Cardiovascular Health in Girls and Women Resource Center

Connecting science, care, and health across women’s lives

A Multi-Society Framework for Cardiovascular Health in Girls and Women: Female Life Stages

A first-of-its-kind framework redefining cardiovascular health in girls and women — developed by 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 connecting clinicians, societies, and patients.
Smiling doctor talking with girl's father and mother
American Heart Association logo
American Academy of Pediatrics logo
American College of Obstetricians and Gynecologists logo
Society for Maternal Fetal Medicine logo

Explore the multi-society Cardiovascular Health in Girls and Women Resources

The resources include the three-part series, accompanying videos, educational resources, and patient information – all in one place.

For the first time, four leading medical societies have aligned around a shared, female-specific framework that recognizes women's cardiovascular risk develops across a lifetime and is uniquely shaped by biological transitions men do not experience.

A landmark three-part series define the new Female Life Stages, provides clinical guidance for the prevention and management of cardiovascular disease, and the systems needed to deliver care. This multi-society compendium brings together hormonal, psychosocial, and cardiovascular health to recognize risk earlier and coordinate preventive care sooner. Explore the publications, hear from the experts, and access resources designed to support clinical application.

Learn how this multi-society collaboration came together.

A group of leading experts across specialties came together for a consensus meeting to align on a shared, life-course framework for women’s cardiovascular health, translating the latest science into more consistent approaches to prevention, risk assessment and care.
Consensus Meeting Overview
Life Course Consensus Discussions

Watch what the Female Life Stages mean for cardiovascular health.

Perimenarche
This is the earliest time point doctors may see signals that are specific to a female's heart health.
Ovarian Cycling
A woman's menstrual cycle is a vital sign or clue for her heart health.
Perimenopause and Postmenopause
The menopausal transition is not a simple drop in estrogen. This is a turning point when heart risk starts to speed up.

The Framework – A Road Map for Lifelong Women’s Health

S0 Premenarche – Childhood, before a girl’s first period.

S1 Perimenarche – Adolescence, around the time of a girl’s first period.

S2 Ovarian cycling – Young adulthood, the reproductive years. Peri-pregnancy is a modifying lide event that can happen during this time.

S3 Perimenopause – Midlife, the beginning of the transition to menopause.

S4 Postmenopause – Older adulthood, after a woman’s last period.

A woman’s health is made up of interconnected domains of hormonal, psychological, and cardiovascular health.

The Cardiovascular Health in Girls and Women Compendium provides a practical life-stage framework for women’s heart health that points patients and their care team to specific windows in life when clues or risk can be spotted and acted on early. It’s also important for the people in women’s lives, such as spouses and family members, to understand this connection so they can support and advocate for their loved ones during their health journeys.

01

Connect health domains

Consider hormonal, psychosocial and cardiovascular health together.

02

Connect the life course

Use earlier health experiences to inform current care and anticipate future needs.

03

Connect specialties

Establish shared assessment, communication and follow-up across care teams.

Coming Soon: Read how the new Female Life Stages can be applied to clinical cases

