Beyond Traditional Risk Scores: Precision Medicine for Comprehensive Cardiovascular Risk Assessment in Women and Men

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.