Early detection in women’s health is critical for identifying cardiovascular risk before symptoms appear.
For decades, cardiovascular disease has remained the leading cause of death in women [1]. Yet new data suggest the trajectory is not improving; it’s worsening.
Recent findings show rising risk across age groups, particularly among younger women. At the same time, many traditional screening approaches continue to rely on markers that identify disease only after it has begun to develop.
A 2026 analysis from the American Heart Association (AHA) predicts that 59.1% of adult women in the United States may have some form of cardiovascular disease by 2050.
Even more concerning, the AHA projects that hypertension, obesity, and diabetes will rise substantially in women over time, with some of the greatest increases occurring in younger women (below the age of 45) [2].
This is not just a public health issue - there’s a major gap in early detection measures, particularly in women.
For most women, cardiovascular risk doesn’t appear suddenly. It develops gradually, sometimes silently, often over decades before symptoms emerge or an issue is flagged via traditional screening methods. Often by the time women are aware they’re at risk, cardiovascular disease may already be well underway.
This raises a critical question: Are we detecting risk early enough to change outcomes?
Why early detection in women’s health matters more than ever
Early detection is foundational to improving long-term cardiovascular outcomes in women.
Cardiovascular disease is progressive. The earlier you can identify cardiovascular risk factors, the more opportunity doctors have to intervene before structural or irreversible changes occur. This may include slowing or reversing metabolic dysfunction, improving vascular health, and implementing more targeted, personalized strategies.
Without early detection, care becomes reactive, focused on managing established disease rather than preventing it.
Younger women may be at increased risk of cardiovascular disease
Younger women are often assumed to be low-risk, but outward appearance doesn’t reliably reflect what’s happening internally. In many cases, early shifts in key biomarkers may signal rising cardiovascular risk long before symptoms appear.
The rise in cardiovascular risk among younger women appears to be driven by a combination of metabolic, lifestyle, and physiologic factors. Earlier onset of insulin resistance, changes in body composition, and more sedentary lifestyles are contributing to risk profiles that may differ from those of previous generations.
But awareness around these risk factors seems to be lacking. Research shows that many younger women don’t perceive themselves to be at risk of heart issues, in part because traditional screening frameworks are not presented to them until later on in life [3].
It’s becoming clearer that preventing cardiovascular risk factors from forming must begin much earlier.
Warning signs of cardiovascular dysfunction go unnoticed
Early changes in cardiovascular health are usually subtle and often develop without obvious symptoms. These include:
Declining VO2 max (a key marker of cardiorespiratory fitness)
Increasing visceral fat despite stable weight
Early insulin resistance
Elevated inflammatory markers
Changes in energy, endurance, or recovery
While these findings don’t meet criteria for established disease, they often signal early, preclinical changes in cardiometabolic physiology already moving in the wrong direction. Left unaddressed, they can progress along a continuum from early dysfunction to overt cardiovascular disease – making this a critical window for intervention.
Traditional screenings are missing early warning signs
Traditional screening typically relies on markers such as cholesterol, blood pressure, and glucose (sugar) levels. These are essential and can certainly reflect early stages of risk, but in practice, they’re often acted on only once they cross treatment thresholds. Borderline abnormal or gradually rising values are frequently dismissed rather than addressed, reinforcing a more reactive model of care.
At the same time, these markers alone don’t capture the full spectrum of early change. Subtle changes in metabolic and vascular function, such as increases in visceral fat or declines in cardiorespiratory fitness, may emerge even earlier and remain undetected.
As a result, younger women may still be classified as “low risk” despite measurable shifts in underlying physiology. This gap highlights two limitations in early detection in women’s health: the absence of screening tools that identify more subtle risk, and the reactive approach of acting on traditional risk factors only when they’re clearly abnormal.
The connection between hormones and cardiovascular health
Cardiovascular risk in women is also shaped by key hormonal and reproductive life stages that are often under-recognized in standard screening models. These include the following factors
![Research shows that early menstruation, classified as 10 years of age or younger and late, or 15 years or older, are both associated with increased CVD risk [4].](https://framerusercontent.com/images/ppoShsI032kVMcxzznU9vbkyvgE.png?width=100&height=100)
The age of first menstruation
Research shows that early menstruation, classified as 10 years of age or younger and late, or 15 years or older, are both associated with increased CVD risk [4].
![Irregular or absent menstrual cycles, particularly in adolescence and early adulthood, have been associated with increased cardiovascular risk, even after accounting for traditional risk factors [5].](https://framerusercontent.com/images/oyu7DFt8lYS9i12ZNu2lj1IU.png?width=100&height=100)
Menstrual irregularities
Irregular or absent menstrual cycles, particularly in adolescence and early adulthood, have been associated with increased cardiovascular risk, even after accounting for traditional risk factors [5].
![PCOS has been associated with significantly elevated cardiovascular risk, including higher rates of heart attack, stroke, and overall cardiovascular disease [6, 7]. Current international guidelines recommend that all women with PCOS be screened for cardiovascular risk factors [8].](https://framerusercontent.com/images/pXAMEo2MmE3ZsrXyLKrHcgeX1aI.png?width=100&height=100)
Polycystic ovary syndrome (PCOS)
PCOS has been associated with significantly elevated cardiovascular risk, including higher rates of heart attack, stroke, and overall cardiovascular disease [6, 7]. Current international guidelines recommend that all women with PCOS be screened for cardiovascular risk factors [8].
