A coordinated framework for women's heart health
Four medical organizations released a joint framework on Monday that treats women's heart health as something shaped by biology across a lifetime. The groups are the American Heart Association, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics and the Society for Maternal-Fetal Medicine, according to NBC 5 Dallas-Fort Worth.
Called the "Female Life Stages" framework, it describes how periods, pregnancy, perimenopause and menopause affect cardiovascular health. It offers age-specific recommendations for preventing, detecting and managing heart problems in girls and women.
Dr. Stacey E. Rosen, a former volunteer president of the AHA who helped write the three scientific papers, said, "Heart disease and other forms of cardiovascular disease don’t suddenly become relevant when we become older women." She called the guidance "a paradigm shift in how we look at women’s cardiovascular and brain health."
Why doctors are focused on women now
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 deaths combined. Yet only about 4 in 10 women, or 41%, recognize it as their greatest health threat.
The association projected earlier this year that the percentage of women with at least one type of cardiovascular disease will climb from 10.7% in 2020 to 14.4% in 2050. Nearly 60% of U.S. women are forecast to have high blood pressure by 2050.
The authors also point to fragmented care. Women receive care from several specialties over a lifetime, which the guidance says "contributes to suboptimal care in girls and women." Dr. Sadiya S. Khan, chair of the AHA's science advisory group for women's health, said the reports aim to "connect the dots" so care is holistic and begins in adolescence.
How hormones and life stages affect risk
The framework emphasizes hormones. Rosen said scientists long overlooked their role in heart health because monthly fluctuations complicated research. Estrogen, estradiol and progesterone affect cells in blood vessels, the brain and heart muscle, she said. They also influence cholesterol, blood cell stickiness, inflammation, blood pressure and the body's stress response.
In puberty, the pattern of a girl's periods can offer clues about the future. Persistent heavy or irregular bleeding can be an early marker of cardiovascular risk, as in polyendocrine metabolic ovarian syndrome, formerly known as polycystic ovary syndrome. A first period before age 10 is linked to higher heart disease risk later in life. Dr. Amanda M. Perak of Northwestern said that is not automatically cause for alarm or medication, but "a reason to pay a little closer attention to healthy habits and routine checkups."
Perak also noted that eating disorders, which can affect future cardiovascular health, become more common in girls starting around age 12. She said the goal is not to worry teens about heart attacks, but that "it’s much easier to keep good heart health than to get it back."
Pregnancy, perimenopause and menopause
For ages 15 to 44, the guidance describes regular ovulatory and hormone cycles and the period when pregnancy typically occurs. Pregnancy is often seen as a "stress test" for the heart. Conditions such as preeclampsia and gestational diabetes are not just temporary and can signal higher heart disease risk later. Perinatal depression and anxiety, which affect up to 20% of pregnant women, can raise the risk of cardiovascular complications.
During perimenopause, cycles become unpredictable and estrogen begins to fall. Dr. Natalie A. Cameron, an internal medicine specialist at Northwestern, said women may see increases in LDL cholesterol, weight gain and potentially rising blood pressure. Lower estrogen can also contribute to cholesterol buildup on artery walls and stiffer blood vessels. Mood shifts and poor sleep, which also influence cardiovascular health, can accompany these changes, Khan said.
Menopause is reached after 12 full months without a period, usually around age 51. Loss of protective estrogen raises the risk of heart problems, particularly for women who reach menopause before age 45, who face a significantly higher risk of coronary heart disease.
Khan stressed that the message is not alarmist: "We don’t want to make it seem like it’s doom and gloom." She said not everyone needs hormone therapy, but clinicians should evaluate cholesterol, blood sugar and body composition so traditional risk factors can be treated.
