Assessment of Cardiovascular Risk in Women: Progress so Far and Progress to Come

Abstract

Lena Tschiderer,1,2 Lisa Seekircher,1 Peter Willeit,1,3 Sanne AE Peters2,4,5 1Institute of Health Economics, Medical University of Innsbruck, Innsbruck, Austria; 2Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; 3Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; 4The George Institute for Global Health, School of Public Health, Imperial College London, London, UK; 5The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, AustraliaCorrespondence: Lena Tschiderer, Institute of Health Economics, Medical University of Innsbruck, Innsbruck, Austria, Tel [phone], Email [email protected]: Cardiovascular disease is the leading cause of death in women worldwide. Nonetheless, there exist several uncertainties in the prediction, diagnosis, and treatment of cardiovascular disease in women. A cornerstone in the prediction of cardiovascular disease is the implementation of risk scores. A variety of pregnancy- and reproductive-factors have been associated with lower or higher risk of cardiovascular disease. Consequently, the question has been raised, whether these female-specific factors also provide added value to cardiovascular risk prediction. In this review, we provide an overview of the existing literature on sex differences in the association of established cardiovascular risk factors with cardiovascular disease and the relation between female-specific factors and cardiovascular risk. Furthermore, we systematically reviewed the literature for studies that assessed the added value of female-specific factors beyond already established cardiovascular risk factors. Adding female-specific factors to models containing established cardiovascular risk factors has led to little or no significant improvement in the prediction of cardiovascular events. However, analyses primarily relied on data from women aged ≥ 40 years. Future investigations are needed to quantify whether pregnancy-related factors improve cardiovascular risk prediction in young women in order to support adequate treatment of risk factors and enhance prevention of cardiovascular disease in women.Keywords: sex differences, female-specific factors, cardiovascular disease, risk prediction, added value

Keywords

• sex differences
• female-specific factors
• cardiovascular disease
• risk prediction
• added value