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Fulltext Cardiorespiratory Fitness in Youth: An Important Marker of Health: A Scientific Statement From the American Heart Association

Raghuveer G, Hartz J, Lubans DR, Takken T, Wiltz JL, Mietus-Snyder M, et al.

Circulation, 2020 08 18;142(7):e101-e118.
PMID: 32686505 DOI: 10.1161/CIR.0000000000000866

Cardiorespiratory fitness (CRF) refers to the capacity of the circulatory and respiratory systems to supply oxygen to skeletal muscle mitochondria for energy production needed during physical activity. CRF is an important marker of physical and mental health and academic achievement in youth. However, only 40% of US youth are currently believed to have healthy CRF. In this statement, we review the physiological principles that determine CRF, the tools that are available to assess CRF, the modifiable and nonmodifiable factors influencing CRF, the association of CRF with markers of health in otherwise healthy youth, and the temporal trends in CRF both in the United States and internationally. Development of a cost-effective CRF measurement process that could readily be incorporated into office visits and in field settings to screen all youth periodically could help identify those at increased risk.

Matched MeSH terms: American Heart Association*
Fulltext Toward a Roadmap for Best Practices in Pediatric Preventive Cardiology: A Science Advisory From the American Heart Association

Perak AM, Baker-Smith C, Hayman LL, Khoury M, Peterson AL, Ware AL, et al.

Circ Cardiovasc Qual Outcomes, 2023 Sep;16(9):e000120.
PMID: 37548024 DOI: 10.1161/HCQ.0000000000000120

Cardiovascular disease risk factors are highly prevalent among youth in the United States and Canada. Pediatric preventive cardiology programs have independently developed and proliferated to address cardiovascular risk factors in youth, but there is a general lack of clarity on best practices to optimize and sustain desired outcomes. We conducted surveys of pediatric cardiology division directors and pediatric preventive cardiology clinicians across the United States and Canada to describe the current landscape and perspectives on future directions for the field. We summarize the data and conclude with a call to action for various audiences who seek to improve cardiovascular health in youth, reduce the burden of premature cardiovascular disease, and increase healthy longevity. We call on heart centers, hospitals, payers, and policymakers to invest resources in the important work of pediatric preventive cardiology programs. We urge professional societies to advocate for pediatric preventive cardiology and provide opportunities for training and cross-pollination across programs. We encourage researchers to close evidence gaps. Last, we invite pediatric preventive cardiology clinicians to collaborate and innovate to advance the practice of pediatric preventive cardiology.

Matched MeSH terms: American Heart Association
Fulltext Life's Essential 8: Updating and Enhancing the American Heart Association's Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association

Lloyd-Jones DM, Allen NB, Anderson CAM, Black T, Brewer LC, Foraker RE, et al.

Circulation, 2022 Aug 02;146(5):e18-e43.
PMID: 35766027 DOI: 10.1161/CIR.0000000000001078

In 2010, the American Heart Association defined a novel construct of cardiovascular health to promote a paradigm shift from a focus solely on disease treatment to one inclusive of positive health promotion and preservation across the life course in populations and individuals. Extensive subsequent evidence has provided insights into strengths and limitations of the original approach to defining and quantifying cardiovascular health. In response, the American Heart Association convened a writing group to recommend enhancements and updates. The definition and quantification of each of the original metrics (Life's Simple 7) were evaluated for responsiveness to interindividual variation and intraindividual change. New metrics were considered, and the age spectrum was expanded to include the entire life course. The foundational contexts of social determinants of health and psychological health were addressed as crucial factors in optimizing and preserving cardiovascular health. This presidential advisory introduces an enhanced approach to assessing cardiovascular health: Life's Essential 8. The components of Life's Essential 8 include diet (updated), physical activity, nicotine exposure (updated), sleep health (new), body mass index, blood lipids (updated), blood glucose (updated), and blood pressure. Each metric has a new scoring algorithm ranging from 0 to 100 points, allowing generation of a new composite cardiovascular health score (the unweighted average of all components) that also varies from 0 to 100 points. Methods for implementing cardiovascular health assessment and longitudinal monitoring are discussed, as are potential data sources and tools to promote widespread adoption in policy, public health, clinical, institutional, and community settings.

Matched MeSH terms: American Heart Association*
Fulltext Female Life Stages for Cardiovascular Disease Prevention and Management in Girls and Women: A Case-Based Approach

Lau ES, Faubion S, Gangopadhyaya A, Grobman WA, Perak AM, Schulte J, et al.

