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Under-recognized cardiovascular risk enhancers in women: A call to rethink clinical assessment on risk stratification
Albertina M Ghelfi1,2,3, Gustavo J Staffieri3,4, Mildren A Del-Sueldo3,5
1Unidad de Hipertensión Arterial y Riesgo Cardiovascular, Hospital Escuela Eva Perón. Granadero Baigorria, Santa Fe, Argentina.
Insights
Women with cardiovascular risk enhancers (CVRE) have increased arterial stiffness (AS), indicated by higher pulse wave velocity (PWV). This highlights the need to consider CVRE in women's cardiovascular health assessments.
Area of Science:
- Cardiovascular Medicine
- Vascular Physiology
- Women's Health
Background:
- Traditional cardiovascular risk (CVR) stratification often overlooks CVR enhancers (CVRE).
- Women may have under-recognized CVREs contributing to arterial stiffness (AS), a precursor to cardiovascular disease.
- Arterial stiffness, measured by carotid-femoral pulse wave velocity (cf-PWV), is a key indicator of vascular health.
Purpose of the Study:
- To determine cf-PWV values and assess AS in women with low CVR but presence of CVRE.
- To compare cf-PWV and AS between women with CVRE and a control group.
- To investigate the relationship between CVRE and arterial stiffness in women.
Main Methods:
- Multicentric cross-sectional study conducted in Argentina (2022-2024).
- Included 280 women (18-59 years) with low traditional CVR (<5% 10-year risk) and controlled blood pressure.
- Group 1 (N=174) had CVREs (e.g., history of preeclampsia, autoimmune diseases, oncological treatment, abortions, early menopause, mood disorders, HIV). Group 2 (N=106) was a control group.
- Exclusion criteria included hypertension, diabetes, target organ damage, chronic kidney disease, current smoking, prior CV events, and specific medications.
Main Results:
- Women with CVRE (Group 1) exhibited significantly higher cf-PWV (7.02±1.20 vs. 5.71±0.86, p < 0.0001) and a higher frequency of AS (52.9% vs. 0.9%, p < 0.0001) compared to controls.
- A sub-analysis in women with stricter blood pressure control (<130/85 mmHg office BP, <121 mmHg central systolic BP) confirmed higher cf-PWV (6.70±1.07 vs. 5.62±0.78, p < 0.0001) and AS (43.4% vs. 0.0%, p < 0.0001) in the CVRE group.
- Multivariate analysis confirmed that cf-PWV values were significantly related to the presence of CVRE (p < 0.0001).
Conclusions:
- Women with cardiovascular risk enhancers (CVRE) demonstrate significantly increased arterial stiffness (AS).
- Higher cf-PWV values in women with CVRE underscore the importance of these factors in vascular health.
- These findings suggest that CVRE should be integrated into cardiovascular risk assessment for women.
Objectives:
Traditional cardiovascular risk (CVR) stratification does not consider CVR enhancers (CVRE). Women present under-recognized CVRE factors that may lead to arterial stiffness (AS). AS is associated with long-term cardiovascular disease. AS can be determined by carotid-femoral pulse wave velocity (cf-PWV). In women with low-CVR and a CVRE, our objective was to determine cf-PWV values and AS, and to compare with a control group.
Material And Methods:
Multicentric cross-sectional study, from 2022 to 2024 in Argentina. Included women between 18 and 59 years-old, without traditional CVR-factors, low (<5 %) 10-year CVR, and office blood-pressure (BP) <140/90 mmHg. Inclusion criteria: Group 1: presence of a CVRE (history of gestational hypertension, preeclampsia; autoimmune rheumatic or hematological disease in clinical remission; previous oncological treatment in current complete remission; history of abortions; early menopause or menarche; anxiety or depression disorder; human immunodeficiency virus infected virally suppressed). Group-2: women who attended routine control. Exclusion criteria: hypertension; diabetes; target organ damage; chronic kidney disease; current smoking; history of CV-event; statins, aspirin, or antihypertensive treatment.
Results:
Included 280 women: Group-1 (N = 174); Group-2 (N = 106). Group-1 showed higher cf-PWV: 7.02±1.20 vs. 5.71±0.86 (p < 0.0001) and higher AS frequency: 52.9 % vs. 0.9 % (p < 0.0001). A sub-analysis performed in the 199 women with office-BP <130/85 mmHg and central (aortic) systolic-BP was <121 mmHg also showed higher cf-PWV 6.70±1.07 vs. 5.62±0.78 (p < 0.0001) and higher AS: 43.4 % vs. 0.0 % (p < 0.0001) in Group-1. cf-PWV values maintain related with CVRE presence (p < 0.0001) at multivariate analysis.
Conclusions:
Women with CVRE showed greater cf-PWV and higher frequency of AS.
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