High Risk, High Stakes: Optimizing Cardiovascular Risk Assessment in Women

Women worldwide are at risk for cardiovascular disease (CVD), with CVD mortality accounting for > 50% of deaths in women in the United States. CVD risk stratification in women was traditionally similar to that in men, leading to under-detection of disease in women. Recently women-specific guidelines have raised awareness of female-specific risk factors. Pre-eclampsia has a striking correlation with increased CVD events in women decades after pregnancy. New serum markers of CVD such as C-reactive protein show promise of early detection but have uncertain clinical value since they may not help re-stratify women at intermediate risk. Imaging tests such as coronary artery calcium scoring and carotid intimal medial thickness have been investigated in women. They too may fail to recognize women at long-term increased risk and how to apply these tests clinically is uncertain. This article critically reviews new developments in risk stratification of CVD in women.