Pregnancy Biomarkers Predict Long-Term Cardiovascular Risk

Fresh research suggests that measuring levels of soluble fms-like tyrosine kinase-1 (sFlt-1) and high-sensitivity cardiac troponin I (hs-cTnI) during pregnancy could support identify women at higher risk of developing cardiovascular disease (CVD) years later. The findings highlight pregnancy as a potential “stress test” for cardiovascular health and emphasize the need for improved postpartum care.

Biomarkers and Cardiovascular Risk

A study published in JAMA Cardiology in February 2026, focused on data from the Odense Child Cohort in Denmark, a population-registry of pregnancies reaching at least 22 weeks in southern Denmark from 2010-2013. Researchers analyzed data from 2,056 women without pre-existing CVD who had biomarker data at either week 12 or week 29 of their pregnancy. The median age of participants was 30 years, with a median pre-pregnancy BMI of 23.4. Approximately 62% were nulliparous (first-time mothers), and 16% experienced adverse pregnancy outcomes such as fetal growth restriction, preterm delivery, or stillbirth.

Over a median follow-up of 11.9 years, 28 women (1.4%) developed CVD. The study found that maternal age, hypertensive disorders of pregnancy (HDPs), and third-trimester concentrations of sFlt-1 and hs-cTnI were all independently associated with a higher long-term risk of CVD. Biomarkers measured earlier in pregnancy did not demonstrate the same association.

sFlt-1 and hs-cTnI: Predictive Power

A model combining age and sFlt-1 levels at week 29 improved the prediction of CVD compared to using age alone, demonstrating a 0.16 increase in the area under the curve. Interestingly, a combination of age, systolic blood pressure, and non–HDL-C did not show the same improvement. These results remained consistent even when analyzing women without prior births, hypertension, or HDPs.

The authors concluded that third-trimester sFlt-1 levels can be extended from obstetric risk stratification to long-term cardiovascular risk assessment. The ability of sFlt-1 to predict both short-term obstetric outcomes and long-term CVD risk suggests that a single antepartum measurement could provide valuable insights into a woman’s health across two critical life stages. JAMA Cardiology

Pregnancy as a Cardiovascular Stress Test

An accompanying editorial in JAMA Cardiology by Sadiya S. Khan, MD, FACC, and Lynn M. Yee, MD, MPH, highlighted the increasing incidence of adverse pregnancy outcomes in the U.S. And their link to increased maternal cardiovascular risk. Both the 2019 ACC/AHA Primary Prevention Guideline and the 2025 AHA/ACC/Multisociety High Blood Pressure Guideline recognize HDPs as a cardiovascular risk enhancer.

The editorial emphasized the importance of viewing adverse pregnancy outcomes as a “clinical red flag” that warrants improved counseling, support for transitions from obstetric to primary care, and the development of payer and health systems strategies to ensure appropriate longitudinal care for postpartum individuals. Pregnancy is uniquely positioned as a time when individuals regularly interact with the healthcare system, offering an opportunity to optimize both pregnancy outcomes and long-term cardiovascular health.

Implications for Postpartum Care

These findings underscore the need for a more holistic approach to women’s health, recognizing pregnancy not just as a reproductive event but as a potential indicator of future cardiovascular risk. Further research is needed to determine the optimal strategies for utilizing these biomarkers to improve long-term cardiovascular health for women. PubMed