Multi-society framework ties cardiovascular risk to female life stages

The American Heart Association (AHA), American Academy of Pediatrics (AAP), American College of Obstetricians and Gynecologists (ACOG), and Society for Maternal-Fetal Medicine (SMFM) released joint guidance on October 26, 2026, that organizes cardiovascular prevention in girls and women around 4 “Female Life Stages,” from puberty through menopause and beyond. The 3 manuscripts, published in Circulation, form the first coordinated multisociety framework to prevent, detect, and manage cardiovascular disease in this population.

Cardiovascular disease is the leading cause of death in women, claiming more than 400,000 lives in the US each year, more than breast cancer, lung cancer, and chronic lung disease combined. Only about 4 in 10 women (41%) recognize it as their greatest health threat, and progress in preventing cardiovascular deaths among women has stalled over the past 2 decades.

“Women experience their healthcare across clinical specialties, but it often is fragmented or disconnected,” said Sadiya S. Khan, MD, MSc, chair of the collaborative writing group and Magerstadt Professor of Cardiovascular Epidemiology at Northwestern University Feinberg School of Medicine in Chicago.

“Specifically, these reports connect the dots for clinicians, for patients and across health domains so that care is holistic and begins in adolescence, recognizing that women’s heart health is uniquely shaped by biological transitions not experienced by men—periods, pregnancy, perimenopause and menopause,” added Khan.

Why do women need a life course approach to cardiovascular risk?

A 2026 AHA scientific statement forecast that, if current trends continue, the proportion of US women aged 20 years and older living with high blood pressure will increase from approximately 49% in 2020 to 59% in 2050. Maternal mortality has also increased, and cardiovascular disease is now the leading cause of medical-related deaths during pregnancy, accounting for more than one-third of maternal mortality in the US.¹

“Women’s cardiovascular health has unfortunately been overlooked and historically under-resourced. The sobering fact is that a third of deaths in women occur from heart disease, which is also a leading cause of death in pregnant individuals,” said ACOG President Camille A. Clare, MD, MPH, CPE, FACOG, in a statement posted on ACOG’s LinkedIn page.²

How does the female life stage framework work?

Each stage is defined by a hormonal change unique to girls and women. Perimenarche, the transition around the first menstrual period, spans approximately ages 8 to 15 years. Ovarian cycling, when regular ovulatory cycles are established and pregnancy typically occurs, spans approximately 15 to 44 years. Perimenopause, marked by variable cycle length, skipped cycles, and hormone changes, spans approximately 45 to 51 years, and postmenopause begins 12 months after the final menstrual period, at approximately 51 years and older. Pregnancy, which may occur in any stage, is described as a biological “stress test” that can identify previously unrecognized cardiovascular risk. Within each stage, the framework considers cardiovascular, hormonal, and emotional health together.

“Heart health begins long before adulthood. As pediatric clinicians, we have the opportunity to help every girl start strong and to ensure that what we learn about her health follows her as she grows,” said Amanda Marma Perak, MD, MSc, vice chair of the collaborative writing group and a pediatric cardiologist at Lurie Children’s Hospital in Chicago.

Menstrual, metabolic, and psychosocial markers of cardiovascular risk

The publications recognize menstrual cycle patterns as a female-specific vital sign, with heavy or irregular bleeding serving as an early marker of cardiovascular risk, such as polyendocrine metabolic ovarian syndrome (PMOS), formerly known as polycystic ovary syndrome. Changes in cholesterol and metabolic health during perimenopause can be early signs of risk. The years after menopause can represent up to 40% of a woman’s lifetime, and most heart attacks, strokes, and heart failure events occur in this stage; according to the AHA, these events are more than 80% preventable if action is taken early. Women are also more likely to experience anxiety, depression, and eating disorders, each of which can contribute to poor heart health.

Pregnancy complications and postpartum follow-up

High blood pressure, preeclampsia, gestational diabetes, preterm birth, small-for-gestational-age infants, and stillbirth are recognized as female-specific risk enhancers, and the 2026 AHA/American College of Cardiology cholesterol guideline now includes pregnancy-related factors in cardiovascular risk assessment for women. Only about 60% of US women with high blood pressure-related complications during pregnancy receive follow-up care for their high blood pressure within 6 months of delivery, a prevention gap the societies called for immediate action to address.

“Pregnancy and the postpartum period are important windows into cardiovascular health throughout the life course. An adverse pregnancy outcome can unmask increased cardiovascular risk and that information should guide care well beyond pregnancy,” said William A. Grobman, MD, MBA, vice chair of the writing group and professor of obstetrics and gynecology at The Warren Alpert Medical School of Brown University in Providence, Rhode Island.

Risk estimation and centers of excellence for women’s cardiovascular care

Khan noted that clinicians can now identify cardiovascular risk earlier in women using 10- and 30-year sex-specific estimates from the AHA PREVENT equations. A science advisory accompanying the framework maps current women’s cardiovascular centers and calls for a national infrastructure of Comprehensive Centers of Excellence for Women’s Cardiovascular Care, built on interdisciplinary clinical care, professional education and training, research, and community engagement.¹

“This important work examines heart health at every stage of life from childhood onward to help clinicians identify women’s cardiovascular risk early and take the appropriate steps to lessen it,” Clare said.²

The societies also called for prioritizing the inclusion of women in research, expanding funding for women’s health, and translating evidence into practice. The AHA noted that its scientific statements and advisories inform guideline development but do not make treatment recommendations.¹

References:

1. Leading health groups redefine heart health for girls and women. News release. American Heart Association. October 26, 2026. Accessed October 27, 2026. https://newsroom.heart.org/news/leading-health-groups-redefine-heart-health-for-girls-and-women
2. ACOG collaborates on American Heart Association compendium on cardiovascular health in girls and women. LinkedIn post. American College of Obstetricians and Gynecologists. Accessed October 27, 2026.