The American Heart Association, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine have jointly published a landmark three-part framework that redefines cardiovascular care for girls and women. The guidance, released in Circulation, establishes four "Female Life Stages" and calls for a national network of Comprehensive Centers of Excellence for Women's Cardiovascular Care. The effort matters because cardiovascular disease remains the leading cause of death in women, claiming more than 400,000 lives in the U.S. each year, yet only about 41% of women recognize it as their greatest health threat.
The publications connect care across specialties that historically have operated in silos, from pediatrics to obstetrics to cardiology. "Women experience their healthcare across clinical specialties, but it often is fragmented or disconnected," said Sadiya S. Khan, chair of the collaborative writing group, in the release link. The framework is detailed in a A Female-Specific Life Course Approach to the Prevention and Management of Cardiovascular Disease, which establishes the life stage construct, and a companion Consensus Guidance for the Female-Specific Prevention and Management of Cardiovascular Disease that provides clinical guidance. A third paper, Comprehensive Centers of Excellence for Women's Cardiovascular Care, maps the current landscape and proposes a national infrastructure.
The stakes are underscored by projections. A 2026 American Heart Association scientific statement warned that if trends continue, the proportion of U.S. women ages 20 and older with high blood pressure will rise from approximately 49% in 2020 to 59% in 2050. Meanwhile, maternal mortality has increased, with cardiovascular conditions accounting for more than one-third of pregnancy-related deaths. The framework identifies pregnancy as a biological "stress test" that can unmask previously unrecognized risk, and it notes that only about 60% of U.S. women with high blood pressure complications during pregnancy receive follow-up care within six months of delivery.
For clinicians, the guidance offers concrete tools. The 2026 American Heart Association/American College of Cardiology cholesterol guideline now includes pregnancy-related factors in risk assessment, and the PREVENT equations enable 10- and 30-year sex-specific risk estimation. The publications also recognize menstrual cycle patterns as a female-specific vital sign and highlight Perimenopause as a cardiovascular inflection point when changes in cholesterol and metabolic health can signal early risk.
The framework's four stages span perimenarche (ages 8-15), ovarian cycling (15-44), perimenopause (45-51), and postmenopause (51 and older), with pregnancy as an event that may occur at any stage. "Heart health begins long before adulthood," said Amanda Marma Perak, vice-chair of the writing group, in the release. The societies are calling for earlier prevention and better continuity of care, urging clinicians to consider cardiovascular, hormonal, and emotional health together. For the public, the Association offers practical resources, including guidance on Learn more about supporting good heart health in adolescence, as well as information on pregnancy and postpartum heart health. Additional tools include Learn more about supporting good heart health in midlife and Learn more about supporting good heart health during menopause and beyond.
The initiative also emphasizes that most heart attacks, strokes, and heart failure events occur after menopause and are more than 80% preventable with early action. By linking clinical specialties and prioritizing women's inclusion in research, the societies aim to close long-standing gaps in evidence and care. As Khan put it, "Advancing women's health is a responsibility we all share." The framework represents a shift from treating heart disease as an acute event to managing it as a lifelong, female-specific condition.
