Cardiovascular Prevention: Editorial Comment Cardiology 2020;145:648–651 Searching Novel Approaches to Cardiovascular Risk: Hypertensive Disorders of Pregnancy Maurizio Giuseppe Abrignani Operative Unit of Cardiology, S. Antonio Abate Hospital, ASP Trapani, Erice, Italy Received: April 28, 2020 Accepted: May 6, 2020 Published online: July 8, 2020 Maurizio Giuseppe Abrignani Operative Unit of Cardiology S. Antonio Abate Hospital, ASP Trapani Via Cosenza 82, IT–91016 Erice, Trapani (Italy) maur.abri @alice.it © 2020 S. Karger AG, Basel karger@karger.com www.karger.com/crd DOI: 10.1159/000508651 Although many traditional cardiovascular risk factors have been well identified [1], it remains difficult to pre- dict who will develop an atherosclerotic cardiovascular disease (ASCVD) and who will not. The current guide- line-based approach, using risk charts able to identify the risks at population level [2], is not patient-specific enough. Therefore, the development of clinical prediction models and the search of new biomarkers and risk modifiers can help to personalize cardiovascular risk management, which is essential as we move towards the era of precision medicine. This is particularly true in women, in whom ASCVD remains the leading cause of mortality, responsible for a third of all deaths worldwide. Besides, over the last few decades, while mortality rates in men have steadily de- clined, those in women remained stable, particularly among young adults [3]. We have come a long way dispel- ling the conventional myth that women are “immune” from ASCVD. Historically, medical research has focused on male patients and subsequently, until recent years, there has been decreased awareness of the burden of ASCVD in females, also underrepresented in clinical tri- als. The biological, cultural, behavioral, psychosocial, and socioeconomic differences between sexes contribute, to various degrees, to gender differences in ASCVD risk fac- tors. However, the interaction between gender-related factors and ASCVD outcomes in women remains largely unknown. With these differing risk profiles, risk assess- ment is different in women and men [3]. Traditional risk prediction score models for cardiovascular disease, in fact, underestimate the risk in young women, and a high prevalence of subclinical ASCVD was found in women categorized as being at low risk according to the Framing- ham score. Therefore, there is an urgent need to better understand women’s risk over the lifespan, from men- arche, to pregnancy, through menopause, and it is im- perative to develop more sensitive markers of cardiovas- cular risk in the female sex to reduce their ASCVD bur- den and to bridge the outcomes gap [3]. The study of the biological basis of sex differences promises to optimize preventive, diagnostic, and therapeutic strategies for ASCVD. Arterial hypertension is a proven “driver” of athero- sclerosis. Hypertension, endothelial dysfunction, and vascular stiffness are, in fact, closely interrelated and con- stitute an independent pathophysiological atherogenesis cluster. There is a primary cause of hypertension that oc- curs only in women: hypertensive disorders of pregnancy (HDP), an umbrella term that includes preexisting and gestational hypertension, preeclampsia, and eclampsia. It