Cardiovascular disease remains the leading cause of death among women, yet fewer than half of them recognize it as their primary health threat. A new set of clinical guidelines, published October 26 in the journal Circulation, aims to change this by mapping cardiovascular risk across the hormonal transitions women experience throughout their lives. The recommendations come from experts at the American Heart Association, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine. The streaming series Body Language by takes an unflinching look at the unspoken health experiences in women’s lives. Understanding risk can help women now and help them to prepare for what comes next.
Dr. Sadiya S. Khan, lead author of the guidelines and a professor of cardiovascular epidemiology at Northwestern University Feinberg School of Medicine, noted that there is a clear pattern linking these life stages to heart health. According to Dr. Nisha Parikh, system director of the Women’s Heart Program at Northwell Health, framing medical care around these specific transitions provides natural checkpoints to identify risks early, rather than leaving significant portions of a woman’s life unmonitored. Dr. Khan emphasized that these guidelines are intended to be empowering rather than frightening for patients. And because of “the gendered aspects of being a girl or a woman in the world,” Khan said, women need to take those impacts seriously.
Pediatricians play a vital role in these early assessments. Dr. Tamara Hannon, a professor of pediatrics at Indiana University School of Medicine, stated that it is never too early to consider cardiovascular wellness. Parents are encouraged to monitor their children’s growth patterns, as both stunted and excessive growth may signal hormonal imbalances that could later impact heart health. Furthermore, Hannon recommended that children with a family history of heart disease, high cholesterol, or heart attacks before age 50 undergo cholesterol screenings early. It’s not normal to have excessive bleeding to the point where you’re missing school or having periods more often than every 28 days,” Hannon said. “This pattern can be a sign of increased risk for cardiovascular disease. “Everything that happened before can inform your risk and guide your ongoing care,” she said. “There’s a lot that can be done.”. For example, “bad” LDL cholesterol may rise, arteries stiffen and fat can accumulate around organs. Fortunately, she added, there are treatments that help perimenopause symptoms, including hormone replacement and behavioral therapy.
The guidelines underscore that behaviors formed in childhood and adolescence carry long-term weight. A healthy diet can mitigate the risk of type 2 diabetes and obesity—both significant contributors to future heart disease. Experts also advise viewing regular physical activity as a fundamental life skill rather than a temporary weight-loss strategy. Proper sleep hygiene is equally essential, as poor sleep quality can be detrimental to cardiovascular systems over time. The greater the risk, according to the US Centers for Disease Control and Prevention, people with diabetes are twice as likely as those without it to get heart disease — and the longer you have diabetes. Made simple, get inspired by a weekly roundup on living well.
Adolescence presents a specific window for early detection. Dr. Afshan B. Hameed, a clinical professor of obstetrics and gynecology, observed that doctors often overlook cholesterol in healthy 18-year-olds, even though early plaque accumulation—referred to as silent atherosclerosis—can lead to issues decades later. Research indicates that approximately one in 13 people between the ages of 18 and 29 already exhibit these early markers of arterial buildup. During these teen years, clinicians should also monitor blood pressure, blood sugar, and A1c levels, given that nearly one-third of adolescents currently show signs of prediabetes. According to doctors might not pay attention to a healthy 18-year-old’s cholesterol level, “but that cholesterol is going to affect her 20 years or 30 years from now,”, Coauthor Dr. Afshan B. A recent European study found “silent atherosclerosis,” or early buildup of cholesterol plaques in blood vessels, in 1 out of 13 people ages 18 to 29. Vegetables and whole grains, and limiting ultraprocessed foods, fat from animal sources and juice and other sugary drinks — isn’t just good for developing bodies but makes it the norm as kids grow up, encouraging healthy eating — including lots of fruits. Chest pain, extreme fatigue, swelling in the legs or don’t feel up to your usual energy level, it could be due to the stress of pregn, if you are pregnant or have given birth in the last year and have shortness of breath. Or you are well-acquainted with Aunt Flow, it is crucial to pay attention to irregular cycles, changes in your cycle or heavy bleeding, whether you have only had your period for a few years. Hameed likened pregnancy to being on a treadmill for nine months.
Hormonal markers, such as the timing of the first menstrual period, are also under scrutiny. Starting menstruation before age 10 is associated with a higher cardiovascular risk later in life. Additionally, conditions like polyendocrine metabolic ovarian syndrome (PMOS)—formerly known as PCOS—affect roughly 10% to 13% of women and can increase insulin resistance and visceral fat. Since these conditions are frequently misdiagnosed, the new report urges women to discuss menstrual irregularities, heavy bleeding, and related symptoms with their healthcare providers. Irregular cycles, heavy periods pregnancy complications and going into menopause before age 45 all raise the risk of cardiovascular problems, getting her first period early. The condition is often misdiagnosed — or missed entirely. When women no longer produce cardio-protective estrogen, that changes with menopause.
As women progress toward perimenopause and beyond, their risk profile shifts significantly. Dr. Hameed noted that in the years following a woman’s final period, cardiovascular risk often climbs until it matches or exceeds that of men. During perimenopause, issues like mood changes and sleep disturbances can negatively impact quality of life and heart health. However, experts stress that with proactive vigilance, these life stages offer meaningful opportunities to intervene and prevent future strokes, heart attacks, or coronary artery disease. Dr. Khan concluded that by integrating these historical health factors into standard medical discussions, clinicians can create more effective, personalized care plans for women.
