Objective:

To develop and validate a cardiovascular disease risk prediction model for reproductive-aged women incorporating pregnancy-related and female-specific risk factors alongside traditional cardiovascular risk factors.

Approach:

• Cohorts: The primary cohort included 262,891 women aged 15 to 45 years with a live birth or stillbirth, while a secondary cohort of 109,858 women with first deliveries was used to evaluate model performance.
• Model Comparison: A base model with traditional cardiovascular risk factors was compared to a full model that included pregnancy-related and sex-specific predictors.
• Outcome Definition: Incident cardiovascular disease was defined as a composite of various cardiovascular events and mortality.
• Follow-Up: Participants were followed for a median of 3.8 years.

Key Findings:

• 943 participants experienced a cardiovascular event, with an incidence rate of 0.81 per 1,000 person-years, including coronary artery disease, myocardial infarction, and cardiovascular-related mortality.
• The full model showed improved performance with an optimism-corrected C-statistic of 0.637 compared to 0.613 for the base model.
• Pregnancy-related factors, particularly hypertensive disorders of pregnancy, gestational diabetes, and preterm birth, were significant predictors.

Interpretation:

Incorporating pregnancy-related and female-specific factors may enhance postpartum cardiovascular risk assessment.

Limitations:

• Adverse cardiovascular events were relatively uncommon, potentially limiting the model's discriminatory performance.
• Follow-up duration was insufficient to estimate lifetime cardiovascular risk.
• Some predictors required multiple imputation due to missing data.
• The model underwent internal validation only, lacking external validation.

Conclusion:

Further refinement and external validation are necessary before the model can be used clinically.

Sources:

• JACC: Advances