Women’s heart health gets a new playbook, starting in childhood

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Women's heart health gets a new playbook, starting in childhood

Four top medical societies create first-ever shared framework to assess and improve women's heart health

• Heart disease remains the leading cause of death among U.S. women
• Previously siloed across specialties, women's heart health begins in childhood and should be tracked across four female life stages
• Pregnancy complications like preeclampsia, gestational diabetes are cardiovascular risk enhancers

CHICAGO - For the first time, four leading medical societies have banded together to create a shared framework for assessing and improving women's heart health across the lifespan, starting in childhood.

Today (Oct. 26), the American Heart Association (AHA), American Academy of Pediatrics, American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine have released a three-part publication introducing a new framework for cardiovascular care in girls and women. Northwestern University cardiology experts Dr. Sadiya Khan and Dr. Amanda Marma Perak are chair and vice chair, respectively, of the collaborative science advisory group for the new shared framework. Northwestern internal medicine expert Dr. Natalie Cameron is a member of the writing group.

Three manuscripts, published simultaneously today in the AHA's flagship journal Circulation, outline the framework. Two papers establish "Female Life Stages" with four stages to help clinicians identify cardiovascular risks earlier and intervene sooner. The third proposes a national network of comprehensive cardiovascular care centers for women built around four pillars: interdisciplinary care, professional training, research and community engagement.

"Each of these four societies has been addressing women's heart health but it has been siloed across specialties, which leads to fragmented care for women," said Khan, associate professor of preventive medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine cardiologist. "It's like we've all been playing different sports and now we're trying to create a new sport with a singular playbook."

Cardiovascular disease remains the leading cause of death among U.S. women, yet progress in reducing those deaths has largely stalled over the past two decades.

"Heart health begins long before adulthood," said Perak, associate professor of pediatrics and preventive medicine at Feinberg and a pediatric cardiologist at Ann & Robert H. Lurie Children's Hospital of Chicago. "As pediatric clinicians, we have the opportunity to help every girl start strong and ensure that what we learn about her health follows her as she grows."

Pregnancy complications, including preeclampsia, gestational diabetes and preterm birth, are already recognized as female-specific cardiovascular risk enhancers. In addition, conditions often viewed primarily through a reproductive-health lens, such as polycystic ovary syndrome (now known as polyendocrine metabolic ovarian syndrome), may serve as early indicators of future cardiovascular risk, Khan said.

"This work was a truly collaborative, multidisciplinary effort, reflecting the interdisciplinary nature of cardiovascular health promotion in women and the importance of partnerships across specialties," said Cameron, assistant professor of general internal medicine and preventive medicine at Feinberg and a Northwestern Medicine physician.

Sex matters in personalized medicine

The new compendium arrives amid growing attention on women's health and longstanding gaps in cardiovascular care and research for women, who make up half the population, Khan said.

The framework provides clinicians with evidence-based guidance for identifying cardiovascular risk earlier and delivering more personalized care to girls and women throughout life.

"As we continue to advance a personalized approach to health, sex matters," Khan said. "There are clear differences by sex and gender that influence cardiovascular health. Both must be accounted for."

A first-of-its-kind Female Life Stage framework

The Female Life Stage framework gives clinicians across specialties a common way to identify, monitor and address cardiovascular risk as girls and women move through major hormonal transitions. Each of the four stages is anchored in key hormonal transitions unique to female development:

Stage 1 perimenarche: The years around a girl's first menstrual period, as hormone cycles mature. Approximate age range is 8 to 15.

Stage 2 ovarian cycling: Regular ovulatory and hormone cycles are established and when pregnancy may occur. Approximate age range is 15 to 44 years old.

Stage 3 perimenopause: The transition to variable cycle length, skipped cycles and hormone changes. Approximate age range is 45 to 51 years old.

Stage 4 postmenopause: The years that begin after menopause or 12 months after the final menstrual period. Approximate age is 51 years and older.

The time before, during and after pregnancy is highlighted as a biological "stress test" that can identify cardiovascular risks that may have been previously unrecognized, according to the new framework.

"Women's health is an everyone issue," Khan said. "Health starts very early in life and those foundational years matter."

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