400,000 deaths a year: doctors redraw women's heart care

Heart disease and stroke kill more than 400,000 women in the U.S. each year, the American Heart Association said on Oct. 26. That is more than breast cancer, lung cancer and chronic lung disease combined. The same day, the AHA and three other medical groups released their first shared guidance on finding that risk earlier in girls and women.

The other three groups are the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists and the Society for Maternal Fetal Medicine. Their three papers ran in Circulation, the AHA’s flagship journal. The groups call it the first coordinated framework across those specialties to prevent, detect and manage heart disease in women.

Why it matters: a woman sees a pediatrician, then an OB GYN, then a primary care doctor, and her heart risk can fall through the gaps between them. This guidance gives all three the same checklist.

The four life stages

The papers sort a woman’s life into four stages, each set by a change in hormones:

• Stage 1, around the first period: roughly ages 8 to 15.
• Stage 2, regular cycles: roughly ages 15 to 44, when most pregnancies happen.
• Stage 3, perimenopause: roughly ages 45 to 51.
• Stage 4, after menopause: roughly age 51 and up.

Pregnancy sits outside the stages. The groups call it a biological “stress test” that can surface heart risk at any age.

What changes in the exam room

The guidance asks clinicians to treat the menstrual cycle as a vital sign. Heavy or irregular bleeding can be an early marker of heart risk, including polyendocrine metabolic ovarian syndrome, the condition long called PCOS.

Pregnancy history counts as heart history. High blood pressure in pregnancy, preeclampsia, gestational diabetes, preterm birth, a small baby for its age and stillbirth are all listed as risk enhancers. The AHA notes that the 2026 AHA and American College of Cardiology cholesterol guideline already folds pregnancy factors into risk scoring for women.

Perimenopause is called a turning point. Cholesterol and metabolic changes in those years can be the first sign of trouble.

Anxiety, depression and eating disorders are more common in women, and the papers name each one as a drag on heart health.

The numbers behind the push

• About 60%: the share of U.S. women with blood pressure complications in pregnancy who get follow up care for that blood pressure within six months of delivery. The groups call for “immediate action” on that gap.
• 49% to 59%: the projected rise in U.S. women 20 and older with high blood pressure, from 2020 to 2050, if trends hold, per a 2026 AHA statement.
• More than one third: the share of U.S. maternal deaths caused by heart and blood vessel conditions.
• Up to 40%: the share of a woman’s life spent after menopause. Most heart attacks, strokes and heart failure events happen then, and the AHA says more than 80% are preventable with early action.
• 41%: the share of women who name heart disease as their greatest health threat.

“Women’s heart health is uniquely shaped by biological transitions not experienced by men,” said Dr. Sadiya Khan, chair of the writing group and a cardiovascular epidemiologist at Northwestern University’s Feinberg School of Medicine.

What it does not do

The papers are a scientific statement and advisories, not a clinical practice guideline. The AHA says such statements “do not make treatment recommendations.” They also call for a national network of Comprehensive Centers of Excellence for Women’s Cardiovascular Care, with no funding attached in the release.

What to ask at your next visit

The AHA posted a patient checklist and four infographics, one per stage, with the release. Based on the guidance, three questions fit any checkup: Has my period history been noted as a heart risk factor? Did a past pregnancy complication change my heart risk? Has anyone run my 10 year and 30 year risk with the AHA’s PREVENT equations?

Women who had high blood pressure in pregnancy are the group the guidance flags first. About four in 10 of them do not get that follow up within six months.