"Women's heart health is neglected by society and the medical profession"

Sciences and Future: You are interested in cardiovascular diseases specific to women. How are they emblematic of gender inequalities in health?

In several ways. First, there's a bias going back several decades that the classic patient with a heart attack or cardiovascular disease was a stressed man because his job was too demanding, he was overweight, he drank, and he smoked. But now, women smoke much more than before, and they accumulate multiple stresses, both work and home, often more significant than those experienced by some men. These are factors that have significantly changed the situation regarding cardiovascular risks.

“Every day in France, 35 women die from breast cancer and almost 6 times more from cardiovascular disease!”

Then there's a lack of awareness among women themselves about these risks. This stems partly from this historical bias and partly from what society continues to convey. For example, there are very broad prevention campaigns on breast cancer, but very little is done for cardiovascular diseases.

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Yet, every day in France, 35 women die from breast cancer and nearly 6 times more from cardiovascular disease! Moreover, among those affected, the mortality rate for women has exceeded that of men and is now 56% compared to 46%.

The fact remains that nearly one in two women between the ages of 18 and 25 wrongly believes that these diseases primarily affect the opposite sex. If awareness hasn't grown, it's because we don't talk about them enough. Moreover, these are silent diseases. Hypertension sometimes appears just before menopause. However, this is not a time when women will check their cardiovascular health.

The clinical and epidemiological data on the subject are clear. They show that there is better care for men, which has resulted in a decrease in the number of cases. But nothing of the sort in women. While over the past twenty years, we have gained a much better understanding of what is happening to men's cardiovascular health, women's cardiovascular health still suffers from many unknowns, even though they have specific disorders.

What are these specific heart diseases?

There are forms of heart attack that differ from the classic form. These are patients who are not overweight, do not have high cholesterol. They have a very healthy lifestyle and are young. And yet they will have a heart attack at some point in their lives. And these atypical cases that fall outside the usual framework are mostly women. In our team, we work on a specific form of myocardial infarction, SCAD, which is a spontaneous dissection of the coronary artery. Women represent 90% of cases.

"The symptoms in women do not necessarily correspond to what is expected in the imagination of a classic heart attack."

The same female overrepresentation for another form, Minoca, an abnormal cardiac microvascularization. In this case, it is not the coronary artery, the large artery of the heart, which is the cause, but a whole bunch of micro-vessels. These atypical forms can be missed very easily by a doctor because to spot them, imaging must be done at the time of the event. Even a cardiologist in the emergency room can miss them because the patient will be young, in her forties, and the symptoms will be different from a classic heart attack. They may be accompanied by digestive problems such as vomiting, for example, things that do not necessarily correspond to what is expected in the imagination of a classic heart attack.

Can regular monitoring by a general practitioner prevent these incidents?

Unfortunately, general practitioners are even less aware of all this. What they can do, in terms of prevention, is, for example, detect abnormal fatigue that lasts for several weeks. But for that, the woman would still have to go for a consultation. And a tired woman, I want to say, is almost the rule. It's not taken seriously enough.

These heart diseases are called "rare." But in truth, they are described as such primarily because they are overlooked because they are underdiagnosed. For example, a retrospective French study examined records of myocardial infarctions in young women. These were people under 60 years old with no obvious risk factors such as being overweight or high cholesterol.

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In these cases, there is a one in three chance that these heart attacks in young women are SCAD, a coronary artery dissection. This disease was usually observed around pregnancy or just after childbirth. It was also called "pregnancy heart attacks." But it is far from unique to this population. It's just that this is a period during which women are regularly monitored.

On this subject, my opinion as a researcher is that we should be interested in women's health beyond the reproductive phase. Everything related to fertility is pretty well funded. There is funding. Beyond that, much less. As a result, we are seriously lacking data for these premenopausal and postmenopausal periods.

Since we do not have epidemiological studies on women's heart health in general, our team has therefore turned to the genetic approach, collaborating in particular with researchers from other countries to share our results in order to discover other risk factors.

This will allow us to uncover the underlying mechanisms behind these cardiovascular disorders in order to better detect them and offer appropriate, and above all, more specific, medication management. Currently, statins, drugs to lower cholesterol, are almost automatically prescribed. However, this is a heavy treatment, not without side effects. And being forced to take such treatment for life from the age of 45 is not the same as being forced to take such treatment at 70 or 80...