![One study shows that women with endometriosis have a 23% higher risk of developing cardiovascular disease compared to those without the reproductive condition [9]. This suggests that chronic inflammation and hormonal factors may play a role in long-term heart health.](https://framerusercontent.com/images/DTn08WskQxGMo03UXvJiY8h6I1k.png?width=100&height=100)
Endometriosis
One study shows that women with endometriosis have a 23% higher risk of developing cardiovascular disease compared to those without the reproductive condition [9]. This suggests that chronic inflammation and hormonal factors may play a role in long-term heart health.
![Fibroids have been associated with sustained increases in atherosclerotic cardiovascular disease risk, with some research showing elevated risk persisting for up to a decade after diagnosis [10].](https://framerusercontent.com/images/pQU5TUZ4kGbryU0yeJ3GH4vbI4.png?width=100&height=100)
Uterine fibroids
Fibroids have been associated with sustained increases in atherosclerotic cardiovascular disease risk, with some research showing elevated risk persisting for up to a decade after diagnosis [10].
![Menopause before age 40 has been associated with a significantly higher lifetime risk of coronary heart disease in both Black and white women, highlighting the role of estrogen in cardiovascular protection [11].](https://framerusercontent.com/images/nIThhLK7CHQBbwDK72pGFRrJbSQ.png?width=100&height=100)
Premature menopause
Menopause before age 40 has been associated with a significantly higher lifetime risk of coronary heart disease in both Black and white women, highlighting the role of estrogen in cardiovascular protection [11].
![These conditions are associated with substantially higher long-term risk, including future hypertension, heart disease, stroke, and heart failure [12,13].](https://framerusercontent.com/images/e131IXFi7E6Ntm0MePrOVda0.png?width=100&height=100)
Hypertensive disorders of pregnancy (preeclampsia, gestational hypertension)
These conditions are associated with substantially higher long-term risk, including future hypertension, heart disease, stroke, and heart failure [12,13].
![Also known as diabetes that happens exclusively during pregnancy, has been linked to increased long-term cardiovascular risk, even after blood sugar levels return to normal postpartum [14].](https://framerusercontent.com/images/l85BJq0uyw9LlWyJjLXqFis0Jwc.png?width=100&height=100)
Gestational diabetes
Also known as diabetes that happens exclusively during pregnancy, has been linked to increased long-term cardiovascular risk, even after blood sugar levels return to normal postpartum [14].
![Preterm birth has been associated with a higher risk of future cardiovascular disease, independent of traditional risk factors [15].](https://framerusercontent.com/images/MsMRyaggHXDvhOl7kFBFwOzfbY.png?width=100&height=100)
Preterm delivery
Preterm birth has been associated with a higher risk of future cardiovascular disease, independent of traditional risk factors [15].
How advanced diagnostics can help improve early detection in women’s health
Early detection in women’s health improves when diagnostics move beyond basic screening. Advanced diagnostics allow for a more comprehensive evaluation of cardiovascular and metabolic health, including:
Cardiovascular imaging to detect early structural changes in coronary arteries
DEXA scans to assess body composition
VO2 max testing to evaluate functional capacity
Expanded biomarker panels (Biograph offers a 30+ marker assessment to provide early insight across key health systems)
What early detection can reveal
Consider a hypothetical Biograph member in her late 30s. Her standard labs fall within normal lab reference ranges. Blood pressure is slightly above goal but not in the hypertensive range, and she maintains a regular exercise routine. Under traditional care, she would likely be considered low risk.
But a more comprehensive assessment reveals:
Slightly elevated visceral fat
Early signs of insulin resistance
VO2 max below expected range
History of preeclampsia during pregnancy and early age at menarche
Individually, these findings may not raise concern. Together, they suggest the early stages of cardiometabolic risk.
With this insight, targeted interventions can be implemented and tracked over time. This is the value of early detection in women’s health: identifying risk before it becomes disease.
The bottom line
Women’s health is at a tipping point.
Cardiovascular risk is emerging earlier than in decades past, while traditional detection methods still detect it too late. This calls for a shift toward earlier and more precise assessment.
Early detection isn’t, however, the endpoint – it’s the leverage point. The goal is not only to identify risk but to change its trajectory when the risk is still modifiable.
Outcomes improve when early signals are recognized, translated into meaningful action, and tracked over time.
Common questions about women’s cardiovascular health
Why is early detection important in women’s health?
Early detection allows risk to be identified before symptoms appear, when intervention may be most effective. Many cardiovascular conditions often develop silently over time, especially in women.
Why is heart disease often missed in women?
Women may present with different or less obvious symptoms, and traditional screening often focuses on later-stage markers rather than early physiologic changes that can point to cardiovascular and metabolic dysfunction.
What are some early signs of cardiovascular risk in women?
Early signs may include reduced cardiorespiratory fitness, increased visceral fat, insulin resistance, and changes in inflammatory markers, often before symptoms develop. Traditional markers such as cholesterol, blood pressure, and glucose remain important, and can reflect early signs of cardiovascular risk when values are rising or borderline – even if they have not crossed treatment thresholds.
At what age should women start thinking about cardiovascular health?
Sooner than most women think! The time to start thinking about cardiovascular health is now , ideally before risk is clearly visible on standard screening. Establishing a comprehensive baseline focused on an individualized cardiovascular and metabolic risk assessment can help women get ahead of disease.
About the author
Dr. Chen is a Clinic Physician at Biograph NYC. She joined Biograph after building her expertise at the intersection of innovation and academia. Her foundation includes an MD from Tulane University School of Medicine and completing both residency and Chief Residency in Internal Medicine at UCLA.
Clinical references
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