Four medical societies redefine women's heart health, starting at puberty

A framework that starts in girlhood

Cardiovascular disease remains the leading cause of death among U.S. women, and progress in reducing those deaths has largely stalled over the past two decades. ^[1] Four medical societies have now released publications that redefine women's heart health, starting at puberty. ^[2]

The American Heart Association, American Academy of Pediatrics, American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine produced the work. ^[2] Three manuscripts in the AHA flagship journal Circulation are described as the first coordinated, multi-society framework to prevent, detect and manage cardiovascular disease among girls and women. ^[2]

The framework is said to allow earlier recognition of risk, earlier prevention, and better continuity of care beginning in childhood. ^[2]

Why the societies worked together

Khan said each of the four societies had been addressing women's heart health, but in siloed fashion across specialties, which leads to fragmented care for women. ^[1] Khan also said women uniquely see many different clinicians, yet there was no shared playbook, and existing work missed the connections between specialties. ^[3]

The four female life stages

The framework outlines four distinct Female Life Stages based on female biology. ^[2] They offer windows of opportunity to prevent heart disease and stroke. ^[2]

Stage 1, perimenarche, covers the years around a girl's first menstrual period, as hormone cycles mature, at roughly ages 8 to 15. ^[2] Stage 2, ovarian cycling, is when regular ovulatory and hormone cycles are established and pregnancy may occur, at roughly ages 15 to 44. ^[2]

Stage 3, perimenopause, is the transition to variable cycle length, skipped cycles and hormone changes, at roughly ages 45 to 51. ^[2] Stage 4, postmenopause, begins after menopause or 12 months after the final menstrual period, at approximately age 51 and older. ^[2]

Perimenopause is described as a cardiovascular inflection point, and changes in cholesterol and metabolic health at that time can be early signs of cardiovascular risk. ^[3]

Periods and pregnancy as heart signals

Dr. Marma Perak said menstrual cycle patterns are now recognized as a female-specific vital sign and that periods can be a marker of heart health. ^[2] Heavy bleeding is the most common cause of iron deficiency in young women, which affects energy, activity, and heart health. ^[2]

Heavy menstrual bleeding can lead to iron deficiency, which can impair a girl's ability to participate in activity or exercise and can also impair cardiovascular health. ^[3]

Pregnancy is identified as a modifying life event for cardiovascular health that can intersect with more than one life stage. ^[2] The time before, during and after pregnancy is highlighted as a biological stress test that can identify previously unrecognized cardiovascular risks. ^[2]

Pregnancy complications, including preeclampsia, gestational diabetes and preterm birth, are already recognized as female-specific cardiovascular risk enhancers. ^[1] Polycystic ovary syndrome, now known as polyendocrine metabolic ovarian syndrome, may serve as an early indicator of future cardiovascular risk. ^[1]

Proposed centers of excellence

The societies propose a national infrastructure of Comprehensive Centers of Excellence for Women's Cardiovascular Care. ^[2] It would rest on four pillars: interdisciplinary clinical care, professional education and training, research and community engagement. ^[2]