Un cardiologue du CHU de Clermont-Ferrand explique pourquoi les jeunes femmes aussi sont malades du cœur

Health – A cardiologist from the Clermont-Ferrand University Hospital explains why young women also have heart disease

They were believed to be more spared than men from cardiovascular disease. However, for the past thirty years, women have been much more exposed to cardiovascular pathologies. These diseases are even the leading cause of death in women and kill seven times more than breast cancer.

For myocardial infarction, its incidence increased by nearly 20% before the age of 65, between 2008 and 2013, and increased by 5% per year between the ages of 45 and 54.
When he began his career at Clermont-Ferrand University Hospital, Professor Pascal Motreff, cardiologist and former president of the Group of French Interventional Cardiologists very rarely saw heart attacks in women. Today, the situation has changed, and the increase in cardiovascular pathologies among them remains worrying.

How do we explain this increase in the number of cases?

“Many cardiovascular pathologies are linked to aging. Few specialties are as impacted by age as cardiology. However, advances in medicine mean that patients are aging and have time to develop heart disease and, on the other hand, heart patients are living longer and longer, surviving a first accident. It is therefore logical to find an over-representation of women in all degenerative cardiac pathologies of old age.

In addition, over the past thirty years, we have witnessed a transformation in the way of life of women, which exposes them more to cardiovascular pathologies.

Atherosclerosis

is one of the scourges in industrialized countries.

It mainly affects men, women being less exposed until menopause due to hormonal protection. In addition to irreversible factors such as heredity, aging and male gender, there are risk factors that greatly contribute to the development of atherosclerosis: Smoking, hypercholesterolemia, diabetes, high blood pressure, obesity, stress, physical inactivity…”

Have women caught up with men in these areas?

“During the last few decades, we have been able to observe in women an increase in smoking, stress, poor diet, which means that the female risk is approaching the male risk. Moreover, it would seem that smoking, drugs, diabetes are even more harmful in women and we know the dangerousness of contraception in smokers.

This atherosclerosis, which increasingly affects women, contributes to the development of coronary disease in all its forms (angina pectoris, myocardial infarction). For all these reasons, the proportion of women among patients hospitalized for coronary disease is increasing and, worryingly, that of women aged under 60 has doubled in just 15 years. »

This is very worrying…

“Yes, and today what worries the French cardiology community is both the increase in the number of heart attacks in women but also the poorer prognosis that accompanies it (mortality at + 40% per relation to man) including taking account of age. »

Why is this prognosis less good in women?

“The reasons for this increased risk are unclear, and are the subject of numerous hypotheses and constitute as many avenues for improvement. It is known that women call the emergency services on average 30 minutes later. The latest studies confirm that the symptomatology is hardly different from that of men.

A greater resistance to pain, a less good empathetic listening of the entourage, a lack of information or the weight of stereotypes prohibiting to evoke the diagnosis are described as potentially responsible for a delay whose consequences can be dramatic.
The weight of stereotypes could also mislead health professionals and cause the symptoms described by a woman, especially a young woman, to have long been poorly considered. However, the training of all the actors of the emergency, the access to new diagnostic tools mean that the coronary woman is less and less penalized and should benefit from the same course of care. »

Atherosclerosis is characterized by the deposit of a plaque, the atheroma (composed of lipids) on the wall of the arteries.

More than 11% of female victims of myocardial infarction are under 50 years old. The incidence of heart attacks increased by nearly 20% before the age of 65 between 2008 and 2013 and increases by 5% per year between 45 and 54 years.

Signs of a heart attack that should alert

Myocardial infarction or heart attack is the result of the occlusion of a coronary artery which supplies blood to the heart muscle (myocardium). In the management of infarction, “enormous progress has been made in 30 years with hospital mortality reduced by 80%! observes Professor Pascal Motreff. But notifying the emergency services as soon as possible considerably increases the chances.

Here are the symptoms that he says should be known to both men and women: A crushing pain in the chest, a feeling of tightness, sometimes with radiation in the neck, jaw, arms or abdomen, a feeling of imminent death. “It is fundamental to remember that as soon as these persistent symptoms are perceived, it is necessary to

dial 15

because a real race against time begins. This call has the merit of shortening delays and avoiding the intervention of intermediary actors likely to slow down the emergency chain,” he insists.

This race is essential for two reasons:

The first is to allow resuscitation by emergency physicians in the event of the occurrence of ventricular fibrillation (the main and formidable complication of the infarction in the first minutes, which justifies the distribution of defibrillators in public places).

“The second is to accelerate the process of recanalization of the coronary allowing to limit the extent of the damage. In fact, the most effective treatment for infarction is coronary angioplasty. This recanalization technique (unblocking the artery and implanting a stent) will be performed by an interventional cardiologist, on call 24 hours a day.

In Auvergne, Cardiauvergne watches over more than 600 patients with severe heart failure

The infarction occurs 3 times out of 4 in a man, between 60 and 65 years. Half the time, it occurs inaugurally in a patient who had previously had no discomfort, and half the time it follows premonitory symptoms of angina pectoris.

Avoidable causes on which we can act “It is essential to prevent cardiovascular risk in women, especially since there is a family history”, supports Professor Pascal Motreff, from the interventional cardiology department of the Clermont-Ferrand University Hospital.

A recent study confirms that 75% of heart attacks in young women occur in smokers.

“Tobacco has a catastrophic impact when combined with oral contraception. Regular physical activity and a balanced diet rich in fruits and vegetables also benefit women,” he recommends.

In the event of suspicious but not prolonged symptoms (chest pain, shortness of breath, malaise), especially if they occur on exertion, the patient should undergo a cardiological assessment.
Last but not least, in the event of prolonged chest pain, a patient should dial 15 in order to have the same chance of healthy survival.

Michele Gardette

michele.gardette@centrefrance.com

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