A collaborative effort among the American Heart Association, American Academy of Pediatrics, Society for Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists has produced guidance addressing gaps in cardiovascular care for women. The framework, detailed in three articles published Monday in Circulation, aims to establish a coordinated approach to women’s heart health from adolescence through menopause and beyond, with cardiovascular disease remaining the leading cause of death in women.
The new guidance emphasizes that female-specific biological transitions—including menstruation, pregnancy, perimenopause, and menopause—significantly impact cardiovascular health across the lifespan. Currently, women often receive fragmented care from multiple specialists without a unified strategy. Perimenopause, occurring from approximately age 45 to 51 and marked by changes in menstrual cycles and hormone levels, represents a critical period when shifts in cholesterol and metabolic health may signal early cardiovascular risk.
According to Sadiya Khan, chair of the writing group and professor of cardiovascular epidemiology at Northwestern University Feinberg School of Medicine, adolescence and young adulthood establish patterns with lasting consequences. The framework recommends that clinicians and patients develop shared expectations about what constitutes normal changes during key life stages, enabling better preparation for health transitions. Attention to heavy menstrual bleeding in adolescents is particularly important, as it can indicate iron deficiency or metabolic conditions requiring early intervention.
The guidance also highlights connections between reproductive health events and long-term cardiovascular outcomes. Complications during pregnancy, such as elevated blood pressure or diabetes, signal increased future cardiovascular risk. Additionally, the framework acknowledges broader factors affecting women’s health, including mental health conditions like depression and anxiety, which are influenced by hormonal changes and structural inequities related to gender norms and socioeconomic disparities.
Experts stress that implementing this integrated approach requires moving away from siloed, specialty-focused care toward a cohesive model that prepares women for anticipated health changes and identifies risks early enough for intervention to reduce cardiovascular disease development.
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