Cardiovascular disease remains 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 women recognize it as their greatest health threat. A new series of scientific papers published in the journal Circulation aims to change that by providing a unified, life-stage approach to women's heart health.
The papers, 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, spell out how fluctuating hormones, mental health and well-being, the heart, and the brain are interconnected. The reports represent “a paradigm shift in how we look at women’s cardiovascular and brain health,” said Dr. Stacey E. Rosen, immediate past volunteer president of the American Heart Association, in a news release.
“Heart disease and other forms of cardiovascular disease don’t suddenly become relevant when we become older women,” Rosen said. The documents view a woman’s life in distinct stages—adolescence, early adulthood, pregnancy, and the years around and after menopause—each offering chances for early detection, risk factor identification, and treatment.
For clinicians, the papers offer a unified approach to cardiovascular concerns specifically for women. “We can go all the way back to adolescence and even childhood and figure out, ‘This person is at risk; we need to keep a closer eye on them,’” said Dr. Esther S.H. Kim, director of the Center for Women’s Cardiovascular Health at Atrium Health in Charlotte, North Carolina. The reports emphasize how hormonal health affects cardiovascular health across a woman’s life. Estrogen, estradiol, and progesterone impact cells in blood vessels, the brain, and heart muscle, affecting cholesterol levels, inflammation, blood pressure, and the body’s stress response.
While the most common cardiovascular issue in women is the same as in men—plaque buildup that narrows arteries—women are more likely to have other serious problems. These include microvascular coronary disease, which affects small blood vessels in the heart; heart failure with preserved ejection fraction; and spontaneous coronary artery dissection. Doctors need to think about such conditions because they require specific diagnostic tests, Kim said.
“Heart health for women doesn’t start at menopause,” said Dr. Amanda M. Perak, a pediatric cardiologist at Ann & Robert H. Lurie Children’s Hospital of Chicago. “Puberty is a big turning point.” A first period before age 10 is linked to a higher risk of heart disease later in life, and irregular periods can be a sign of polyendocrine metabolic ovarian syndrome. “The goal isn’t to worry teens about the chance of a heart attack, which are decades away for nearly all of them,” 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.”
In early adulthood, women can ask their clinicians how to optimize heart health, and the basics known as Life’s Essential 8 will be part of the answer. The reports also emphasize the importance of having good cardiovascular health before pregnancy, yet 9 out of 10 women ages 20 to 44 have less-than-ideal heart health when they become pregnant. High blood pressure in pregnancy, gestational diabetes, or having a preterm birth are linked to higher risk of heart disease later in life, making the first year after pregnancy a critical time for monitoring those risks.
Mental health is another key focus. Starting around age 12, eating disorders become more common in girls, and by age 17, girls are twice as likely as boys to be diagnosed with depression. The papers call for making mental health and well-being screening a routine part of a woman’s care. Resources are available to help protect and strengthen your heart at every stage of life.
