Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Jul 16;22(9):46.
doi: 10.1007/s11883-020-00864-6.

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

Priya M Freaney  1   2 , Sadiya S Khan  3   4 , Donald M Lloyd-Jones  3   4 , Neil J Stone  3   4
Affiliations
Review

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

Priya M Freaney et al. Curr Atheroscler Rep. .

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. 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.

Keywords: Adverse pregnancy outcomes; Atherosclerotic cardiovascular disease; Primary prevention; Risk prediction; Sex-specific risk factors.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest

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.

Dr. Lloyd-Jones has nothing to disclose.

Dr. Stone has nothing to disclose.

Figures

Figure 1.
Figure 1.
Personalization of ASCVD Risk Prediction to include sex-specific risk enhancing factors (as suggested in 2018 Prevention Guidelines)
Figure 2.
Figure 2.
Vulnerable periods of cardiovascular disease risk across a woman’s life course
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

  • Traditional Therapeutics and Potential Epidrugs for CVD: Why Not Both?
    Gladwell LR, Ahiarah C, Rasheed S, Rahman SM, Choudhury M. Gladwell LR, et al. Life (Basel). 2023 Dec 22;14(1):23. doi: 10.3390/life14010023. Life (Basel). 2023. PMID: 38255639 Free PMC article. Review.
  • Body Mass Index, Adverse Pregnancy Outcomes, and Cardiovascular Disease Risk.
    Khan SS, Petito LC, Huang X, Harrington K, McNeil RB, Bello NA, Bairey Merz CN, Miller EC, Ravi R, Scifres C, Catov JM, Pemberton VL, Varagic J, Zee PC, Yee LM, Ray M, Kim JK, Lane-Cordova AD, Lewey J, Theilen LH, Saade GR, Greenland P, Grobman WA; NICHD nuMoM2b and NHLBI nuMoM2b Heart Health Study Networks. Khan SS, et al. Circ Res. 2023 Oct 13;133(9):725-735. doi: 10.1161/CIRCRESAHA.123.322762. Epub 2023 Oct 10. Circ Res. 2023. PMID: 37814889 Free PMC article.
  • Brazilian Guideline on Menopausal Cardiovascular Health - 2024.
    de Oliveira GMM, de Almeida MCC, Arcelus CMA, Espíndola L, Rivera MAM, da Silva-Filho AL, Marques-Santos C, Fernandes CE, Albuquerque CJDM, Freire CMV, Izar MCO, Costa MENC, de Castro ML, Lemke VMG, de Lucena AJG, Brandão AA, Macedo AVS, Polanczyk CA, Lantieri CJB, Nahas EP, Alexandre ERG, Campana EMG, Bragança ÉOV, Colombo FMC, Barbosa ICQ, Rivera IR, Kulak J, Moura LAZ, Pompei LM, Baccaro LFC, Barbosa MM, Rodrigues MAH, Albernaz MA, de Decoud MSP, Paiva MSMO, Sanchez-Zambrano MB, Campos MDSB, Acevedo M, Ramirez MS, de Souza OF, de Medeiros OO, de Carvalho RCM, Machado RB, da Silva SCTF, Rodrigues TCV, Avila WS, da Costa-Paiva LHS, Wender MCO. de Oliveira GMM, et al. Rev Bras Ginecol Obstet. 2024 Oct 15;46:e-rbgo100. doi: 10.61622/rbgo/2024rbgo100. eCollection 2024. Rev Bras Ginecol Obstet. 2024. PMID: 39530071 Free PMC article. No abstract available.
  • High Prevalence of Asymptomatic Intracranial Atherosclerosis in Elder Women With Tubal Ligation: Result From a Community-Based Study in Shandong, China.
    Ma X, Sang S, Zhao Y, Wang X, Ji X, Shao S, Wang G, Xue F, Du Y, Lv M, Sun Q. Ma X, et al. Front Cardiovasc Med. 2022 Mar 2;9:830068. doi: 10.3389/fcvm.2022.830068. eCollection 2022. Front Cardiovasc Med. 2022. PMID: 35310999 Free PMC article.
  • PlacEntal Acute atherosis RefLecting Subclinical systemic atherosclerosis in women up to 20 years after pre-eclampsia (PEARLS): research protocol for a cohort study.
    Jansen G, Alers RJ, Janssen EB, Jorissen LM, Morina-Shijaku E, Severens-Rijvers C, van 't Hof A, van Drongelen J, Scholten RR, Al-Nasiry S, Stevens D, Ganzevoort W, Gordijn S, Cornette J, Mihl C, Kietelaer B, Ghossein-Doha C, Spaanderman ME. Jansen G, et al. BMJ Open. 2025 May 24;15(5):e100542. doi: 10.1136/bmjopen-2025-100542. BMJ Open. 2025. PMID: 40413047 Free PMC article.
See all "Cited by" articles

References

    1. Heron M. Deaths: Leading Causes for 2017. National Vital Statistics Report. 2019;68(6). - PubMed
    1. World health statistics 2019: monitoring health for the SDGs, sustainable development goals. World Health Organization; 2019.
    1. Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S1–45. - PubMed

    1. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol. Journal of the American College of Cardiology. 2019;73(24):e285–e350.

      ** Guideline document that highlights importance of incorporating risk enhancing factors and sex-specific risk factors into primary prevention risk assessment.

    1. Lloyd-Jones DM, Braun LT, Ndumele CE, Smith SC Jr., Sperling LS, Virani SS, et al. Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease: A Special Report From the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2019;73(24):3153–67. - PubMed

Publication types