Pulse check: modern strategies for cardiovascular risk in women with detection and prevention in women with HIV.

PURPOSE OF REVIEW: To summarize women-specific contributors to cardiovascular disease (CVD) in women with HIV (WWH) and translate recent evidence on imaging, biomarkers, and prevention into practical strategies for assessment and management.

RECENT FINDINGS: WWH experience higher rates of adverse pregnancy outcomes and cardiometabolic complications. Weight gain associated with some integrase inhibitors may compound postpartum risk. Early menopause is more common, and biochemical confirmation improves attribution of symptoms and risk. Subclinical myocardial injury is frequent; coronary microvascular dysfunction and cardiac magnetic resonance markers of fibro-inflammation appear even with viral suppression. Traditional calculators often underpredict CVD events. Novel tools, including triglyceride-glucose trajectories, and imaging-linked scores, show promise for earlier detection. The REPRIEVE trial demonstrated efficacy of primary prevention statins for people with HIV across sexes, yet women remain less likely to receive statins.

SUMMARY: Care requires integration of sex-specific risk enhancers, trauma-informed approaches, and proactive cardiovascular surveillance. Consideration for annual risk assessment incorporating HIV-related immune and metabolic factors, early statin initiation when 10-year risk is ≥5% or enhancers are present, selective advanced imaging in advanced immunosuppression, and use of accessible biomarkers such as the triglyceride-glucose index. Priorities include validation of women-specific prediction tools and closing implementation gaps.