Table.

Key Research Questions/Gaps in Evidence

Question	Current Evidence	Gaps in Evidence/Future Directions
Does inclusion of sex-specific risk factors in short-term and long-term ASCVD risk prediction have clinical utility and inform initiation of preventive therapies?	Multiple sex-specific risk factors (premature menarche, adverse pregnancy outcomes, premature menopause) are associated with higher risk of ASCVD, independent of traditional risk factors.	Prospective, adjudicated, epidemiological studies incorporating pregnancy and non-pregnancy cohorts and electronic health record data are needed to understand the potential additional predictive utility of these risk factors
What are the pathways and mechanisms that underlie the transition from adverse pregnancy outcomes to ASCVD?	Adverse pregnancy outcomes constitute a spectrum of placental vascular disorders that are associated with higher risk of ASCVD risk factors in follow-up.	Dissemination and implementation of collaborative care beginning in the early post-partum period focusing on lifestyle behavior modification and optimization of CVH to assess best strategies to assess, modify, and prevent a woman’s risk of ASCVD needs to be studied. Discovery of unique biomarkers that may predict risk or be targeted to prevent ASCVD may enhance personalized care.
Should subclinical imaging tools (CAC) be employed in women with a sex-specific risk factor to identify women at risk earlier in life and inform guideline-recommended initiation of evidence-based therapy?	Sequential screening with CAC can reclassify risk for ASCVD in intermediate and high predicted risk middle-aged women.	Randomized controlled trial evidence to assess the impact of CAC on ASCVD events may complement the available robust epidemiological data to guide decisions on statin therapy initiation when there is uncertainty.