Prof Angela Maas, University Medical Center, The Netherlands

Sex-specific factors related to hormonal and reproductive status are known to relate to CVD risk. When considering all age-groups together, reproductive and pregnancy related disorders do not seem to be relevant in 10 years risk estimation (1). However, when focusing on younger patients (< 55 years) evidence is increasing that assessment of female-specific risk factors may indeed add to identify women at higher risk. This is especially important as young women are considered to be at low risk, until a first premature event has occurred. Reproductive and pregnancy-related factors may predispose to earlier signs of endothelial dysfunction, vascular inflammation and premature atherosclerosis. Recently, the Dutch Society of Obstetrics and Gynaecology published a first national multidisciplinary guideline for cardiovascular risk management after reproductive and pregnancy-related disorders, which was endorsed by the nationwide cardiology, internal medicine and GP societies (2). A systematic review was done on hypertensive pregnancy disorders, preeclampsia, miscarriages, polycystic ovary syndrome and premature ovarian insufficiency. Gestational diabetes was not studied as this had been done in another guideline. Recommendations were based on the number and quality of the studies and the presence or absence of a RR>2 of developing CVD events and/or risk factors from the meta-analysis. For all reproductive and pregnancy-related disorders a moderate increased relative risk was found for overall CVD, except for preeclampsia (relative risk 2.15, 95% confidence interval 1.76–2.61). Of note is that for most hormonal and reproductive factors long-term follow-up studies are still relatively scarce and need more attention. Preeclampsia, which occurs in 2-3% of pregnancies, has now also been acknowledged in the latest 2016 ESC guidelines CVD prevention and should be routinely assessed in our female patients (3). Follow-up should contain regular blood pressure measurements, which can also be done by self-measurements. Adherence to a healthy lifestyle and early treatment of modifiable risk factors if needed is strongly recommended.


  1. Parikh NI, Jeppson RP, Berger JS, Eaton CB, Kroenke CH, LaBlanc ES, et al. Reproductive Risk Factors and Coronary Heart Disease in the Women’s Health Initiative Observational Study. Circulation. 2016 ; 133(22): 2149-58.
  2. Heida KY, Bots ML, de Groot CJ, van Dunné FM, Hammoud NM, Hoek A, Laven JS, Maas AH, Roeters van Lennep JE, Velthuis BK, Franx A. Cardiovascular risk management after reproductive and pregnancy-related disorders: A Dutch multidisciplinary evidence-based guideline. Eur J Prev Cardiol. 2016 Jul 18. pii: 2047487316659573. [Epub ahead of print] Review.
  3. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts): Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart Journal  2016; 37(29):2315-81.