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 new series of scientific papers published in the journal Circulation aims to change that by reframing women’s heart health as a continuous, hormone-influenced journey that begins in adolescence and extends well past menopause.
The three papers, a joint effort by the American Heart Association, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine, represent what Dr. Stacey E. Rosen, immediate past volunteer president of the American Heart Association, called “a paradigm shift in how we look at women’s cardiovascular and brain health.” The reports spell out how fluctuating hormones, mental health and well-being, the heart, and the brain are linked, and why those connections need to be a routine part of care from a young age. The announcement was shared through NEWMEDIAWIRE.
For decades, scientists largely ignored the role of hormones in women’s heart health because monthly fluctuations complicated research, Rosen said. But estrogen, estradiol, and progesterone affect cells in blood vessels, the brain, and heart muscle. They influence cholesterol levels, the stickiness of blood cells, inflammation, blood pressure, and the body’s stress response. “If you appreciate the understanding that these hormones are not just affecting the uterus, ovaries and fallopian tubes but affecting in a rhythmic way every part of the cardiovascular system and brain, you can appreciate why these fluctuations or issues related to these hormones in women have an enormous impact” on heart and brain health, she said. The writing group detailed these connections in a news release.
The papers emphasize that women may experience heart disease differently from men. While plaque buildup that narrows arteries is the most common issue in both sexes, women are more likely to have conditions such as microvascular coronary disease, which affects small blood vessels in the heart; heart failure with preserved ejection fraction; or spontaneous coronary artery dissection. “If you don’t think of the disease processes, you won’t order the right tests, and these diseases will be missed,” said Dr. Esther S.H. Kim, director of the Center for Women’s Cardiovascular Health at Atrium Health.
Each life stage offers what Kim called “windows of opportunity.” Puberty is a major turning point: a first period before age 10 is linked to higher heart disease risk later, and persistent irregular periods can signal polyendocrine metabolic ovarian syndrome. During early adulthood, women should discuss contraceptive options, pregnancy planning, and the basics of Life’s Essential 8. Pregnancy acts as a stress test for the heart, and the first year postpartum is critical for monitoring risks. Around menopause, rising LDL cholesterol, weight gain, and blood pressure changes can accelerate risk, but it is never too late to act. “It’s always about opportunities,” Rosen said.
The reports also call for routine mental health screening, noting that depression and anxiety are intertwined with cardiovascular health at every stage. To help women take charge, the American Heart Association offers resources to protect and strengthen the heart at every life stage, including guidance on pregnancy and postpartum care. Additional tools include a A Woman’s Heart Through Every Stage of Life - A guide to protecting your heart from your first period through menopause and beyond and a My Heart & Health Checklist - Questions to think about before your next visit. More information is available at heart.org and stroke.org.
