Adults diagnosed with fetal alcohol spectrum disorders (FASDs) face dramatically elevated cardiovascular disease risks, including congenital heart defects (6% versus 1% in controls), myocardial infarction (6% versus 2%), and stroke (4% versus 1%). This retrospective cohort study of 208 adults with FASDs found particularly pronounced risks for women, who showed higher rates of hypertension, arrhythmia, and heart failure compared to men. The cardiovascular burden persisted even after accounting for metabolic factors like obesity and diabetes. These findings illuminate a critical gap in adult healthcare for the estimated 5% of US children affected by prenatal alcohol exposure. While congenital heart defects from fetal alcohol exposure have been documented, this research reveals the lifelong cardiovascular consequences extending well into adulthood. The sex-specific patterns suggest hormonal or developmental factors may amplify risks in women. However, this preprint awaits peer review, and the retrospective design limits causal inferences. The relatively small cohort size also constrains generalizability. If validated, these results underscore the urgent need for targeted cardiovascular screening protocols for adults with FASDs, potentially preventing serious cardiac events in this vulnerable population.