Combatting Cardiovascular Risk in Postpartum and Menopausal Women, With Amy Sarma, MD

Women’s cardiovascular disease has long been a comparatively understudied sphere of cardiology as a whole – but in recent years, this sphere is positioned for a major reversal, particularly in such tumultuous times as postpartum and menopause.

At the American College of Cardiology (ACC) Scientific Sessions 2026, the omnipresent issue of women’s access to cardiovascular care was again highlighted. In a series of presentations chaired in part by Amy Sarma, MD, co-director of the Corrigan Women’s Heart Health Program and Cardiovascular Disease and Pregnancy Programs at the Massachusetts General Hospital, as well as the Cathy E. Minehan Endowed Chair in Cardiology, the focus fell on 2 periods of women’s lives in particular, both of which are inherently transitory – the postpartum period and menopause.

“We’ve increasingly discovered that women are not just little men – we have unique sex-specific risk factors and differences in the types of cardiovascular conditions for which there is a greater susceptibility,” Sarma told HCPLive in an exclusive interview. “It’s very exciting that the ACC is increasingly covering topics highlighting these sex-specific differences – there’s a lot of excitement in this space that there hasn’t necessarily been in the past.”

A 2024 Scientific Statement from the American Heart Association (AHA) highlighted the risk of cardiovascular disease after adverse pregnancy outcomes, including hypertensive disorders of pregnancy, gestational diabetes, fetal growth restriction, and placental abruption. These conditions can directly influence the lifetime risk of atherosclerotic cardiovascular disease (ASCVD), heart failure, stroke, vascular dementia, and chronic kidney disease (CKD).1

However, despite these associations, at the time of the statement’s writing, guidelines lacked recommendations to reduce cardiovascular disease risk and optimize health after adverse pregnancy outcomes. The fourth trimester, defined as the 12 weeks after delivery, is widely understood to be an optimal time for cardiovascular care to reduce maternal morbidity and improve transitions for postpartum patients.1

Unlike the postpartum period, menopause is a physiologic event occurring in all women at roughly 52 years of age. Given the current life expectancy among women of 81 years, this results in roughly 1/3 of a woman’s life spent in menopause. Although women have a comparatively lower prevalence of cardiovascular disease than men, these rates exhibit a substantial increase after menopause, typically manifesting around 10 years after.2

A 2021 review attempts to qualify this increase, attributing it largely to the similarly increased prevalence of adverse risk factors that often accompany menopause. These include insulin resistance, dyslipidemia, fat redistribution, and other critical factors, the increase of all of which is thought to begin during the menopausal transition period.2

Sarma spoke to the next steps cardiology should take to provide for women during these transitional periods of their lives. She highlighted more intensive and frequent screening for common cardiovascular risk factors, as well as increasing access to critical care among female patients.

“We need to think about being innovative in the way that we deliver care right now, particularly if we take, for example, the postpartum period,” Sarma said. “This is a period of time where we know that there are dynamic changes in the hemodynamics of patients, occurring on even a daily basis. While we routinely assess and reassess women during their pregnancy, their connection to care really falls off in that postpartum period where they remain at higher risk, but don’t have that same access to care.”

Editors’ Note: Sarma reports disclosures with King Pharmaceuticals, now part of Pfizer.

References

1. Lewey J, Beckie TM, Brown HL, et al. Opportunities in the Postpartum Period to Reduce Cardiovascular Disease Risk After Adverse Pregnancy Outcomes: A Scientific Statement From the American Heart Association. Circulation. 2024;149(7):e330-e346. doi:10.1161/CIR.0000000000001212

2. Nair AR, Pillai AJ, Nair N. Cardiovascular Changes in Menopause. Curr Cardiol Rev. 2021;17(4):e230421187681. doi:10.2174/1573403X16666201106141811