Four professional organizations jointly produced three coordinated papers published in Circulation to reframe heart health for girls and women. The American Heart Association, American Academy of Pediatrics, American College of Obstetricians and Gynecologists and the Society for Maternal‑Fetal Medicine prepared the manuscripts to create a shared clinical foundation. The authors noted that care for women is often fragmented across specialties, and these documents are intended to align prevention, detection and management across the life course.
The writing group chair, Sadiya S. Khan, M.D., M.Sc., FAHA, told the authors the goal was to connect specialty silos so clinicians can recognize biologic transitions—periods, pregnancy, perimenopause and menopause—that uniquely shape cardiovascular risk. The source reported the publications include a Presidential Advisory that establishes the construct, a Scientific Statement providing clinical guidance, and a Science Advisory proposing system-level infrastructure.
The framework categorizes female-specific hormonal transitions into four life stages and treats pregnancy as a cross-stage event that functions as a physiologic stress test. Stage 1, perimenarche, covers the transition around first menses with an approximate age range of 8–15 years. Stage 2, ovarian cycling, spans typical reproductive years, roughly 15–44 years. Stage 3, perimenopause, is the transition with variable cycle length and hormone changes, approximately 45–51 years. Stage 4, postmenopause, begins after 12 months without menses and is usually age 51 and older.
Within each stage, the framework integrates cardiovascular, hormonal and emotional health to identify windows for prevention and earlier intervention. The authors emphasized that heart health can be tracked longitudinally from pediatric care through adult specialties so that risk information follows the patient rather than remaining siloed.
The publications identify several female-specific markers clinicians should treat as risk signals. Menstrual patterns are named a female-specific vital sign; heavy or irregular menstrual bleeding and patterns consistent with polyendocrine metabolic ovarian syndrome (PMOS) can correlate with cardiometabolic risk. Perimenopause was described as an inflection point when changes in cholesterol and metabolic health may reveal emerging risk. Postmenopause is called the stage where most heart attacks, strokes and heart-failure events occur, and the papers state that a large proportion of those events are preventable with earlier action.
Psychosocial conditions — anxiety, depression and eating disorders — are recognized as contributors to cardiovascular risk among women. The writing group also noted that recent guideline updates incorporate pregnancy-related factors into cardiovascular risk assessment, and that sex‑specific 10‑ and 30‑year risk tools such as the AHA PREVENT equations can identify risk earlier.
The authors framed pregnancy and the postpartum period as revealing cardiovascular vulnerability. Pregnancy complications listed as female-specific risk enhancers include hypertensive disorders of pregnancy, preeclampsia, gestational diabetes, preterm birth, small-for-gestational-age infants and stillbirth. The source reported that cardiovascular conditions now account for more than one-third of maternal mortality in the U.S.
The publications highlighted a major care gap: roughly 60% of U.S. women who had high blood pressure–related complications during pregnancy received follow-up care for blood pressure within six months of delivery. The societies called for immediate action to close that prevention gap and to ensure pregnancy history is integrated into long-term cardiovascular risk management.
The multi-society group proposed a national infrastructure built on four pillars: interdisciplinary clinical care, professional education and training, research, and community engagement. The Science Advisory maps the existing landscape of women's cardiovascular centers and sets out a conceptual approach for Comprehensive Centers of Excellence for Women's Cardiovascular Care.
The authors argued existing clinical tools and therapies can be used now to improve outcomes while research and funding expand. They recommended prioritizing inclusion of women in research, expanding funding for women's cardiovascular health, and translating evidence into measurable clinical pathways. The source did not provide specific operational models, funding commitments or timelines for establishing the proposed national network.
The publications call attention to several unanswered clinical questions and implementation barriers. Investigators reported that progress in preventing cardiovascular deaths among women has stalled, and they cited projections of rising prevalence of high blood pressure among U.S. women through 2050. The writing group pointed to insufficient postpartum follow-up, under-recognition of cardiovascular disease by women (only about 41% view it as their greatest health threat), and underrepresentation of women in many research programs.
The papers request targeted research to close these gaps: expand female‑specific evidence, implement sex‑specific risk tools broadly, evaluate operational models for interdisciplinary centers, and study how best to translate guideline recommendations into routine care. The source did not report exact research funding amounts, timelines for implementation, or regulatory milestones for establishing the Centers of Excellence.
Limitations listed in the release include the need for further evidence and implementation science to evaluate the framework's impact on outcomes. The documents call on health systems, funders and investigators to address specific research priorities—greater inclusion of women in trials, expanded funding for women’s cardiovascular health, and prospective evaluation of care models that integrate menstrual, pregnancy and menopausal history into longitudinal cardiovascular risk management.