Four Medical Societies Unite to Help Catch Heart Disease Risk in Women Earlier

Heart disease is the leading cause of death among women in the United States, yet many women don’t see it as their biggest health threat. Now, four major medical organizations have teamed up to change how heart health is approached for girls and women, starting as early as their first period.

The American Heart Association, American Academy of Pediatrics, American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine released the coordinated guidance. Published as three papers in the journal Circulation, it is the first multisociety framework focused on preventing, detecting and managing cardiovascular disease in girls and women.

A Leading Cause of Death That Often Goes Unrecognized

According to the American Heart Association, cardiovascular disease, which includes heart disease and stroke, claims more than 400,000 women’s lives in the U.S. each year. That is more than breast cancer, lung cancer and chronic lung disease combined. However, only about 41% of women recognize it as their greatest health threat.

Progress in preventing heart-related deaths among women has also stalled over the past two decades. A 2026 American Heart Association forecast projected that the share of U.S. women ages 20 and older with high blood pressure could climb from about 49% in 2020 to 59% by 2050 if current trends continue. Heart conditions also now account for more than one-third of maternal deaths in the U.S.

Four Hormonal Transitions, Four Chances to Act

The new Female Life Stage framework is built around changes in hormones that only girls and women experience:

• Perimenarche (about ages 8 to 15): the transition around a first period
• Ovarian cycling (about ages 15 to 44): the years of regular cycles, when pregnancy usually occurs
• Perimenopause (about ages 45 to 51): the shift toward irregular or skipped cycles
• Postmenopause (about age 51 and older): the years following 12 months without a menstrual cycle

Pregnancy, which can happen at any stage, is described as a biological “stress test” that may reveal heart risks that weren’t previously recognized.

Within each stage, the framework looks at heart, hormonal and emotional health together. “For clinicians, this approach underscores that heart health cannot be understood by looking at the heart alone,” said Sadiya S. Khan, M.D., M.Sc., FAHA, chair of the writing group and Magerstadt Professor of Cardiovascular Epidemiology at Northwestern University Feinberg School of Medicine in Chicago.

Menstrual Patterns as a Vital Sign

The guidance treats menstrual cycle patterns as a female-specific vital sign. Heavy or irregular bleeding may be an early marker of heart risk, including conditions such as polyendocrine metabolic ovarian syndrome (PMOS), formerly known as polycystic ovary syndrome (PCOS).

“Heart health begins long before adulthood,” said Amanda Marma Perak, M.D., M.Sc., FAHA, vice chair of the writing group and a pediatric cardiologist at Lurie Children’s Hospital in Chicago.

Pregnancy Complications Carry Long-Term Signals

Complications such as high blood pressure during pregnancy, preeclampsia, gestational diabetes, preterm birth and stillbirth are now recognized as female-specific factors that raise future heart risk. The 2026 American Heart Association and American College of Cardiology cholesterol guideline includes these pregnancy factors when assessing a woman’s risk.

Yet follow-up care often falls short. Only about 60% of U.S. women who had blood pressure complications during pregnancy get follow-up care for their blood pressure within six months of delivery.

“Pregnancy and the postpartum period are important windows into cardiovascular health throughout the life course,” said William A. Grobman, M.D., MBA, vice chair of the writing group and professor of obstetrics and gynecology at the Warren Alpert Medical School of Brown University.

Midlife and Beyond as Key Prevention Windows

Perimenopause can bring changes in cholesterol and metabolic health that signal rising risk. The years after menopause can make up as much as 40% of a woman’s life, and most heart attacks, strokes and heart failure events happen during this stage. According to the guidance, more than 80% of these events are preventable with early action.

The guidance also highlights mental health. Women are more likely to experience anxiety, depression and eating disorders, all of which can affect heart health.

Building More Connected Care

The societies are calling for a national network of Comprehensive Centers of Excellence for Women’s Cardiovascular Care focused on clinical care, education, research and community engagement. They also emphasize tools already available, such as the American Heart Association PREVENT equations, which estimate a woman’s 10- and 30-year heart risk.

“All girls and women deserve more healthy years to live their fullest lives,” Khan said.

Women can bring up their menstrual, pregnancy and menopause history with their health care team as part of a conversation about heart health at any age.