Beyond Traditional Risk Factors: Social, Reproductive, and Environmental Determinants of Cardiovascular Health in Women.

Abstract

Cardiovascular disease remains the leading cause of mortality among women, whose risk is shaped by a complex interaction between biological characteristics and the social, reproductive, and environmental contexts in which they live. Beyond traditional cardiovascular risk factors, socioeconomic disadvantage, limited access to healthcare, caregiving responsibilities, psychosocial stress, discrimination, and neighbourhood deprivation can influence health behaviours, cardiometabolic profiles, and access to preventive care. These determinants also interact with reproductive health. Employment instability and economic uncertainty may affect fertility choices, while infertility, parity, assisted reproductive technology, and hypertensive disorders of pregnancy may provide clinically relevant information about subsequent cardiovascular risk. Environmental exposures - including air pollution, extreme heat, transportation noise, and limited access to green space - represent additional sources of cardiovascular vulnerability and are disproportionately concentrated in socioeconomically disadvantaged communities. Pregnancy and the menopausal transition may constitute periods of heightened susceptibility to these exposures. This narrative review examines how social, reproductive, and environmental determinants interact across the female life course to influence cardiovascular health. An integrated approach incorporating reproductive history, psychosocial conditions, socioeconomic circumstances, and environmental exposures into cardiovascular risk assessment may support more personalized prevention, reduce health inequalities, and inform clinical, community-based, and policy interventions.