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.
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.
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.