Circulation: Doctors Explain How Hormones and Mental Health Affect Women’s Hearts

The series, prepared by the American Heart Association in collaboration with pediatric and obstetric organizations, is described by its authors as a paradigm shift. They divide a woman’s life into stages — adolescence, adulthood, pregnancy and menopause — identifying “windows of opportunity” at each stage to detect cardiovascular risks and adjust lifestyle habits. Currently, healthcare for women is fragmented: pediatricians, primary care physicians, gynecologists and cardiologists rarely have a complete picture of a patient’s health.

Heart disease also presents differently in women than in men. “The classic image of a heart patient is a middle-aged man with obvious risk factors, something like Homer Simpson. But women get heart disease, too — think Marge,” said cardiologist Esther Kim, a co-author of the papers. Women are more likely to experience disease affecting the heart’s small blood vessels, heart failure in which the heart contracts but does not relax properly between beats, and spontaneous tears in the walls of coronary arteries. Without specialized tests, these conditions can easily be missed.

Doctors recommend beginning preventive care during adolescence. Starting menstruation before the age of 10 is associated with a higher cardiovascular risk later in life. Persistently irregular menstrual cycles accompanied by severe acne and excessive hair growth may indicate polycystic ovary syndrome, which is associated with diabetes and heart disease. Mental health also plays a role: by age 17, depression is twice as common in girls as in boys. Depression and eating disorders can damage cardiovascular health, prompting the researchers to recommend making screening for these conditions a routine part of care.

Under the new approach, pregnancy serves as a “stress test” for the heart. High blood pressure, gestational diabetes and preterm birth can predict health problems years later. Yet nine out of 10 American women aged 20–44 enter pregnancy without optimal cardiovascular health. Menopause marks another turning point, when levels of “bad” cholesterol, body weight and blood pressure tend to rise.

Cardiovascular diseases, including stroke, claim more than 400,000 women’s lives every year in the United States alone, yet only four in 10 women consider them their greatest health threat. The foundation of prevention is a set of eight key measures: maintaining a healthy weight and normal blood pressure, blood sugar and cholesterol levels; eating a healthy diet; getting enough physical activity and sleep; and avoiding tobacco.