Read what comes next to transform women’s heart health

Understand the Top Takeaways and Recommendations

1. Hormonal and psychosocial health are central to cardiovascular health, are interconnected, and should be assessed together.
Stage-specific evaluation and management of these interconnected health domains are needed in addition to recognition of female-specific risk enhancers. Menstrual cycle history and patterns can serve as a cardiovascular vital sign (e.g., when dysregulation of hormonal health is recognized such as polyendocrine metabolic ovarian syndrome, formerly known as polycystic ovary syndrome). Psychosocial conditions (e.g., depression, anxiety, eating disorders) are disproportionately common in girls and women, beginning in adolescence and can adversely affect cardiovascular health.
 2. Menarche marks an important transition for female-specific health considerations when the earliest signals of disruption in hormonal, psychosocial, and cardiovascular health may emerge.
Fewer than 1 in 4 adolescent females have high cardiovascular health. Menstrual cycle irregularity, hyperandrogenism, eating disorders, and concerns related to body image can uniquely influence cardiovascular health behaviors in girls. Recognition of these signals creates an opportunity to intervene before adverse trajectories become established.
 3. During the ovarian cycling stage, common hormonal and psychosocial conditions can influence cardiovascular health.
Irregular menstrual cycles may signal underlying cardiovascular risk due to conditions such as polyendocrine metabolic ovarian syndrome or contribute to iron deficiency from heavy menstrual bleeding. Cyclical hormonal changes may also be associated with clinically important mood symptoms, including premenstrual dysphoria disorder. Exogenous hormone therapy is frequently used during this stage for a variety of indications, such as abnormal or heavy uterine bleeding, ovarian suppression, contraception, fertility treatment, and polyendocrine metabolic ovarian syndrome. Decisions about hormone therapy should consider indication, cardiovascular and thrombotic risk, and individual preferences.
 4. The menopause transition during perimenopause and the years after during postmenopause are important stages when cardiovascular risk may accelerate and clinical cardiovascular disease may emerge.
During perimenopause, adverse cardiometabolic changes frequently occur beyond those attributable to chronologic aging alone. During postmenopause, clinical cardiovascular disease becomes increasingly common. Both hormonal and nonhormonal therapies are available and can address menopause-related symptoms while considering individual cardiovascular risk, contraindications, and preferences. Premature or early menopause is associated with greater cardiovascular disease risk and should be recognized as a female-specific risk enhancer.
 5. Pregnancy is a cardiovascular stress test that can reveal new or previously unrecognized susceptibility.
Adverse pregnancy outcomes, including hypertensive disorders, gestational diabetes, preterm birth, and small-for-gestational-age infants, affect approximately 1 in 5 pregnancies and are associated with elevated future cardiovascular disease risk. These pregnancy outcomes should be routinely recognized, documented and incorporated into long-term prevention as risk enhancers. Additionally, the full peri-pregnancy period, spanning 12 months before pregnancy through 12 months after delivery, offers a critical yet frequently missed opportunity to improve maternal and cardiovascular health through a coordinated, life-course approach.
 6. Sex differences in cardiovascular physiology, clinical presentation, and phenotypes should be recognized and integrated into a comprehensive screening, diagnostic, and management plan.
Women may be uniquely, disproportionately, or differentially affected by several cardiovascular conditions, including a greater burden of non-obstructive coronary artery diseases (e.g., myocardial infarction with non-obstructive coronary arteries, ischemia with non-obstructive coronary arteries, spontaneous coronary artery dissection, Takotsubo cardiomyopathy) and stroke. Greater recognition of these differences is necessary to reduce diagnostic delays, avoid misclassification, and ensure evidence-based treatment.
 7. Scientific progress requires the full inclusion of girls and women throughout the research process.
The current evidence base remains limited by underrepresentation of women and the inadequate analysis and reporting of sex-specific findings. Improving representation in clinical trials, implementation studies, and community-engaged research is critical to improving health outcomes in girls and women. Results should be stratified by sex, age, and female life stages when scientifically appropriate. Research should also be conducted “for women, with women” by engaging patients and communities in identifying priorities, co-designing studies, interpreting findings, and planning dissemination.
 8. A coordinated clinical, research, and public health agenda is needed to translate the Female Life Stage framework into better cardiovascular outcomes.
The central objective is earlier identification of adverse cardiovascular health trajectories before the onset of symptoms, thereby improving quality of life, preventing disease, and extending healthy years of life. The Female Life Stages moves beyond episodic care toward longitudinal, life course-based risk assessment, prevention, and management.

Meet the Cardiovascular Health in Girls and Women Authors and Contributors

View All Authors
  • Sadiya S. Khan, MD, MSc

    Sadiya S. Khan, MD, MSc

  • Dr. William Grobman

    William A. Grobman, MD, MBA

  • Dr. Amanda Perak

    Amanda Marma Perak, MD, MSCI

  • Dr. Sonia Angell

    Sonia Angell, MD, MPH 

  • Dr. C. Noel Bairey Merz

    C. Noel Bairey Merz, MD 

  • Dr. LaPrincess Brewer

    LaPrincess Brewer, MD, MPH 

  • Dr. Linda Brubaker

    Linda Brubaker, MD, MS 

  • Dr. Natalie Cameron

    Natalie A. Cameron, MD, MPH

  • Dr. Matthew M. Davis

    Matthew M. Davis, MD, MAPP

  • Dr. Samar El Khoudary

    Samar El Khoudary, PhD 

Key Statistics for Women’s Cardiovascular Health

Current State of Cardiovascular Health:

1 in 3
Deaths among women are due to cardiovascular disease
44.1%
Of U.S. women aged ≥ 20 have cardiovascular disease, including hypertension
10 - 20%
Of pregnancies are complicated by adverse pregnancy outcomes

2050 Projections:

59.1%
Of women projected to have hypertension

Up from 48.6% in 2020
25.3%
Of women projected to have diabetes

Up from 14.9% in 2020
61.2%
Of women projected to have obesity

Up from 43.9% in 2020

Choose Your Path

Coming Next: From Science to Evidence and Implementation Gaps

The next phase will focus on helping clinical teams apply the framework and evaluate its use in practice. Planned opportunities include additional clinical education opportunities, identifying implementation tools, and funding new research for improving the evidence.

Additional Resources

2026 Cardiovascular Disease in Girls and Women Presidential Advisory
Introduces the multi-society Female Life Stages framework and the rationale for integrating hormonal, psychosocial, and cardiovascular health across clinical specialties

2026 Cardiovascular Disease in Girls and Women Scientific Statement
Reviews the evidence and defines clinical guidance for risk assessment, prevention, and management of cardiovascular disease for girls and women

2026 Cardiovascular Disease in Girls and Women Science Advisory
Surveys the clinical landscape and describes opportunities to strengthen multi-disciplinary collaboration, referral pathways, and continuity of care

2026 Heart Disease and Stroke Statistics

2050 Projections

PREVENT Online Calculator

Coming Soon - Circulation on the Run Podcast: Hear from the Experts
Listen to the discussion of the scientific rationale, clinical implications, and priorities for implementation on the Circulation on the Run journal podcast

Professional Heart Daily hub for compendium

Women in American Heart Research