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The Role of Sex-Specific Risk Factors in the Risk Assessment of Atherosclerotic Cardiovascular Disease for Primary Prevention in Women

  • Women and Ischemic Heart Disease (P. Kohli, Section Editor)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Robust evidence is emerging regarding the contribution of sex-specific risk factors to a woman’s unique risk of atherosclerotic cardiovascular disease (ASCVD). This review summarizes the available literature regarding the association of sex-specific risk factors and ASCVD in women.

Recent Findings

The American College of Cardiology and American Heart Association Guidelines recommend estimation of 10-year risk of a first ASCVD event using the 2013 Pooled Cohort Equations. This can be further personalized by identifying sex-specific risk factors present in a woman’s history. There are multiple vulnerable periods across a woman’s life course that are associated with increased risk of ASCVD. Risk factors across the reproductive life course that have been shown to correlate with higher risk for future ASCVD include early menarche, adverse pregnancy outcomes (such as pre-eclampsia or preterm birth), and early natural or surgical menopause. In addition, certain conditions that are more common among women, including autoimmune diseases, history of chest irradiation, and certain chemotherapies, also need to be considered. Finally, risk assessment can be refined with subclinical disease imaging (coronary calcium score) if there remains uncertainty about clinical management with lipid-lowering therapies for primary prevention after inclusion of these risk enhancers.

Summary

Risk assessment for ASCVD in women requires a personalized approach that incorporates sex-specific risk factors to guide primary prevention measures, such as lipid-lowering therapies. Coronary calcium score imaging may also help further refine risk assessment, but no clinical trials conducted to date have addressed this question.

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Funding

This research was supported by grants from the National Institutes of Health/National Heart, Lung, and Blood Institute (KL2TR001424), and the American Heart Association (AHA#19TPA34890060) to Dr. Khan. Research reported in this publication was supported, in part, by the National Institutes of Health’s National Center for Advancing Translational Sciences, Grant Number KL2TR001424 (SSK). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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  1. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA

    Priya M. Freaney, Sadiya S. Khan, Donald M. Lloyd-Jones & Neil J. Stone

  2. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Priya M. Freaney, Sadiya S. Khan, Donald M. Lloyd-Jones & Neil J. Stone

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Correspondence to Priya M. Freaney.

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Dr. Mehta has nothing to disclose.

Dr. Khan reports grants from NIH/NCATS and grants from American Heart association, which are outside the submitted work.

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Freaney, P.M., Khan, S.S., Lloyd-Jones, D.M. et al. The Role of Sex-Specific Risk Factors in the Risk Assessment of Atherosclerotic Cardiovascular Disease for Primary Prevention in Women. Curr Atheroscler Rep 22, 46 (2020). https://doi.org/10.1007/s11883-020-00864-6

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