The Warning Starts Before Midlife: How Pregnancy Predicts, and Shapes, Women’s Heart Disease
From preeclampsia to hypertension, the strongest clues often arrive decades before the first heart attack.
Why women’s heart risk is rising, and why the clock starts earlier
The path forward: treat pregnancy history like a heart health vital sign
Why women’s heart risk Is rising, and why the clock starts earlier
Heart disease is often framed as a problem that strikes later in life: men first and women later. But across the U.S., the trend line for women is moving in the wrong direction: more high blood pressure, more obesity, more diabetes, and more women living long enough for those risks to turn into heart disease and stroke. That slow build, year after year, is what makes the American Heart Association’s warning about the next few decades so alarming.
American Heart Association (AHA) researchers forecast that by 2050, nearly 6 in 10 U.S. women will have at least one type of cardiovascular disease. The AHA projects that high blood pressure in adult women will rise from 49% in 2020 to 59% in 2050; obesity, from 44% to 61%; and diabetes, from 15% to 25%.
The most urgent lesson may be about timing. Cardiovascular risk is building earlier, and pregnancy is a major hinge point. Complications like preeclampsia and gestational hypertension can be early warning signs for future heart disease; at the same time, underlying cardiovascular risks can make pregnancy itself more dangerous. In plain terms: the relationship is bidirectional, and ignoring either is how the forecast becomes reality.
At first, it can feel like a small thing: a cuff on your arm, a few seconds of squeezing, and a number on a screen. But that number, especially blood pressure, is one of the biggest reasons the AHA now says the future of women’s heart health in the U.S. could look so rough.
Longer lives, more time for risk to accumulate
A key reason the total burden rises is simple: women generally live longer than men, and heart risk rises with age. The AHA notes that women make up about half of new and existing cardiovascular disease cases and, because women tend to outlive men, the long-term burden and costs are especially high.
This creates a tough paradox. Medicine can help more women survive earlier problems, but if prevention is weak, more women will live long enough to develop chronic heart disease later.
Pregnancy as an early warning system for heart disease
The AHA’s forecast is not only about older women.
One reason experts are paying closer attention to younger women is that pregnancy complications can act like an early warning sign. Hypertensive disorders of pregnancy — like gestational hypertension and preeclampsia — are linked to a two-times higher risk of later cardiovascular disease, even for women who did not have major risk factors before pregnancy.
This matters because it changes the timeline. Heart disease is not just a “later in life” issue. For many women, the earliest red flags show up in their 20s and 30s, when there is still time to prevent a lifetime of problems.
Who bears the brunt: race, geography, and access to care
The AHA projects American Indian/Alaska Native or multiracial, Black, and Hispanic women will be hit hardest by these trends.
They also point to “deep inequities” tied to race and ethnicity and describe how overlapping barriers, like poverty, low health literacy, rural residence, and chronic stress, can stack on top of one another and worsen heart outcomes.
The path forward: treat pregnancy history like a heart health vital sign
Prevention is the most efficient and least costly path forward, but it has to happen both in clinics and in communities.
In the clinic, the biggest wins are still basic, even if they are not easy: finding and controlling high blood pressure, preventing and treating diabetes, and treating obesity with effective tools that people can actually access.
Pregnancy needs to be treated as part of heart care, not a separate lane. A history of hypertensive disorders of pregnancy should trigger real follow-up, because it can signal higher cardiovascular risk years before a heart attack or stroke.
Outside the clinic, the public health answer is that healthier communities make healthier hearts. That means neighborhoods with safe places to walk, affordable healthy food, stable housing, less chronic stress, and accessible and affordable healthcare.