Cardiovascular disease (CVD), including heart disease and stroke, is the leading cause of death among women, claiming more than 400,000 lives every year, according to the American Heart Association. But only about 41 percent of women see it as a threat to their health.

That's why the American Heart Association, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine recently collaborated on three papers about the need to find ways to prevent, diagnose and treat cardiovascular disease that are specific to women and girls.

Women who are having a heart attack are likely to present with three or more symptoms such as stomach, chest or jaw pain or heart palpitations. The most common symptom in women is a feeling of tightness or pressure in the chest.

“Women make up more than half the population, and their heart health must be a part of everyday care across medicine,” Mariell Jessup, chief science and medicine officer of the American Heart Association, said in a statement.

Women who are having a heart attack are likely to present with three or more symptoms such as stomach, chest or jaw pain or heart palpitations. The most common symptom in women is a feeling of tightness or pressure in the chest. These symptoms are often simply missed or dismissed.

Women are also less likely than men to be given appropriate treatment after a heart attack, and researchers argue that hormone levels should be considered when deciding what kind of treatment is best for a woman's cardiovascular health.

The research teams examined factors that can affect women's cardiovascular health during different stages of their lives, from puberty through the postmenopausal period, and identified the risks and opportunities present at each stage:

  • Perimenarche, the time around a girl's first period, between the ages of about eight to 15 years old.

    Cardiovascular health in adolescent girls is determined by the effects of puberty on cardiometabolic markers such as cholesterol levels, insulin resistance and blood pressure. Other factors, including heart-healthy behaviors such as exercise, can also affect girl's cardiovascular health. Current pediatric guidelines do not account for the stage of puberty adolescents are in. Cholesterol and blood sugar screening recommendations also do not account for gender or stage of puberty.

  • Ovarian cycling, when ovulation and hormone cycles are established between the ages of 15 and 44 years old.

    Women have low rates of CVD before they reach menopause because estrogen protects the lining of the blood vessels.

  • Perimenopause, when menstrual cycles become more variable and hormone levels change between the ages of 45 and 51 years old.

    Perimenopause offers an important opportunity to recognize and prevent CVD. During this time, levels of low-density lipoprotein, the bad cholesterol, increase and the quality of high-density lipoprotein cholesterol, the good cholesterol, changes. Blood vessels may change, too, which can affect their ability to function properly. About a third of women who experience vasomotor symptoms such as night sweats and hot flashes during perimenopause have frequent or severe symptoms, which can increase their risk of CVD. Perimenopause is also associated with an increased risk of depression and anxiety, which are risk factors for CVD.

  • Postmenopause, which begins about 12 months after the final menstrual period starting at 51 years old.

    The postmenopausal stage can represent about 40 percent of a woman's lifespan, so it has implications for her CVD risk. Cardiovascular health after menopause is determined by the risk factors a woman had earlier in life and the common cardiovascular risks associated with aging.

  • Pregnancy and postpartum

    Poor cardiovascular health is a significant risk factor for poor maternal health, the researchers point out. Pregnancy and the postpartum period affect the cardiovascular system in a unique way, and a woman's risk for cardiovascular disease may first be recognized or increase during this time.

Factors that can affect women's cardiovascular health vary during different stages of their lives — from puberty through the postmenopausal period.

The researchers recommend establishing a nationwide network of Comprehensive Centers of Excellence in Women's Cardiovascular Care. Existing tools and therapies can improve cardiovascular care now, but more studies are needed to address the gaps specific to women in research. “The goal is to assess health across all life stages and identify earlier opportunities for prevention,” said Sadiya Khan, chair of the writing group and the Magerstadt Professor of Cardiovascular Epidemiology at Northwestern University Feinberg School of Medicine.

The science advisory, presidential advisory and accompanying scientific statement are published in the American Heart Association journal, Circulation.