Beyond Traditional Risk Scores: Precision Medicine for Comprehensive Cardiovascular Risk Assessment in Women and Men
9 affiliations
- 1Department of Cardiology, Hospital Universitario Son Llatzer, 07198 Palma de Mallorca, Spain
- 2Departamento de Medicina, University of the Balearic Islands, 07120 Palma de Mallorca, Spain
- 3CIBEROBN (CIBER Physiopathology of Obesity and Nutrition CB12/03/30038), Carlos III Health Institute, 28029 Madrid, Spain
- 4Department of Cardiology, Hospital Clínico San Carlos, 28040 Madrid, Spain
- 5Departamento de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
- 6Obstetrics and Gynecology, Vall D’Hebron Hospital Universitari, 08035 Barcelona, Spain
- 7Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Cerdanyola Del Vallès, Spain
- 8Department of Medicine, Universitat Jaume I, 12071 Castellon, Spain
- 9Department of Internal Medicine, Psychiatry and Dermatology, Universidad de Zaragoza, 50009 Zaragoza, Spain
Abstract
Background and Objectives: Conventional 10-year cardiovascular risk estimation algorithms are insufficient because they fail to integrate non-traditional clinical, biological, reproductive, and psychosocial modifiers that exhibit marked sex differences. The objective of this position framework is to address this gap by developing structured, sex-stratified clinical checklists for routine clinical practice. Methods: An expert narrative review and literature screening were conducted across PubMed/MEDLINE, Embase, Cochrane, and 14 international clinical practice guidelines (2020–2026 window) to identify robust sex-stratified risk modifiers. The multidisciplinary working group (comprising cardiology, gynecology, and primary care) conducted iterative internal review rounds to synthesize evidence and structure two comprehensive clinical checklists across six operational domains. Results: Epidemiological evidence mandates a life-course prevention model starting prior to conception. In women, obstetric history (preeclampsia, gestational diabetes, preterm birth), gynecological milestones (PMOS, endometriosis), early menopause, and oncological therapies markedly elevate vascular risk. In men, persistent erectile dysfunction, functional hypogonadism, androgen deprivation therapy, and premature androgenetic alopecia serve as early indicators of vascular and metabolic risk. Advanced biomarkers (Lp(a) ≥ 50 mg/dL, ApoB > 100 mg/dL, persistent hs-CRP ≥ 2 mg/L) and social determinants of health further refine risk stratification. Conclusions: Incorporating these structured checklists into daily consultations complements validated population risk scores (SCORE2, PREVENT, QRISK3), mitigates systematic underdiagnosis—especially in women—and provides an actionable framework for personalized cardiovascular prevention.
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BibTeX
@article{gamez2026beyond,
title = {{Beyond Traditional Risk Scores: Precision Medicine for Comprehensive Cardiovascular Risk Assessment in Women and Men}},
author = {José M. Gámez and David Vivas and María Goya and Vicente Pallarés-Carratalá and Maria A. Sánchez-Calavera},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15218365},
url = {https://www.mdpi.com/2077-0383/15/21/8365},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Beyond Traditional Risk Scores: Precision Medicine for Comprehensive Cardiovascular Risk Assessment in Women and Men
AU - José M. Gámez
AU - David Vivas
AU - María Goya
AU - Vicente Pallarés-Carratalá
AU - Maria A. Sánchez-Calavera
PY - 2026
DA - 2026/10/27
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218365
UR - https://www.mdpi.com/2077-0383/15/21/8365
AB - Background and Objectives: Conventional 10-year cardiovascular risk estimation algorithms are insufficient because they fail to integrate non-traditional clinical, biological, reproductive, and psychosocial modifiers that exhibit marked sex differences. The objective of this position framework is to address this gap by developing structured, sex-stratified clinical checklists for routine clinical practice. Methods: An expert narrative review and literature screening were conducted across PubMed/MEDLINE, Embase, Cochrane, and 14 international clinical practice guidelines (2020–2026 window) to identify robust sex-stratified risk modifiers. The multidisciplinary working group (comprising cardiology, gynecology, and primary care) conducted iterative internal review rounds to synthesize evidence and structure two comprehensive clinical checklists across six operational domains. Results: Epidemiological evidence mandates a life-course prevention model starting prior to conception. In women, obstetric history (preeclampsia, gestational diabetes, preterm birth), gynecological milestones (PMOS, endometriosis), early menopause, and oncological therapies markedly elevate vascular risk. In men, persistent erectile dysfunction, functional hypogonadism, androgen deprivation therapy, and premature androgenetic alopecia serve as early indicators of vascular and metabolic risk. Advanced biomarkers (Lp(a) ≥ 50 mg/dL, ApoB > 100 mg/dL, persistent hs-CRP ≥ 2 mg/L) and social determinants of health further refine risk stratification. Conclusions: Incorporating these structured checklists into daily consultations complements validated population risk scores (SCORE2, PREVENT, QRISK3), mitigates systematic underdiagnosis—especially in women—and provides an actionable framework for personalized cardiovascular prevention.
SN - 2077-0383
ER -