Cardiovascular disease is 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 trio of scientific papers published in the journal Circulation aims to change that by outlining a new, life-stage approach to women's heart health that connects hormonal, mental, and cardiovascular health from adolescence through menopause and beyond. The publications are 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.
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. The papers emphasize that heart disease does not suddenly become relevant in older age; rather, each life stage offers “windows of opportunity” for early detection, risk factor identification, and treatment. For clinicians across pediatrics, primary care, endocrinology, obstetrics and gynecology, and cardiology, the documents offer a unified approach to cardiovascular concerns specifically for women.
Central to the new approach is the role of hormones. For years, scientists ignored the importance of hormones in women's heart health because monthly fluctuations made research more complicated, Rosen said. But estrogen, estradiol, and progesterone affect cholesterol levels, the stickiness of blood cells, inflammation, blood pressure, and the body's stress response. “If you appreciate the understanding that these hormones are not just affecting the uterus, ovaries and fallopian tubes but affecting in a rhythmic way every part of the cardiovascular system and brain, you can appreciate why these fluctuations or issues related to these hormones in women have an enormous impact” on heart and brain health, she said.
The papers also highlight that women may experience different forms of heart disease than men, including microvascular coronary disease, heart failure with preserved ejection fraction, and spontaneous coronary artery dissection. These conditions require specific diagnostic tests, and doctors need to think of them in women to avoid missing them.
The adolescent years are a critical starting point. “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 that persist can signal polyendocrine metabolic ovarian syndrome, previously known as polycystic ovary syndrome, which is linked to diabetes and heart disease. The goal is not to worry teens but to establish healthy patterns early, and resources are available to learn more about supporting good heart health in adolescence.
In young adulthood, women should be aware they can be at risk and ask how to optimize heart health, including discussing pregnancy planning and postpartum care, as 9 out of 10 women ages 20 to 44 have less-than-ideal heart health when they become pregnant. The years around menopause bring increases in bad cholesterol, weight gain, and rising blood pressure, making it a key time to learn more about supporting good heart health in midlife and to learn more about supporting good heart health during menopause and beyond.
Mental health is woven throughout. Depression and anxiety can influence lifestyle choices and are more common in women with established cardiovascular disease. The papers call for routine mental health screening as part of women's care. A My Heart & Health Checklist - Questions to think about before your next visit is among the resources offered to help women prepare for appointments.
Because women's health care is often fragmented across specialties, the publications spell out the need for coordinated care and encourage women to track their medical history and ensure their clinicians communicate. The overarching message, Rosen said, is that “it’s always about opportunities.” More information is available at heart.org and stroke.org.
