Pregnancy and Reproductive Risk Factors for Cardiovascular Disease in Women

Beyond conventional risk factors for cardiovascular disease, women face an additional burden of sex-specific risk factors. Key stages of a woman's reproductive history may influence or reveal short- and long-term cardiometabolic and cardiovascular trajectories. Early and late menarche, polycystic ovary syndrome, infertility, adverse pregnancy outcomes (eg, hypertensive disorders of pregnancy, gestational diabetes, preterm delivery, and intrauterine growth restriction), and absence of breastfeeding are all associated with increased future cardiovascular disease risk. The menopause transition additionally represents a period of accelerated cardiovascular disease risk, with timing (eg, premature menopause), mechanism, and symptoms of menopause, as well as treatment of menopause symptoms, each contributing to this risk. Differences in conventional cardiovascular disease risk factors appear to explain some, but not all, of the observed associations between reproductive history and later-life cardiovascular disease; further research is needed to elucidate hormonal effects and unique sex-specific disease mechanisms. A history of reproductive risk factors represents an opportunity for comprehensive risk factor screening, refinement of cardiovascular disease risk assessment, and implementation of primordial and primary prevention to optimize long-term cardiometabolic health in women.

Automated summary

In addition to conventional risk factors, women also face sex-specific risk factors for cardiovascular disease. Key stages of a woman's reproductive history, such as early and late menarche, polycystic ovary syndrome, infertility, adverse pregnancy outcomes, and absence of breastfeeding, are associated with increased future cardiovascular disease risk. The menopause transition period also represents an accelerated cardiovascular disease risk, with timing, mechanism, and symptoms of menopause playing a role. Differences in conventional risk factors explain some, but not all, of the observed associations between reproductive history and cardiovascular disease; further research is needed to understand hormonal effects and unique sex-specific mechanisms. A history of reproductive risk factors provides an opportunity for comprehensive screening, refinement of risk assessment, and implementation of prevention strategies to optimize women's long-term cardiometabolic health.