Sex-specific differences in cardiovascular risk factors and implications for cardiovascular disease prevention in women

Cardiovascular disease prevention in women – the current state in 2023

“…While these tools are a reasonable starting framework, it is well acknowledged that these risk calculators, which only incorporate demographics and traditional risk factors, may both overestimate and underestimate risk in certain populations. Numerous studies have demonstrated the need to account for risk factors specific to women, including early menarche, PCOS, adverse pregnancy outcomes (APOs) and early menopause, as well as chronic inflammatory conditions that are more prevalent among women, in current risk assessment models [2,3 ▪▪ ,6]. Acknowledging some of the limitations with traditional 10-year risk calculators, the 2019 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline on the Primary Prevention of CVD [4] and the European Society of Cardiology (ESC) Guideline on CVD Prevention [5] additionally include ‘risk-enhancers’ (ACC/AHA) or ‘risk-modifiers’ (ESC), conditions that would place an individual into a higher risk category where intensification of preventive efforts (such as initiation of statin therapy) may be warranted.…”

“…The average age of menarche is about 12 years, with early menarche typically defined as 11 years or less. Early menarche has been associated with 15-30% excess risk for incident CVD [2,6] and a 9% risk of incident heart failure in a recent UK Biobank study [7]. The risk of CVD associated with early menarche is concerning, given the linear decrease in the mean age of menarche observed in the U.S. from 1995 to 2017 [8].…”

“…The risk of CVD associated with early menarche is concerning, given the linear decrease in the mean age of menarche observed in the U.S. from 1995 to 2017 [8]. Although the mechanism by which early menarche increases CVD risk has yet to be fully elucidated, multiple studies have demonstrated that early menarche is associated with dyslipidemia, elevated blood pressure, and obesity in adulthood [2,6,9].…”

“…Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality for women in the United States (U.S.) [1]. While traditional risk factors apply to both sexes, some factors such as hypertension, smoking, obesity, and type 2 diabetes (T2D) are more prevalent or confer a greater relative risk for CVD in women [2]. Additionally, there are conditions that are female-specific or female-predominant that also confer increased CVD risk.…”

“…Additionally, there are conditions that are female-specific or female-predominant that also confer increased CVD risk. These include hormonal factors [e.g., early menarche, polycystic ovary syndrome (PCOS), premature menopause], pregnancy-related conditions (e.g., gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), preterm delivery), and autoimmune diseases [e.g., systemic lupus erythematosus (SLE), rheumatoid arthritis (RA)] that can increase cardiovascular risk [2,3 ▪▪ ]. Identifying and managing these specific risk factors has become a key component of prevention strategies…”