A trio of scientific papers published in the journal Circulation is calling for a fundamental shift in how women's heart health is approached, arguing that cardiovascular risk should be assessed and managed across every stage of a woman's life, 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.
"Women experience their healthcare across clinical specialties, but it often is fragmented or disconnected," said Dr. Sadiya Khan, chair of the writing group and the Magerstadt Professor of Cardiovascular Epidemiology at Northwestern University's Feinberg School of Medicine in Chicago, in a news release. "Specifically, these reports connect the dots for clinicians, for patients, and across health domains so that care is holistic and begins in adolescence."
The reports emphasize how hormonal health affects cardiovascular health throughout a woman's life. Estrogen, estradiol and progesterone impact cells in blood vessels, the brain and heart muscle, affecting cholesterol levels, inflammation, blood pressure and the body's stress response. Dr. Stacey E. Rosen, immediate past volunteer president of the American Heart Association, said the publications represent "a paradigm shift in how we look at women's cardiovascular and brain health."
While the most common cardiovascular issue in women is the same as in men—plaque buildup that narrows arteries—women are more likely to experience conditions such as microvascular coronary disease, which affects small blood vessels in the heart. "The classic image of heart disease is a Homer Simpson-type of person—a middle-aged or older man with very obvious cardiovascular risk factors. But you know, Marge Simpson can also have heart disease," said Dr. Esther S.H. Kim, director of the Center for Women's Cardiovascular Health at Atrium Health in Charlotte, North Carolina.
The papers highlight adolescence as a critical window. A first period before age 10 is linked to a higher risk of heart disease later in life, and irregular periods can signal polyendocrine metabolic ovarian syndrome, which has been linked to diabetes and heart disease. "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." Resources are available to help protect and strengthen heart health at every stage of life.
Pregnancy is often seen as a stress test for the heart. High blood pressure in pregnancy, gestational diabetes, or having a preterm birth are linked to higher risk of heart disease later in life. Yet 9 out of 10 women ages 20 to 44 have less-than-ideal heart health when they become pregnant. The first year after pregnancy is "a very critical time" for controlling and monitoring those risks. Women can learn more about supporting good heart health in pregnancy and postpartum.
Mental health is also closely tied to heart health. By age 17, girls are twice as likely as boys to be diagnosed with depression, and teens with depression are more likely to develop obesity later. The papers call for making mental health and well-being screening a routine part of a woman's care. During perimenopause, women may experience increases in LDL cholesterol, weight gain and rising blood pressure. "The answer is an absolute, positive, emphatic no" to surrendering to inevitable heart disease, Rosen said. It's never too late to make healthy changes. Women can learn more about supporting good heart health in midlife and learn more about supporting good heart health during menopause and beyond.
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 My Heart & Health Checklist - Questions to think about before your next visit is available to help women prepare for appointments. The American Heart Association's Go Red for Women initiative aims to empower women to take charge of their heart health, with additional resources at heart.org and stroke.org.
