Cardiovascular Risk Enhancers in Women Across the Life Course: Toward an Integrated Prevention Framework

Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality among women worldwide. Although conventional cardiovascular risk factors account for much of this burden, reproductive, endocrine, obstetric, and psychosocial histories may provide additional clinical context. Evidence from observational studies links several conditions—including polycystic ovary syndrome, infertility, pregnancy loss, adverse pregnancy outcomes, and premature menopause—with subsequent cardiovascular or cardiometabolic outcomes, although the magnitude and independence of these associations vary. Assisted reproductive technologies and psychosocial adversity warrant consideration in relation to underlying conditions and social context rather than being treated uniformly as female-specific risk factors. Potential mechanisms include metabolic dysregulation, endothelial dysfunction, and inflammation, but a single shared causal pathway has not been established. This narrative review summarizes current evidence and proposes a Female Cardiovascular Life-Course Model as a conceptual framework for considering relevant clinical histories at different stages of life. Such information may complement established cardiovascular risk assessment and guideline-based prevention; however, the incremental predictive value and clinical utility of the proposed framework have not been prospectively validated. Further longitudinal research is needed to determine whether incorporating these histories improves risk prediction or cardiovascular outcomes.