“Traditionally, people think of OB/GYN and cardiology as separate fields, but now we’re talking about assessing risk over a lifetime, and that really requires multidisciplinary, longitudinal care and thought,” said Dr. Molly Siegel, an obstetrician-gynecologist and maternal-fetal medicine specialist at Massachusetts General Hospital. “One of the most remarkable things about this is that so many associations are coming together to think through the whole lifetime for women in that way.” It was the first coordinated effort between societies to lay out a framework for women’s heart health.According to the American Heart Association and Centers for Disease Control, cardiovascular disease continues to be the leading cause of death in women worldwide, causing more than 400,000 deaths per year in the United States.In February, the American Heart Association projected that six in 10 US women would have at least one type of cardiovascular disease by 2050. While heart health is more commonly associated with later stages of life, the report projected that nearly one-third of women ages 20 to 44 would have a cardiovascular disease by 2050, compared to less than one in four currently. “Women make up more than half the population, and their heart health must be a part of everyday care across medicine,” said Dr. Mariell Jessup, chief science and medical officer of the American Heart Association, in a Monday press release. The framework outlined distinct life stages marked by major biological shifts that are unique to women, such as menstruation , pregnancy, and menopause. Each stage is presented as a window of opportunity to prevent, detect, and manage cardiovascular conditions in women and girls.The first stage is marked by the first menstrual period, around 8 to 15 years old. Stage two is when regular ovulatory and hormone cycles are established and when pregnancy typically occurs, from the late teens to around 44 years old. Stage three is perimenopause, around 45 to 51 years old, followed by stage four at postmenopause, ages 51 and older.Pregnancy, whenever it may occur, is identified in the framework as a biological “stress test” where previously unrecognized cardiovascular risks might appear due to the intense hormonal, emotional, and physical shifts a woman goes through. Siegel said she specializes in “high-risk” pregnancy care, meaning she works with patients who have complications that require additional care during pregnancy. She said many of these complications are related to cardiovascular disease. “What we’re seeing is an explicit outlining of the way health patterns and, to some extent, health behaviors early in life may connect to outcomes later in life,” she said. “When we think about pregnancy, it’s important that those complications from the obstetric side of things get conveyed to a primary care doctor or cardiologist, so that those are flagged as things to monitor for the patient’s future health.”Siegel also noted that the framework encourages pediatricians to look out for early signs of cardiovascular risk in puberty, such as irregular periods, heavy flow, getting a first period before age 10, or mental health conditions like eating disorders. For women in menopause, the framework recommended clinicians monitor menopausal symptoms that might also mark cardiovascular risk, like sleep disturbances or mood changes. Postmenopausal women over 50 are most at risk for heart attack, stroke, or heart failure due to low estrogen (a hormone that helps prevent heart disease, but decreases during menopause). However, Siegel said, those conditions can be prevented with attention and action in the earlier stages of life.“The framework came out this week, so I don’t know that it’s changed the systems of care quite yet, but I hope that it encourages collaboration across disciplines in working towards connecting these time frames,” she said. “Looking at them not as isolated clinical encounters — like, you see your primary care doctor, you see your pregnancy doctor, you see your cardiologist — and instead thinking long term across the lifespan to help to improve cardiovascular outcomes for patients.”Chloe Craft can be reached at chloe.craft@globe.com.
