Beyond Traditional Factors: Refining Cardiovascular Risk Assessment in Women
Recent research highlights the need to broaden the scope of cardiovascular risk assessment in women, moving beyond established factors to incorporate psychosocial, environmental, and reproductive elements. An editorial in Heart emphasizes that a more nuanced approach could yield important “pragmatic benefits.”
Expanding the Risk Profile
Studies are increasingly focusing on previously underappreciated factors impacting women’s heart health. A study published in The Heart (Shan S et al., 2025 Aug 4:heartjnl-2025-326345) analyzed data from 233,125 women participating in the UK Biobank, followed for a median of 13.7 years (with 6,077 developing heart failure). This research examined 22 risk factors,ranging from well-known contributors like hypertension to those historically less emphasized,such as depression and socioeconomic hardship,and those specific to women,like early menopause.
While hypertension remained the strongest single risk factor for heart failure, the study identified a history of chronic inflammatory disease, early menopause, and early frist pregnancy as “key” contributors. This suggests a need to integrate these elements into existing risk scores.
The Impact of Domestic Violence and Harassment
Emerging evidence also points to a significant, yet often overlooked, cardiovascular risk factor: domestic violence, including harassment. Research published in Circulation (Lawn RB et al.,2025 Sep 2;152(9):570-81) and an accompanying editorial advocate for greater consideration of this issue,noting women are disproportionately affected.
The Circulation study, conducted with over 66,000 women from the American Nurses’ Health Study 2 cohort (7,721 of whom reported experiencing harassment), found a link between harassment and increased risk of myocardial infarction or stroke. Women reporting harassment had a 41% increased risk of self-reported cardiovascular disease (HR = 1.41) even after adjusting for sociodemographic factors, childhood experiences, health behaviors, treatments, and depressive symptoms.
The editorial accompanying the study suggests the need for a dedicated movement addressing domestic violence as a cardiovascular risk factor, drawing a parallel to the “me too” movement. (Guilt JY et al., Heart 025 September 16, 1625705).
These findings underscore the importance of a holistic approach to cardiovascular risk assessment in women, acknowledging the complex interplay of biological, psychological, social, and environmental factors.
