New Framework Aims to Improve Cardiovascular Health for Women Across Lifespan
A collaborative effort introduces a new approach to healthcare that connects women's reproductive health with their long-term cardiovascular well-being.
A new framework developed by leading medical organizations seeks to transform cardiovascular care for women by integrating reproductive health milestones with lifelong heart health monitoring.
The framework, published in a three-part series in the journal Circulation, was created by the American Heart Association in collaboration with the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine. It introduces the Female Life Stage tool, offering clinical guidance and outlining strategies for health systems to deliver coordinated care throughout a woman's life.
Cardiovascular disease remains the leading threat to women's health, accounting for approximately one in three deaths annually. Despite this, fewer than half of women in a 2019 survey recognized heart disease as the primary cause of death for their gender. Experts note that a narrow focus on women's health, often limited to reproductive organs and pregnancy, has historically overlooked crucial links between life events and cardiovascular risk.
Unique indicators of cardiovascular risk can emerge years before heart disease develops, according to Sadiya S. Khan, a preventive cardiologist and epidemiologist. These signals can be identified through menstrual patterns, pregnancy complications, and menopause. For instance, pregnancy can act as a "natural stress test," revealing underlying cardiovascular risks. Conditions like preeclampsia necessitate continued cardiovascular preventive care long after delivery. The 2026 Cardiovascular Kidney Metabolic Syndrome Guideline now explicitly includes pregnancy complications and premature menopause as factors for personalized prevention.
Menstrual cycle irregularities and early menopause also signal increased cardiovascular risk. A study of over 10,000 women found that natural menopause before age 40 was associated with roughly a 40% higher lifetime risk of coronary heart disease. Additionally, mental health is intertwined with hormonal and cardiovascular health, with symptoms like premenstrual syndrome (PMS) affecting sleep and activity patterns, and mood symptoms during menopause requiring comprehensive assessment.
The new framework defines four key Female Life Stages: the transition around the first period, the years of ovarian cycling (including pregnancy), perimenopause, and postmenopause. This provides a shared language for clinicians and patients to recognize evolving health needs, identify risks earlier, and guide prevention strategies.
Perimenopause is recognized as a distinct stage that can significantly disrupt daily life and requires treatment. Decisions on hormone and nonhormonal therapies are guided by symptoms, age, cardiovascular and cancer history, and patient preferences, alongside assessments of cardiovascular disease risk and changes in cholesterol and cardiometabolic health.
Women may spend nearly 40% of their lives in the postmenopause stage, yet conversations about hormonal health's enduring impact often cease after the last period. The framework emphasizes the continued relevance of hormonal health history in cardiovascular care.
Beyond clinical guidance, the initiative calls for systemic changes in how care is delivered, addressing barriers, bias, and discrimination that can lead to symptoms being dismissed and delayed care. The underrepresentation of women in clinical research, particularly in trials for acute coronary syndromes, remains a challenge, though efforts like the creation of a new women's health division at the National Institutes of Health aim to improve data collection and understanding.
This framework builds on decades of advocacy, including the American Heart Association's Go Red for Women campaign and philanthropic investments in women's health. The upcoming documentary "HORMONAL!" by Katie Couric and Dawn Porter is expected to further raise public awareness.
Experts stress that girls and women, who constitute half the population, require integrated care across all medical specialties and health systems. While women can take steps to protect their health, the responsibility for coordinating care should not fall solely on them.