Consensus Guidance for the Female-Specific Prevention and Management of Cardiovascular Disease: A Scientific Statement From the American Heart Association, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and Society for Maternal-Fetal Medicine

There is growing recognition that the optimal prevention and management of cardiovascular disease in girls and women requires attention to sex-specific considerations relevant to the interconnected domains of hormonal, psychosocial, and cardiovascular health across the life course. Dysregulation in these health domains tends to co-occur and is associated with increased risk of cardiovascular disease. However, healthcare for girls and women is uniquely fragmented across clinical specialties, including pediatrics, adolescent medicine, primary care, obstetrics, maternal-fetal medicine, gynecology, cardiology, endocrinology, hematology, and neurology. Furthermore, inconsistent alignment across society guidelines contributes to missed opportunities to optimize cardiovascular health. Therefore, the American Heart Association, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and Society for Maternal-Fetal Medicine convened a multisociety science advisory group and developed the Female Life Stage construct. This construct defines 4 distinct and clinically meaningful stages-perimenarche (S1), ovarian cycling (S2), perimenopause (S3), and postmenopause (S4)-to enable female-specific screening, prevention, and treatment considerations. In addition, this construct incorporates pregnancy as a unique modifying life event when cardiovascular risk may emerge or be unmasked (eg, adverse pregnancy outcomes). This scientific statement crosswalks major society guidelines, synthesizes the evidence, and provides consensus-based clinical guidance for each Female Life Stage and interconnected health domain (ie, hormonal, psychosocial, and cardiovascular health). We conclude with a call to action to improve clinical workflows, enhance clinician education, and address scientific and implementation gaps to improve cardiovascular health in girls and women.