J Am Heart Assoc, 2026 Oct 26.
PMID: 42929293 DOI: 10.1161/JAHA.126.055294

Cardiovascular disease remains the leading cause of death among women in the United States and worldwide, yet current approaches to prevention and management do not fully account for female-specific biology. To address this need, the American Heart Association, in collaboration with the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine, published a Presidential Advisory defining the Female Life Stage construct, which defines four distinct stages across the life course: Perimenarche (Stage 1), Ovarian Cycling (Stage 2), Perimenopause (Stage 3), and Postmenopause (Stage 4), with pregnancy including the time before and after (Peripregnancy period) recognized as a distinct life period when cardiovascular risk may be modified.1 To provide examples of how this framework and the accompanying consensus guidance published in an accompanying Scientific Statement can be translated into a personalized care approach, this special report presents six hypothetical cases spanning the Female Life Stages, including adolescence and young adulthood, the peripartum period, midlife, perimenopause, and postmenopause.2 These cases illustrate how a female-specific life course framework that reflects hormonally-mediated physiologic transitions can promote earlier recognition of cardiovascular risk, guide cardiovascular screening and inform cardiovascular management. The cases underscore how hormonal health (e.g., menstrual cycle assessment, pregnancy planning and prevention, assessing and managing perimenopausal and postmenopausal symptoms) and psychosocial health (e.g., anxiety, depression, disordered eating) have cardiovascular implications. Moreover, this approach integrates well-established female-specific cardiovascular risk factors (e.g., premature menopause and adverse pregnancy outcomes), in addition to less well-recognized risk factors (e.g., early menarche, polyendocrine metabolic ovarian syndrome). We also review key evidence to inform a patient-centered approach to exogenous hormone therapy and associated cardiovascular risks for a variety of indications, including management of abnormal uterine bleeding, ovarian suppression, pregnancy prevention, and menopausal symptoms. By contextualizing the Female Life Stage framework within practical case scenarios, this article provides clinicians with a structured, evidence-based approach to improve cardiovascular prevention and management for girls and women.
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

Khan SS, Grobman WA, Perak AM, Angell S, Brubaker L, Cameron NA, et al.

Circulation, 2026 Oct 26.
PMID: 42929148 DOI: 10.1161/CIR.0000000000001483

Cardiovascular disease is the leading cause of morbidity and mortality in women, contributes markedly to healthcare expenditures, and is projected to increase substantially by 2050 if current trends continue. There is growing recognition of the complex role of sex as a biologic variable and its influence on cardiovascular health and disease. However, cardiovascular risk remains underrecognized and underaddressed in girls and women, particularly as it relates to female-specific exposure to sex hormones (both endogenous and exogenous), which are systemic modulators of cardiovascular biology. Moreover, girls and women uniquely experience fragmented care spanning specialties, including pediatrics, adolescent medicine, primary care, obstetrics and gynecology, maternal-fetal medicine, cardiology, endocrinology, hematology, and neurology. Consequently, there is a need for a unified life course approach that addresses the female-specific interconnectedness of hormonal, psychosocial, and cardiovascular health. To address these gaps, the American Heart Association, in collaboration with the American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and Society for Maternal-Fetal Medicine, established a Female Life Stage framework to optimize the prevention and management of cardiovascular disease in girls and women. Physiologic changes in sex hormones define clinically distinct life stages (ie, perimenarche, ovarian cycling, perimenopause, postmenopause), which directly inform female-specific considerations for screening, prevention, and management of cardiovascular disease. This presidential advisory details the framework and its scientific rationale, highlights opportunities for implementation across settings, and identifies priorities for research, clinician education, patient advocacy, and policy. This framework offers a transformative opportunity to equitably improve cardiovascular health for all girls and women.
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

Khan SS, Grobman WA, Angell S, Brubaker L, Cameron NA, de Ferranti S, et al.

Circulation, 2026 Oct 26.
PMID: 42929102 DOI: 10.1161/CIR.0000000000001482

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.
Comprehensive Centers of Excellence for Women's Cardiovascular Care: A Science Advisory From the American Heart Association, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and Society for Maternal-Fetal Medicine

Cameron NA, Khan SS, Bairey Merz CN, Brewer LC, Davis MM, Ferranti EP, et al.

Circulation, 2026 Oct 26.
PMID: 42929153 DOI: 10.1161/CIR.0000000000001481

Improving cardiovascular health in women is an urgent public health priority given the persistent and pervasive gaps in awareness, prevention, and management of cardiovascular disease in this population. Advances in scientific understanding have led to increased recognition of female-specific considerations in cardiovascular disease, which informed the development of the Female Life Stage construct by the American Heart Association in collaboration with the American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and Society for Maternal-Fetal Medicine. This construct integrates assessment of hormonal, psychosocial, and cardiovascular health across life stages. However, gaps remain in operationalizing this construct and optimizing the delivery of patient-centered, interdisciplinary care among women. Over the past several decades, women's cardiovascular centers have emerged as leaders, expanded rapidly, and elevated the recognition of cardiovascular diseases that exclusively, disproportionately, or differently affect women (eg, myocardial infarction with nonobstructive coronary arteries, spontaneous coronary artery dissection, Takotsubo syndrome). In this science advisory, we describe the current landscape of women's cardiovascular centers and propose a national infrastructure to support the expansion of dedicated Comprehensive Centers of Excellence for Women's Cardiovascular Care. These centers are conceptualized as interdisciplinary care models comprising 4 defining pillars: interdisciplinary clinical care, education and training, research, and community engagement. By establishing integrated pathways that span clinical disciplines, these centers can reduce fragmentation, enhance earlier risk identification, and expand opportunities to increase representation of women in clinical research. In doing so, they offer a bold opportunity for a scalable and equitable model to improve cardiovascular health for all women.
Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association

Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al.

Circulation, 2019 03 05;139(10):e56-e528.
PMID: 30700139 DOI: 10.1161/CIR.0000000000000659
Matched MeSH terms: American Heart Association
Fulltext Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association

Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, et al.

Circulation, 2021 Feb 23;143(8):e254-e743.
PMID: 33501848 DOI: 10.1161/CIR.0000000000000950

BACKGROUND: The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).
METHODS: The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease.
RESULTS: Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.
CONCLUSIONS: The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Matched MeSH terms: American Heart Association
Fulltext Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association

Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, et al.

Circulation, 2022 Jan 26.
PMID: 35078371 DOI: 10.1161/CIR.0000000000001052

BACKGROUND: The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).
METHODS: The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy.
RESULTS: Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.
CONCLUSIONS: The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

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