4 societies tie girls' and women's heart health to female life stages

Cardiovascular risk in girls may first surface at the pediatric visit, in menstrual patterns, mental health, and early cardiometabolic changes, according to joint guidance released October 26, 2026, by the American Heart Association (AHA), American Academy of Pediatrics (AAP), American College of Obstetricians and Gynecologists (ACOG), and Society for Maternal-Fetal Medicine (SMFM).¹ The 3-part publication in Circulation introduces a "Female Life Stage" framework that links cardiovascular prevention to hormonal transitions beginning around menarche.¹ ²

"Heart health begins long before adulthood," said Amanda Marma Perak, MD, MSCI, vice chair of the collaborative writing group and a pediatric cardiologist at Lurie Children's Hospital of Chicago. "As pediatric clinicians, we have the opportunity to help every girl start strong and to ensure that what we learn about her health follows her as she grows."¹

Female Life Stage framework defines 4 windows for cardiovascular prevention

The framework, established in an AHA presidential advisory, organizes cardiovascular risk around 4 hormonally defined stages.² These are perimenarche (approximately ages 8–15 years), ovarian cycling (15–44 years), perimenopause (45–51 years), and postmenopause (51 years and older).¹ Pregnancy, which may occur in any stage, is described as a biological stress test that can unmask previously unrecognized cardiovascular risk.¹ Within each stage, the writing group calls for clinicians to assess cardiovascular, hormonal, and emotional health together rather than in separate silos.¹

Menstrual patterns as a cardiovascular vital sign in adolescent girls

For pediatric clinicians, the most immediate shift is the recognition of menstrual cycle patterns as a female-specific vital sign.¹ Heavy or irregular bleeding may serve as an early marker of cardiometabolic risk, including polyendocrine metabolic ovarian syndrome (PMOS), the condition formerly known as polycystic ovary syndrome.¹ The guidance also identifies anxiety, depression, and eating disorders, which are more common in girls and women, as contributors to poor cardiovascular health.¹ A companion scientific statement provides clinical guidance, including a crosswalk aligning existing recommendations across the 4 societies.³

Cardiovascular disease burden and projected risk in US women

Cardiovascular disease causes more than 400,000 deaths among US women each year, more than breast cancer, lung cancer, and chronic lung disease combined, yet only 41% of women recognize it as their greatest health threat.¹ Progress in preventing cardiovascular deaths among women has stalled over the past 2 decades.¹ An AHA forecast published earlier in 2026 projected that hypertension prevalence among US women aged 20 years and older will rise from approximately 49% in 2020 to 59% by 2050 if current trends continue.¹ ⁴ Cardiovascular conditions now account for more than one-third of maternal deaths in the US.¹

Pregnancy history and postpartum follow-up as cardiovascular risk enhancers

The guidance designates adverse pregnancy outcomes, including hypertensive disorders, preeclampsia, gestational diabetes, preterm birth, small-for-gestational-age infants, and stillbirth, as female-specific risk enhancers.¹ The 2026 AHA/American College of Cardiology cholesterol guideline now incorporates these pregnancy-related factors into cardiovascular risk assessment.¹ Still, only about 60% of US women with hypertensive complications of pregnancy receive blood pressure follow-up within 6 months of delivery, a gap the societies call for addressing immediately.¹

"An adverse pregnancy outcome can unmask increased cardiovascular risk and that information should guide care well beyond pregnancy," said William A. Grobman, MD, MBA, vice chair of the writing group and professor of obstetrics and gynecology at The Warren Alpert Medical School of Brown University.¹

References

1. American Heart Association. Leading health groups redefine heart health for girls and women. News release. October 26, 2026. Accessed October 26, 2026. https://newsroom.heart.org/news/leading-health-groups-redefine-heart-health-for-girls-and-women

2. A female-specific life course approach to the prevention and management of cardiovascular disease: a presidential advisory from the American Heart Association, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and Society for Maternal-Fetal Medicine. Circulation. Published online October 26, 2026. doi:10.1161/CIR.0000000000001483

3. Consensus guidance for the female-specific prevention and management of cardiovascular disease. Circulation. Published online October 26, 2026. doi:10.1161/CIR.0000000000001482

4. Forecasting the burden of cardiovascular disease and stroke in women in the United States through 2050: a scientific statement from the American Heart Association. Circulation. 2026. doi:10.1161/CIR.0000000000001406