The centerpiece of the publication is a new construct called the Female Life Stage framework, which divides a woman’s life into four biologically defined phases, each marked by a hormonal transition uniquely experienced by females. Stage one, perimenarche, covers the transition around the first menstrual period, at an approximate age range of 8 to 15 years. Stage two, ovarian cycling, spans roughly ages 15 to 44, when regular ovulatory and hormone cycles are established and pregnancy typically occurs. Stage three, perimenopause, covers approximately ages 45 to 51 and is characterized by variable cycle length, skipped cycles and shifting hormones. Stage four, postmenopause, begins after menopause, defined as 12 months after the final menstrual period, at approximately age 51 and older. Pregnancy, which may occur at any or multiple life stages, is singled out as a biological stress test capable of revealing cardiovascular risks that may have gone previously unrecognized.

The urgency behind the effort is stark. According to the American Heart Association, cardiovascular disease, which includes heart disease and stroke, is the leading cause of death in women, claiming more than 400,000 lives in the United States each year — more than breast cancer, lung cancer and chronic lung disease combined. Yet only about 4 in 10 women, or 41 percent, recognize it as their greatest health threat. Progress in preventing cardiovascular deaths among women has stalled over the past two decades, and maternal mortality has increased, with cardiovascular conditions now the leading cause of medical-related deaths during pregnancy, accounting for more than one-third of maternal mortality in the country.

A 2026 American Heart Association scientific statement that forecasted women’s health and risk factors adds a sobering projection: if current trends continue through 2050, the proportion of U.S. women ages 20 and older living with high blood pressure will rise from approximately 49 percent in 2020 to 59 percent in 2050. These forecasts, the writing group argues, underscore the need to make cardiovascular health a priority at every stage of a woman’s life rather than waiting for disease to emerge in later adulthood.

“Women experience their healthcare across clinical specialties, but it often is fragmented or disconnected,” said Sadiya S. Khan, M.D., M.Sc., FAHA, 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.”

The framework deliberately takes a holistic view, considering cardiovascular, hormonal and emotional health together within each life stage. “For clinicians, this approach underscores that heart health cannot be understood by looking at the heart alone,” Khan said. “We need to recognize that women’s heart health is deeply interconnected with hormonal and emotional health.” Among the specific connections highlighted in the publications, menstrual cycle patterns are now recognized as a female-specific vital sign: heavy or irregular menstrual bleeding can serve as early markers of cardiovascular risk, such as polyendocrine metabolic ovarian syndrome, or PMOS, formerly known as polycystic ovary syndrome, or PCOS. Perimenopause is described as a cardiovascular inflection point, because changes in cholesterol and metabolic health during this transition can be early signs of cardiovascular risk, and identifying and acting on that risk early may reduce the likelihood of cardiovascular disease.

The postmenopausal years carry particular weight in the new guidance. This stage can represent up to 40 percent of a woman’s lifetime, and most heart attacks, strokes and heart-failure events occur during it. The publications note that these events are more than 80 percent preventable if action is taken early. Psychosocial health also receives explicit attention: women are more likely to experience anxiety, depression and eating disorders, each of which can contribute to poor heart health. By weaving these threads together, the framework aims to give clinicians a unified picture of risk rather than isolated snapshots gathered in separate appointments.

Pregnancy history, the writing group emphasizes, is heart history. Changes during pregnancy can unmask cardiovascular disease risk, and complications such as high blood pressure, preeclampsia, gestational diabetes, preterm birth, small-for-gestational-age infants and stillbirth are recognized as female-specific risk enhancers. The 2026 American Heart Association/American College of Cardiology cholesterol guideline now includes pregnancy-related factors in cardiovascular risk assessment for women. Yet postpartum care remains a significant missed opportunity: only about 60 percent of U.S. women with high blood pressure-related complications during pregnancy receive follow-up care for their high blood pressure within six months of delivery, a prevention gap the societies are calling for immediate action to close.

“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 in Providence, Rhode Island. “An adverse pregnancy outcome can unmask increased cardiovascular risk and that information should guide care well beyond pregnancy. This multi-society guidance gives clinicians who provide obstetric, gynecologic, and cardiovascular care a shared framework for recognizing and acting on that risk.” Grobman is also a former president of the Society for Maternal-Fetal Medicine. Pediatric perspectives are equally central to the effort. “Heart health begins long before adulthood,” said 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. “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.”

Beyond clinical guidance, the societies are calling for a national infrastructure 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. The science advisory accompanying the framework maps the current landscape of women’s cardiovascular centers and proposes this national network as the vehicle for coordinated care. The publications stress that existing tools and therapies already offer opportunities to improve cardiovascular health now, while continued research is needed to address gaps in evidence specific to women by prioritizing the inclusion of women in research, expanding funding for women’s health, and translating evidence into action. “Over the last several decades, research has led to substantive advances in the understanding of female-specific risk of cardiovascular disease,” Khan said. “Today, cardiovascular risk can be identified earlier in women with 10- and 30-year sex-specific risk estimation using the American Heart Association PREVENT equations. The goal is to assess health comprehensively and longitudinally across life stages, identify earlier opportunities for prevention, and close implementation gaps for women.”

The joint guidance consists of three papers published in Circulation: a Presidential Advisory establishing the female life stage construct and life course framework, a Scientific Statement providing consensus clinical guidance including a multi-society guideline crosswalk, and a Science Advisory mapping the landscape of women’s cardiovascular centers and proposing the national infrastructure. The papers were prepared by a volunteer writing group on behalf of the four societies. “Women make up more than half the population, and their heart health must be a part of everyday care across medicine,” said Mariell Jessup, M.D., FAHA, chief science and medical officer of the American Heart Association. “These publications give clinicians and health systems a shared foundation for recognizing risk throughout a woman’s life.” As Khan put it, “All girls and women deserve more healthy years to live their fullest lives. Advancing women’s health is a responsibility we all share. This investment improves not only women’s health, but also the health of their families and their communities.”

Subject of Research: A multi-society life-stage framework for preventing and managing cardiovascular disease in girls and women

Article Title: Leading health groups redefine heart health for girls and women

Article References: Leading health groups redefine heart health for girls and women. Original publication (Bibliographic details unavailable.)

Image Credits: AI Generated

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Keywords: cardiovascular disease, women's health, American Heart Association, female life stages, pregnancy, menopause, perimenopause, maternal mortality, risk prevention, Circulation, pediatric cardiology, centers of excellence