure within six months of delivery. The American Heart Association and the collaborating societies call for immediate action on this 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, 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 multisociety 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.

Translating evidence into coordinated interdisciplinary care

The societies call for a national infrastructure 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 offer opportunities to improve cardiovascular health now, while research is needed to continue to address gaps in evidence specific to women by prioritizing inclusion of women in research, expansion of funding of women’s health, and translation of 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.”

Who’s behind this story?

Sadie Harley

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Robert Egan

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