Abstract
Atherosclerotic cardiovascular disease (ASCVD) is one of the leading causes of morbidity and mortality in females worldwide. In this review, we provide insights into how sex differences may affect traditional risk factors associated with ASCVD, and give an overview of non-traditional risk factors that have the potential to enhance cardiovascular risk prediction in females. We review clinically applied cardiovascular risk estimation systems, discussing the integration of promising risk factors within these systems. We also explore the role of novel approaches and future directions to refine primary prevention of ASCVD in females. The development of ASCVD varies by sex and age; therefore, cardiovascular risk estimation systems should incorporate both sex and age interactions with risk factors to improve ASCVD risk estimates. As the incidence of non-ASCVD (such as heart failure and arrhythmias) in females continues to rise, it is crucial to adopt a more holistic approach to risk assessment that extends beyond ASCVD outcomes. This review highlights the need for further studies on female-prevalent diseases and female-specific factors that may refine cardiovascular risk estimation in young females. Raising awareness is crucial to ensure studies include individuals from deprived areas and ethnic minorities, as more insights on the intersection between sex and social determinants of health will enhance understanding of the underlying mechanisms of ASCVD risk prevention in females. Finally, taking steps to improve and standardise data on female-specific risk factors throughout a female's life course could improve preventive cardiovascular care for females.