The Use of Sex-Specific Factors in the Assessment of Women’s Cardiovascular Risk

Abstract

Cardiovascular disease (CVD) is the leading cause of death among women in the United States. As compared with men, women are less likely to be diagnosed appropriately, receive preventive care, or be treated aggressively for CVD. Sex differences between men and women have allowed for the identification of CVD risk factors and risk markers that are unique to women. The 2018 American Heart Association/American College of Cardiology Multi-Society cholesterol guideline and 2019 American College of Cardiology/American Heart Association guideline on the primary prevention of CVD introduced the concept of risk-enhancing factors that are specific to women and are associated with an increased risk of incident atherosclerotic CVD in women. These factors, if present, would favor more intensified lifestyle interventions and consideration of initiation or intensification of statin therapy for primary prevention to mitigate the increased risk. In this primer, we highlight sex-specific CVD risk factors in women, stress the importance of eliciting a thorough obstetrical and gynecological history during cardiovascular risk assessment, and provide a framework for how to initiate appropriate preventive measures when sex-specific risk factors are present.

Sex Differences in Urate Handling

“…HUA is just one of many conditions that have observable sex differences, as differing pathologies based on sex have been observed in a variety of fields [14][15][16][17] including cardiovascular [18][19][20][21], neurological [22][23][24][25], immunological [26][27][28], and renal diseases [29][30][31][32][33]. The architecture of the female kidney is likely distinct from that of the male kidney [34], given women have a lower blood pressure than men [35], women are less likely to develop acute kidney injury than men [36,37], women demonstrate improved tolerance to renal ischemia [38,39], and women are protected from renal and cardiovascular disease before menopause as compared to men [40,41].…”

The risk and added values of the atherosclerotic cardiovascular risk enhancers on prediction of cardiovascular events: Tehran lipid and glucose study

“…It is thought that women with a history of dysglycemia have an underlying cardio-metabolic phenotype that makes them susceptible to GDM and CVD. Glucose screening during pregnancy could identify women at risk for CVD [ 35 ].…”

Pharmacological Approaches to Controlling Cardiometabolic Risk in Women with PCOS

“…Elucidating the factors that increase CV risk in PCOS would help refine current therapeutic strategies. Traditional CV risk factors have received attention [ 3 ] but are associated with emerging sex-specific risk factors such as adverse pregnancy outcomes (e.g., pre-eclampsia and gestational diabetes), ovarian failure, and risk factors outside the realm of pregnancy and menopause such as PCOS, breast cancer, autoimmune disease, and hormone-based contraceptive methods [ 10 ]. Based on a recent metanalysis, total cholesterol, high-density lipoprotein (HDL) cholesterol, fasting glucose, and fasting insulin levels appear to increase specifically in women with PCOS compared with fertile women [ 11 ].…”