Year in Review: Women’s Heart Health in the Spotlight

Cardiovascular disease, for many years, was thought to be a problem for men. At best, women were considered to be men in miniature—at worst, their disease often went undiagnosed and their symptoms unacknowledged. Thankfully, this has begun to change and, while there’s much room to improve, this year encompassed a swell of interest in women’s cardiovascular health.

TCTMD sat down with Stacey E. Rosen, MD (Northwell Health, Manhasset, NY), the American Heart Association’s current president, to hear her thoughts on what progress has been made in 2025. Rosen shared her top five picks for this year’s most noteworthy themes.

Hypertension Management for All

The need to address high blood pressure was a big theme, said Rosen. In August, the AHA and the American College of Cardiology released the latest hypertension guidelines. She pointed to several aspects of the new document that are particularly relevant to women and stressed that “taming blood pressure . . . is really critical” in female patients.

Growing evidence—such as data from the cluster-randomized China Rural Hypertension Control Project, published this year in Nature Medicine—shows that addressing hypertension can reduce dementia risk. As such, the latest guideline document specifies, with a class 1 recommendation: “In adults with hypertension, a goal of < 130 mm Hg systolic BP is recommended to prevent mild cognitive impairment and dementia.” The prior 2017 iteration simply set a class 2a recommendation, meaning that it was considered reasonable to lower BP in hypertensive adults for this purpose.

“Dementia is more prevalent amongst women, so I think that’s important,” said Rosen.

The newer guidelines also emphasize, with greater granularity than before, the need for “close management during pregnancy, aiming for tighter control, defining emergent severe hypertension, and [calling out] the acuity that is needed to treat that,” she noted. “None of what happens in pregnancy [ends after] pregnancy.” Instead, she advised, postpartum care after preeclampsia and other BP-related adverse pregnancy outcomes requires a “forever approach.”

Even when healthy, women tend to see clinicians much more frequently during pregnancy than they otherwise do, making these months an “opportunity to have an enormous impact over a lifetime,” she added.

Although hypertension management is “sort of not sexy,” Rosen added, “I think of it as the most controllable of the traditional risk factors. . . . I am still a practicing clinician and so many people are reluctant to appropriately treat their [hypertension, thinking,] ‘I don’t want to be on a medication. It’s white coat. I don’t need it.’ I think it’s unfortunate.”

Symptoms Without Stenoses

Traditionally, cardiovascular disease has been thought of in terms blockages, but increasing attention is being devoted to patients who suffer from angina, have ischemia, or even have had an MI but still are found to have nonobstructive coronary arteries—conditions referred to ANOCA, INOCA, and MINOCA, respectively.

Women are known to present with atypical symptoms and are disproportionately represented in these various NOCA permutations. For many decades, “when women presented and had clean arteries, we sent them home with Tums or Xanax or, you know, silliness,” said Rosen, who recently gave a talk on sex differences at the AHA 2025 Scientific Sessions.

Only recently has the field started to understand that “ischemic heart disease is a bigger umbrella of different forms of conditions,” she said, adding that this year has been nothing short of “extraordinary” when it comes to fleshing out this concept.

November saw the release of an AHA scientific statement that calls for extra scrutiny when attempting to identify the underlying causes of chest pain in NOCA patients. The report outlines available evidence with the idea of helping clinicians know their options when it comes to testing and treatment, and it describes how recent advances in artificial intelligence, hardware, and software have pointed to a risk continuum between primary and secondary prevention in this area.

“Cardiology is undergoing a transition now from a pure focus on identifying patients with obstructive CAD and treating them aggressively, [sometimes] after they’ve had an MI, to moving sooner [due to] realizing that nonobstructive CAD is not benign—and that it is heterogeneous and that it is common and undertreated,” Leandro Slipczuk, MD, PhD (Montefiore Medical Center, Bronx, NY), vice chair of the writing committee, told TCTMD at the time.

