The AHA, with the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, published a presidential advisory in Circulation on 26 October. It is an expert framework, not a trial or a graded guideline.
Its argument is that cardiovascular risk in women is under-recognised partly because care is split across paediatrics, gynaecology, obstetrics, primary care and cardiology, and nobody holds the whole history. It organises prevention around four hormonal life stages: perimenarche, the years of ovarian cycling, perimenopause and postmenopause. Each stage carries its own risk markers and opportunities, and sex hormones, endogenous and prescribed, are treated as cardiovascular exposures in their own right.
For a cardiologist the practical change is in history-taking. Pregnancy complications, early menopause, polycystic ovary syndrome and hormonal therapy are risk information that often never reaches the cardiology note. The advisory also lists research and policy priorities; it does not change any drug threshold.
- Ask every woman about hypertensive disorders of pregnancy, gestational diabetes and preterm delivery, and record them as cardiovascular risk factors.
- Record age at menopause; early menopause is worth noting when estimating cardiovascular risk.
- Note hormonal contraception and menopausal hormone therapy in the drug history as cardiovascular exposures.
- Perimenopause is a natural point to reassess blood pressure, lipids and glucose in women not already under review.
Why it matters
Much of a woman's cardiovascular risk history sits in obstetric and gynaecological notes that cardiology never sees.
Don't overread it
This is an expert framework; it does not add new treatment thresholds or show that a life-stage approach improves outcomes.
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