Under-recognized cardiovascular risk enhancers in women: A call to rethink clinical assessment on risk stratification

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.