Four major medical organizations released a coordinated framework for women’s heart health from puberty through menopause in Circulation, as cardiovascular disease leads female mortality in the U.S.
Medical Groups Map Four Life Stages
The American Heart Association, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the Society for Maternal-Fetal Medicine created the Female Life Stages Framework to address how hormonal changes affect female heart health throughout their lives.
The organizations together outline four distinct “Female Life Stages” offering women and healthcare professionals a chance to have heart health conversations from puberty through menopause and beyond. Cardiovascular disease has been the leading cause of death for women for a long time, yet less than half recognize it as their greatest health threat.
“biology was left out,” explained Dr. Bakir.
The framework divides care into stages including perimenarche, ovarian cycling, perimenopause, and postmenopause, which can account for up to 40% of a woman’s life. Nisha Parikh, system director of the Women’s Heart Program at Northwell Health, who was not involved in the report, said that organizing care around life stages creates natural checkpoints to catch risks early rather than leaving decades of a woman’s lifespan unmonitored.
The societies also call for a national network 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.
Childhood and Teenage Risks Begin Early
Preventative care starts as early as childhood. Pediatric experts advise healthy diets and physical activity to curb obesity and type 2 diabetes risks.
Tamara Hannon, a professor of pediatrics at Indiana University School of Medicine, advised parents to help children build habits that last, including plenty of fruits, vegetables, and whole grains, and fewer ultraprocessed foods, animal fats, juices, and other sugary drinks.
Amanda Marma Perak, M.D., M.Sc., FAHA, vice-chair of the collaborative writing group and a pediatric cardiologist at Lurie Children’s Hospital in Chicago, said that heart health begins long before adulthood and that teen years are when patterns get set, making it much easier to keep good heart health than to get it back.
An early first period starting at age 10 or younger is linked to a higher risk of diabetes, high blood pressure, and heart disease later in life. Afshan B. Hameed, a clinical professor of obstetrics, gynecology, and cardiology at the University of California, Irvine, pointed out that cholesterol measured at age 18 impacts a person decades into the future.
Research has found that nearly one-third of adolescents and teens have prediabetes, and a recent European study found silent atherosclerosis, an early buildup of cholesterol plaques in blood vessels, in 1 out of 13 people ages 18 to 29.
Pregnancy Serves as a Natural Stress Test
Regular ovulatory and hormone cycles are established during reproductive years, and pregnancy typically occurs, serving as a natural stress test for the cardiovascular system. Adverse pregnancy outcomes such as preeclampsia, and early age at menopause, are risk enhancers that can help personalize heart care plans.
“Women should share with their clinicians their pregnancy history, including any adverse pregnancy outcomes that they experienced, throughout the rest of their lives as they can have long-term impacts,” said Khan.
Projections Forecast Rising High Blood Pressure
A 2026 American Heart Association scientific statement forecasted that if trends continue through 2050, the proportion of U.S. women ages 20 and older living with high blood pressure will increase from about 49% in 2020 to 59% in 2050. Esther Kim, director of the Center for Women’s Cardiovascular Health at Atrium Health, said that identifying risk factors in adolescence allows clinicians to keep a closer watch on vulnerable patients.
“And the outlook is worsening: Nearly six in 10 U.S. women are projected to have some form of cardiovascular disease by 2050,” said May Bakir, M.D., F.A.C.C., a double-board-certified cardiologist and founder of InfiniteHeart Health.