Throughout the year, trials such as WARRIOR, PROMISE, and CorCMR looked into the best strategies for diagnosis and treatment. These trials, said Rosen, “weren’t necessarily practice-changing, [though] they did show the importance of continuing to march along to understand angina, ischemia, and myocardial infarction without obstruction.”

In practice, “telling a man or a woman that ‘Your arteries are clean, [but] we don’t know what you have. So, here’s some medications to take,’ it’s not a particularly satisfying thing either for clinicians or for patients,” she noted. This is why standardizing the diagnostic evaluation is important, as is having conversations about what’s known and unknown.

A Bridge Between Reproductive and CV Health

Rosen highlighted, too, the move toward multidisciplinary collaboration between specialists in women’s reproductive and cardiovascular health. This overlap doesn’t apply only to pregnancy and the immediate postpartum months, she said.

Conditions like polycystic ovary syndrome, endometriosis, and uterine fibroids are often described as “risk enhancers.” Reassuringly, as reported by TCTMD, infertility treatment doesn’t appear to impart higher CV risk. Then, of course, there’s menopause.

“Certainly we know that [in] menopause, hormone therapy does not protect against heart disease, but we’re learning about vasomotor symptoms and sleep disorders” that can appear in that stage of life and negatively affect cardiovascular health, Rosen said. Sleep quality, for example, was added to the AHA’s Life’s Simple 7 a few years back, resulting in Life’s Essential 8.

 All of the above are “opportunities for OB-GYN and cardiovascular science people to work together” to promote women’s risks of heart and brain disease, she noted.

This year, the European Society of Cardiology updated its guidelines on cardiovascular disease and pregnancy to clarify the risks and choices available for women. TCTMD reported on the rising prevalence of CV complications tied to pregnancy, potential genetic explanations for these complications, the harms posed by eclampsia, the link between hypertensive disorders of pregnancy and future atrial fibrillation, the added risk of having twins, and the legacy of high blood pressure among children of women who had poor cardiometabolic health during pregnancy.

Cardio-Kidney-Metabolic Health for Women

A stronger focus on cardio-kidney-metabolic (CKM) health in 2025 also is noteworthy, according to Rosen. Conditions under this umbrella are “more deadly in women,” she said. “It’s clear that there are sex-specific risk factors that need to be studied better,” such as the overlapping effects of high body mass index, hypertension, hyperlipidemia, and diabetes, and renal disease. For example, “we don’t know why hypertension and diabetes are still more potent risk factors in women with regard to chronic kidney disease,” Rosen noted.

CKM, as a framework, puts patients at the center, she continued. “It involves a refined, team-based approach to how we care for these people. In the past, you’d go from a cardiologist to an internist to a kidney specialist, and it was very unaligned care [that] really led to lost opportunities for prevention.”

This year, the PREVENT tool, which takes CKM factors into account when risk-stratifying patients, continued to gain traction: studies showed that it works well irrespective of lipoprotein(a) level and that it can allow young adults to see how they compare to their peers. Other data, however, have sparked discussion by suggesting PREVENT may perform differently across healthcare systems and could reduce the number of candidates for statins and antihypertensives.

Also noteworthy is the widespread use of GLP-1 receptor agonists, known to be particularly popular among women, to address manifold CKM conditions including excess body weight. In June, the American College of Cardiology released a scientific statement calling for cardiologists to add these drugs to their arsenal as a means to encourage weight loss in patients with obesity. The World Health Organization recently endorsed this same tactic, though studies continue to support a role for bariatric surgery as well.

Other Risks Relevant to Women

For Rosen, another theme worthy of attention in 2025 is the uptick in research on conditions “that are either more prevalent in women or different in women with regard to the impact in cardiovascular health.” This list includes autoimmune conditions, migraine with aura, and even the potential for using mammograms to measure breast arterial calcification as a way to gauge women’s cardiovascular risk.

With mammograms, this information comes “free,” so to speak, said Rosen. “It’s part of the mammogram that has been shown to be not causal but somehow linked with increased risk of atherosclerotic heart disease.”

This interest in unique, “sex-specific opportunities, I think has been really exciting,” she concluded.