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

Standard cardiovascular risk calculators were largely built on data from men, and they ask the same handful of questions of everyone. This review argues that for women, those questions miss part of the story — a part written in reproductive and hormonal history.

Drawing on guideline statements, meta-analyses, and cohort data, the authors assemble the sex-specific signals that raise a woman’s later cardiovascular risk: adverse pregnancy outcomes such as preeclampsia and gestational diabetes, premature ovarian failure, polycystic ovary syndrome, early menarche, autoimmune disease, and even lactation history. None of these appear in the conventional pooled-cohort estimate, yet each flags risk the standard tool would understate.

The practical takeaway is a change in the history-taking itself: ask every woman about pregnancy complications, the timing of menarche and menopause, contraceptive use, and autoimmune conditions — then let the answers shift screening frequency and lower the threshold for starting prevention earlier.

The resistance is workflow-shaped. Clinicians and quality programs anchored to a single simplified calculator are slow to fold in risk enhancers that don’t fit the existing checkbox.

We rate the evidence moderate: a peer-reviewed synthesis in a leading journal, but a narrative one, without new data or systematic methodology, from authors with the usual society and guideline affiliations. Its clinical significance scores higher, because the population affected is roughly half of all patients, and acting on these factors could surface high-risk women the standard model overlooks — provided the history is actually taken.