A trio of scientific papers published in the journal Circulation presents a lifespan approach to women's cardiovascular health, emphasizing that heart disease risk and prevention opportunities begin in adolescence and evolve through pregnancy and menopause. The publications are a joint effort among the American Heart Association, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine, according to a news release.
The reports connect hormonal health, mental health and well-being, heart health, and brain health, arguing that these domains should be addressed together as a routine part of care from a young age. Dr. Sadiya Khan, chair of the writing group, said in the release that women experience healthcare across clinical specialties, but it often is fragmented or disconnected. The papers aim to connect the dots for clinicians and patients so that care is holistic and begins in adolescence.
"Heart disease and other forms of cardiovascular disease don't suddenly become relevant when we become older women," said Dr. Stacey E. Rosen, immediate past volunteer president of the American Heart Association. The documents view a woman's life in distinct stages, each offering chances for early detection, risk factor identification, and treatment. Dr. Esther S.H. Kim, director of the Center for Women's Cardiovascular Health at Atrium Health, described these stages as "windows of opportunity" to prevent heart disease, starting as far back as childhood.
The papers highlight how hormonal fluctuations affect the cardiovascular system. Estrogen, estradiol, and progesterone influence blood vessels, the brain, and heart muscle, affecting cholesterol levels, blood stickiness, inflammation, blood pressure, and stress response. While plaque buildup that narrows arteries is the most common cardiovascular issue in both men and women, women are more likely to experience conditions such as microvascular coronary disease, heart failure with preserved ejection fraction, and spontaneous coronary artery dissection. These require specific diagnostic tests, and Kim stressed that if doctors do not consider them, the diseases will be missed.
Adolescence emerges as a critical period. Dr. Amanda M. Perak, a pediatric cardiologist at Ann & Robert H. Lurie Children's Hospital of Chicago, noted that puberty is a big turning point. A first period before age 10 is linked to higher heart disease risk later in life, and persistent irregular periods along with signs of polyendocrine metabolic ovarian syndrome can signal elevated risk. "The goal isn't to worry teens about the chance of a heart attack," Perak said. "It's that the teen years are when patterns get set, and it's much easier to keep good heart health than to get it back." Resources are available to help protect and strengthen heart health at every stage.
In early adulthood, the reports recommend that women discuss contraceptive options, pregnancy planning, and what constitutes a normal period with their clinicians. The basics known as Life's Essential 8 remain central: maintaining healthy weight, blood pressure, blood sugar, and cholesterol; eating a healthy diet; getting enough physical activity and quality sleep; and avoiding tobacco. During pregnancy, 9 out of 10 women ages 20 to 44 have less-than-ideal heart health when they become pregnant, and the first year after pregnancy is a critical time for monitoring risks such as high blood pressure and gestational diabetes.
Mental health is woven throughout. By age 17, girls are twice as likely as boys to be diagnosed with depression, and teens with depression are more likely to develop obesity later. The papers call for mental health and well-being screening to become a routine part of women's care.
Around menopause, women may experience increases in low-density lipoprotein cholesterol, weight gain, and rising blood pressure. "The answer is an absolute, positive, emphatic no" to surrendering to inevitable heart disease, Rosen said. It is never too late to make healthy changes. Cardiovascular disease is the leading cause of death in women, claiming more than 400,000 lives in the U.S. each year, yet only about 4 in 10 women recognize it as their greatest health threat. The American Heart Association's Go Red for Women initiative offers resources, including a My Heart & Health Checklist - Questions to think about before your next visit and guidance on Learn more about supporting good heart health during menopause and beyond. Additional materials include a A Woman’s Heart Through Every Stage of Life - A guide to protecting your heart from your first period through menopause and beyond and a Spanish news release.
