New guidance identifies 4 female-specific life stages and calls for earlier cardiovascular risk assessment across clinical specialties.
Four leading US medical societies have introduced a coordinated framework for cardiovascular risk assessment in girls and women, identifying menstrual abnormalities, pregnancy complications, and menopausal transitions as opportunities for earlier prevention. The guidance also emphasizes that more than 80% of heart attacks, strokes, and heart failure events that occur after menopause are preventable with early intervention, according to the American Heart Association (AHA).
The guidance was developed by the AHA, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and Society for Maternal-Fetal Medicine. Three manuscripts published in Circulation establish a female-specific life-stage framework, provide consensus clinical guidance, and propose a national infrastructure for coordinated cardiovascular care.
The publications address cardiovascular disease, which causes more than 400,000 deaths among US women annually. According to the AHA, cardiovascular conditions account for more than one-third of maternal mortality in the United States. Previous projections also suggest hypertension prevalence among women aged 20 years and older could increase from approximately 49% in 2020 to 59% by 2050.
The framework identifies 4 hormonally defined stages: perimenarche (approximately ages 8 to 15 years), ovarian cycling (ages 15 to 44 years), perimenopause (ages 45 to 51 years), and postmenopause (ages 51 years and older). Pregnancy is recognized as a cardiovascular stress test that can reveal previously unrecognized risk.
The publications identify menstrual cycle patterns as a female-specific vital sign, with heavy or irregular bleeding potentially signaling cardiovascular risk associated with endocrine-metabolic conditions. Perimenopause is also characterized as a cardiovascular inflection point, when changes in cholesterol and metabolic health can indicate emerging risk.
Pregnancy complications, including hypertension, preeclampsia, gestational diabetes, preterm birth, small-for-gestational-age infants, and stillbirth, are recognized as cardiovascular risk enhancers. The 2026 AHA/American College of Cardiology cholesterol guideline incorporates pregnancy-related factors into cardiovascular risk assessment.
Postpartum follow-up remains a concern. Only approximately 60% of US women experiencing hypertensive pregnancy complications receive follow-up care for hypertension within 6 months after delivery.
The guidance also emphasizes psychosocial health and longitudinal cardiovascular risk assessment, including 10- and 30-year sex-specific risk estimation using the AHA PREVENT equations.
The societies propose a national network of Comprehensive Centers of Excellence for Women's Cardiovascular Care, incorporating interdisciplinary clinical care, professional education and training, research, and community engagement.
Source: American Heart Association
