Non-Traditional risk factors, peculiar to the female sex
² Italian Group for Health and Gender. President of International Society of Gender Medicine, Bari, Italy
³ UOC Cardiologia Clinica e Riabilitativa, PO San Filippo Neri, ASL Roma 1, Roma
⁴ Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, Bari, Italy
⁵ Italian College of General Practitioners and Primary Care – SIMG – 50142 Florence, Italy
⁶ Outpatient Cardiology Service ASL2 Savona, Italy
Abstract
The present paper examines non-traditional cardiovascular risk factors that are specific to women, focusing on reproductive history and hormonal transitions. Early menarche, polycystic ovary syndrome (PCOS), functional hypothalamic amenorrhea, and exercise-induced secondary amenorrhea are now recognized as predictors of future cardiovascular disease. Pathological pregnancies – including pre-eclampsia, gestational diabetes, preterm birth, and recurrent miscarriage – significantly increase the risk of hypertension, myocardial infarction, and stroke later in life. Assisted reproductive technologies (ART) are associated with higher maternal and fetal cardiovascular risk compared to spontaneous conception, with risk varying by technique. Menopause, whether natural, premature, or iatrogenic, is a critical period marked by increased cardiovascular risk due to hormonal changes, lipid profile alterations, and endothelial dysfunction. Vasomotor symptoms during menopause, such as hot flashes and night sweats, are emerging as biomarkers of elevated cardiovascular risk, correlating with hypertension, atherosclerosis, and metabolic syndrome. The importance of integrating these female-specific risk factors into cardiovascular risk assessment and management is emphasized, supporting early intervention and increased awareness to improve female outcomes. The transgender population has a higher cardiovascular risk than the cisgender population: psycho-social factors certainly contribute to this, while the role of hormone therapies carried out during the transition is not yet clear.
Key words: Women; Transgender Persons; Female-Specific Risk Factors; Cardiovascular Risk Factors; PCOS; Pregnancy Complications; Menopause; Assisted Reproductive Techniques.
