Pregnancy Biomarkers Reveal Long-Term Cardiovascular Risk in Women

Cardiovascular disease (CVD) remains the leading cause of death among women globally, yet opportunities for early detection are limited.¹ A study suggests that routine pregnancy assessments—particularly third-trimester biomarkers such as high-sensitivity cardiac troponin I and soluble fms-like tyrosine kinase-1 (sFlt-1)—may serve as powerful predictors of long-term maternal CVD risk. These findings position pregnancy as a vital window for preventive cardiovascular care.

This Danish biomarker cohort study is published in JAMA Cardiology.

“Our findings prompt consideration of whether risk stratification should occur during pregnancy or whether these biomarkers exhibit similar associations outside of pregnancy,” wrote the researchers of the study. “The answer likely varies by marker. Intriguingly, first-trimester sFlt-1 values were not associated with later CVD, underscoring the importance of timing. Later stages of pregnancy may better capture the cardiovascular stress relevant to long-term cardiovascular health.”

Cardiovascular disease in women is often underdiagnosed and undertreated due to persistent misconceptions that CVD predominantly affects men and gender‑related differences in symptoms and risk factors.² Women tend to develop ischemic heart disease about a decade later than men—often after menopause when protective estrogen effects decline—and experience unique risk contributors such as pregnancy complications, microvascular angina, and stress cardiomyopathy. Traditional risk factors like smoking, hypertension, diabetes, and dyslipidemia also impact women differently, underscoring the need for gender‑specific recognition, diagnosis, and management strategies to improve outcomes.

This study included all pregnancies reaching at least 22 weeks’ gestation in Southern Denmark between June 2010 and October 2013.¹ Data were obtained from registry linkages and the nested prospective Odense Child Cohort, which provided biomarker measurements at weeks 12 and 29 of pregnancy. Women with preexisting CVD (n = 114) were excluded.

Clinical characteristics, obstetric outcomes, and pregnancy biomarkers, including sFlt-1, placental growth factor, high-sensitivity cardiac troponin I (hs-cTnI), and N-terminal pro–B-type natriuretic peptide (NT-proBNP), were analyzed.

In the biomarker cohort (median [IQR] age, 30.4 [27.4-33.8] years), 28 women (1.4%) developed CVD over a median follow-up of 11.9 (11.2-12.5) years. Maternal age, hypertensive disorders of pregnancy, and third-trimester levels of hs-cTnI and sFlt-1 were independently associated with higher long-term CVD risk.

A combined model incorporating age and week-29 sFlt-1 improved risk discrimination compared with age alone (ΔAUC, 0.16; 95% CI, 0.02-0.30), whereas a clinical model including age, systolic blood pressure, and non-high-density lipoprotein cholesterol did not.

Findings were consistent among women without prior hypertension or hypertensive disorders of pregnancy and in nulliparous women, supporting the potential utility of pregnancy biomarkers in predicting maternal cardiovascular risk.

However, the researchers noted that this study has several limitations. The relatively small number of cardiovascular events limited statistical power and more detailed end point modeling. First-trimester NT-proBNP and hs-cTnI data were unavailable, and generalizability beyond a predominantly Northern European population remains uncertain. Although multiple biomarkers and models were evaluated, the findings should be considered exploratory, and the study cannot determine whether observed associations reflect causal mechanisms or shared predisposition to hypertensive disorders of pregnancy and later CVD.

Despite these limitations, the researchers believe these findings highlight pregnancy as a unique, opportunistic window for identifying women at increased risk of long-term CVD.

“Pending further validation, pregnancy-derived risk indicators, including circulating biomarkers and clinical profiles, could inform earlier and more targeted preventive strategies across the life course of women,” wrote the researchers.

References

1. 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

2. Keteepe-Arachi T, Sharma S. Cardiovascular disease in women: understanding symptoms and risk factors. Eur Cardiol. 2017;12(1):10-13. doi:10.15420/ecr.2016:32:1