Pregnancy may be Window for Early Cardiovascular Risk Identification in Women, Suggests JAMA Study
Germany: Researchers have found in a new study that pregnancy offers a valuable opportunity for assessing future cardiovascular risk in women. With further validation, pregnancy-related risk indicators—such as circulating biomarkers and clinical profiles—may enable earlier identification and more targeted, lifelong preventive cardiovascular strategies.
The findings, published in JAMA Cardiology, come from a population-based cohort study led by Lucas Bacmeister of the University Heart Center Freiburg–Bad Krozingen, Medical Center, University of Freiburg, Germany, and colleagues. Cardiovascular disease (CVD) remains the leading cause of death among women globally, yet tools for early risk detection tailored specifically to women are limited. Pregnancy, often described as a natural cardiovascular stress test, may provide critical insights into long-term heart health.
The investigators analyzed registry-linked data from 38,455 women in Southern Denmark whose pregnancies reached at least 22 weeks between June 2010 and October 2013. Women with preexisting cardiovascular disease were excluded. Among the eligible population, 2,056 women had blood samples collected during pregnancy for biomarker assessment at either 12 or 29 weeks of gestation. These women were followed through December 31, 2023.
The study revealed the following findings:
- Over a median follow-up of nearly 12 years, 28 women (1.4%) in the biomarker subgroup developed cardiovascular disease.
- Higher maternal age and hypertensive disorders of pregnancy were independently associated with increased long-term CVD risk.
- Elevated third-trimester levels of high-sensitivity cardiac troponin I (hs-cTnI) and soluble fms-like tyrosine kinase-1 (sFlt-1) were independently linked to future cardiovascular events.
- A risk model combining maternal age and sFlt-1 measured at 29 weeks significantly improved prediction of future CVD compared with age alone.
- A clinical model including age, systolic blood pressure, and non–high-density lipoprotein cholesterol did not improve predictive accuracy.
- The associations remained consistent in women without prior hypertension or hypertensive pregnancy complications and in nulliparous women.
- Cardiovascular event rates and the predictive performance of age-based models were comparable between the biomarker cohort and the larger background population of more than 36,000 women.
Overall, the study supports the concept that pregnancy represents a strategic window for sex-specific cardiovascular risk evaluation. Measuring select biomarkers during gestation—particularly in the third trimester—may help identify women at elevated long-term risk and open opportunities for earlier surveillance and prevention.
The authors emphasize that additional research is needed to confirm these findings and determine how best to integrate pregnancy-related markers into routine cardiovascular risk assessment for women.
Reference:
Bacmeister L, Glintborg D, Kjer-Møller J, et al. Clinical Factors and Biomarkers During Pregnancy and Risk of Cardiovascular Disease. JAMA Cardiol. Published online February 18, 2026. doi:10.1001/jamacardio.2025.5595
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