Key Takeaway: New guidance from four major medical groups connects female hormonal change over their lifetime with heart disease risk. Here’s what women should know and what to ask their doctors.
Heart disease is the leading cause of death among women in the United States. This is more than all cancers combined. Despite this fact, many women do not see a physician regarding their heart health until the postmenopausal stage. New guidance from four major medical groups highlights why that conversation should start much earlier. Menstrual patterns, pregnancy complications and changes during menopause can all offer clues about cardiovascular health and opportunities to reduce risk.
Recently, the American Heart Association (AHA), the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine released the first shared framework for preventing and managing cardiovascular disease in women. According to the AHA, heart disease and stroke claim more than 400,000 women’s lives in the U.S. each year, yet only about 41 percent of women recognize cardiovascular disease as their greatest health threat.
This article explores the new framework, explains how heart disease risk can change throughout a woman’s life and explains what women can do to protect their heart health at every stage.
What The New Guidance Says
Women’s healthcare often involves different physician specialists. Emerging data shows that when all factors are accounted for, regardless of which specialists women see, we have the opportunity to greatly impact their future cardiovascular health.
Starting in childhood, women usually go from a pediatrician to an OB/GYN. Rarely is a primary care physician or a cardiologist involved in their early life care. Then, eventually after childbearing years, women turn their attention to a primary care physician and possibly a cardiologist. However, there are countless disease processes that, when identified early, can greatly shape a woman’s overall cardiovascular health.
The best example of this is elevated blood pressure or diabetes during pregnancy. Although these issues may resolve after pregnancy, they can place women at a much greater risk for cardiovascular disease and even heart attacks later in life. Yet these risks are very rarely discussed later in life.
The new framework encourages healthcare providers to consider a woman’s health history across all stages of life, including puberty, pregnancy and menopause, and share that information to help identify risks and promote healthier outcomes. It also identifies four life stages, each with its own considerations for cardiovascular health.
The guidance is outlined in three publications: a presidential advisory, a scientific statement and a science advisory.
Four Life Stages of Hormones and Your Heart
The framework identifies four stages based on hormonal changes. The age ranges are approximate. Each stage offers opportunities to assess heart health and address risk factors before cardiovascular disease develops.
Perimenarche: Around the first period (ages 8 to 15)
Heart health begins long before adulthood. Pediatric visits are an opportunity to establish healthy habits, check for early risk factors and discuss menstrual patterns. Discussing wellness including exercise, extracurricular activities and awareness of food groups and food choices can establish a health conscious baseline for young women as they grow.
Heavy or irregular bleeding can sometimes signal an underlying condition associated with cardiovascular risk, such as polyendocrine metabolic ovarian syndrome (PMOS), previously called polycystic ovary syndrome (PCOS). Early identification and treatment can be important for protecting long-term health.
Ovarian cycling: Regular menstrual cycles (ages 15 to 44)
During this stage, menstrual cycles and hormone patterns are generally established. Regular preventive care, including checks of blood pressure, cholesterol and blood sugar, can help identify cardiovascular risk factors even when a woman feels well. Ongoing education about weight, diet and physical activity can help women understand how their hormones affect their health and how to support their health at each stage of life.
Perimenopause: The transition to menopause (ages 45 to 51)
As menopause approaches, menstrual cycles may become less predictable and women may notice other subtle changes in their overall well-being. Hormone fluctuations during this stage can also increase cardiovascular risk. Changes in cholesterol and metabolism are often noticed however they can increase slowly and can often be misconstrued as poor dietary choices. Early identification and treatment can redirect a woman’s overall cardiovascular health.
Postmenopause: After menopause (around age 51 and older)
Postmenopause officially begins 12 months after the final menstrual period and can account for up to 40 percent of a woman’s life. Understanding how long menopause lasts and what to expect during the transition can help you understand the changes that occur during this stage of life.
During these years, metabolic changes become more evident and can be directly linked to the development of heart attacks and strokes. Historically, this has been the stage of life when women first see a cardiologist to help prevent cardiovascular disease, when in fact, the risk may have started to increase decades earlier.
According to the AHA, most heart attacks, strokes and heart failure events in women occur during this stage, and more than 80 percent are preventable with early action.
Pregnancy Can Reveal Heart Disease Risk
Pregnancy is not a separate life stage in the framework. Instead, it is considered a biological “stress test” that can reveal cardiovascular risks that were not previously apparent. The increased demands on the body during pregnancy can uncover conditions that may affect heart health long after delivery.
Several pregnancy conditions and complications are recognized as cardiovascular risk enhancers, meaning they can add to a woman’s overall lifetime risk:
- High blood pressure during pregnancy
- Preeclampsia / Eclampsia
- Gestational diabetes
- Preterm birth
- A baby smaller than expected for gestational age
- Stillbirth
These complications do not directly indicate that a woman will go on to develop heart disease. However, they are very important to share with your physician to continue to monitor lifetime risk as years go by.
Follow-up care after delivery is also important. The AHA reports that only about 60 percent of U.S. women who experience high blood pressure complications during pregnancy receive follow-up blood pressure care within six months of delivery. Establishing care with a primary care physician or a cardiologist outside of an OB/GYN will aid in the long-term care and monitoring of these conditions and further reduce the likelihood of cardiovascular events.
How To Protect Your Heart at Every Stage
The new framework emphasizes early prevention. This can begin at every stage of a woman’s life. There is always something to gain from primary prevention. Understanding how a woman’s health history can shape her cardiovascular risk over time can directly change her future. Here are some steps women can take to protect their hearts:
- Share your pregnancy history. Tell your healthcare provider about complications such as preeclampsia, eclampsia, gestational diabetes or high blood pressure during pregnancy, even if they occurred years ago.
- Know your numbers. Ask about your blood pressure, cholesterol and blood sugar levels and how often they should be checked. If you notice a change for the worse over months or years look for reasons why. Don’t be scared to ask if your hormones could be playing a role in these changes.
- Ask about your cardiovascular risk. Your provider can help assess your risk factors. Stony Brook offers a free heart health risk assessment to help you learn more about your heart health.
- Mention menstrual changes. Tell your provider about heavy or irregular bleeding and changes in your cycle as you approach menopause.
- Discuss your family history. Share your family history of heart disease directly with your providers. How your mothers health story unfolded has a direct implication to yours.
- Discuss your emotional health. Talk about concerns such as anxiety, depression or eating disorders, which can affect overall health and cardiovascular risk.
- Build heart-healthy habits. Regular physical activity, nutritious eating, adequate sleep, avoiding tobacco and limiting alcohol can help protect your heart.
Your Heart Health Has a History
Heart health is a lifelong process. All aspects of a woman’s history can contribute to the development of coronary disease, heart attacks and stroke.
When women visit a healthcare provider, especially a cardiologist, their medical history should include menstrual history, pregnancy history and complications, and family history. Sharing that information at routine appointments gives your healthcare team a fuller picture of your health and helps identify opportunities for prevention at every stage of life. The new guidance encourages clinicians across specialties to work together, and you can help by starting the conversation.
