“Nearly 80% of women put their loved ones’ health before their own”

After long being side­lined by medi­cine, women’s health is gradu­ally com­ing back into the spot­light. But Pro­fess­or Claire Mouni­er-Véh­i­er, a car­di­olo­gist and vas­cu­lar phys­i­cian at Lille Uni­ver­sity Hos­pit­al, has long been work­ing on the top­ic. Co-founder of Agir pour le Cœur des Femmes with Thi­erry Dril­hon, she has been cam­paign­ing for over 30 years for bet­ter care for women’s car­di­ovas­cu­lar health in France.

First, it’s import­ant to remem­ber that car­di­ovas­cu­lar prob­lems are dis­eases linked to envir­on­ment­al factors: in 8 cases out of 10, they could be avoided with an ‘optim­al’ life­style in terms of diet, phys­ic­al activ­ity and sleep. Secondly, while cer­tain tra­di­tion­al risk factors such as high blood pres­sure, smoking, dia­betes, obesity, stress, etc. affect men just as much, there are risks that are ana­tom­ic­ally, physiolo­gic­ally and hor­mon­ally spe­cif­ic to women. Start­ing with the arter­ies, which are much more sens­it­ive and thin­ner: for the same amount of cho­les­ter­ol plaque, the redu­cing effect on the arter­i­al lumen will occur earli­er in women than in men. Women’s car­di­ovas­cu­lar risks also change through­out their lives, par­tic­u­larly dur­ing three key phases: con­tra­cep­tion with oes­tro­gens, preg­nancy and then the menopause.

Pure pro­gestin-based con­tra­cep­tion has no neg­at­ive effect on car­di­ovas­cu­lar health. How­ever, when syn­thet­ic oes­tro­gens such as the pill, vagin­al ring or con­tra­cept­ive patch are pre­scribed, car­di­ovas­cu­lar health may be affected. These hor­mones are meta­bol­ised by the liv­er, increas­ing the risk of arter­i­al hyper­ten­sion and activ­at­ing coagu­la­tion, with a risk of arter­i­al throm­bos­is (stroke, infarc­tion) and ven­ous throm­bos­is (phle­bit­is, pul­mon­ary embol­ism). This com­bined or oes­tro­pro­ges­to­gen­ic con­tra­cept­ive is con­train­dic­ated in young girls with risk factors such as smoking after the age of 35, over­weight, dia­betes, high cho­les­ter­ol or migraines. It is there­fore import­ant to dis­cuss these con­train­dic­a­tions at the first gyn­ae­co­lo­gic­al con­sulta­tion, and to take stock of car­di­ovas­cu­lar hered­ity. I remem­ber a 27-year-old patient who had to have both her legs ampu­tated because of unsuit­able con­tra­cep­tion! That’s unac­cept­able! You should also know that after the age of 40, you should try to avoid syn­thet­ic oes­tro­gens as much as possible.

Let me give you the strik­ing example of massive pul­mon­ary embol­ism. From the second tri­mester onwards, a preg­nant woman’s body physiolo­gic­ally goes into ‘throm­bos­is mode’, i.e. it is easi­er for the body to pro­duce clots that block the blood ves­sels to pre­vent excess­ive bleed­ing dur­ing childbirth. 

How­ever, the syn­thet­ic oes­tro­gens used in con­tra­cep­tion have the same effect, which is why they are con­train­dic­ated for up to 6 weeks after child­birth. When women leave the mater­nity ward, only pure micro-pro­ges­to­gen con­tra­cept­ives are pre­scribed. But when minor bleed­ing per­sists, women go back on the old pack of pills with the oes­tro­gen left on the bed­side table, and there’s a risk of massive embol­ism and sud­den death. We’re not talk­ing about anec­dot­al events here!

Oth­er more com­mon patho­lo­gies include hyper­ten­sion dur­ing preg­nancy, which affects one preg­nancy in 10, and gest­a­tion­al dia­betes, which needs to be screened reg­u­larly, par­tic­u­larly for preg­nan­cies in women over 35.

Yes, but talk­ing about ‘early men­o­pause’ to a woman who is 30, 35 or 40 can be very stig­mat­ising. Instead, we talk about pre­ma­ture ovari­an fail­ure (POI). In such cases, hor­mone replace­ment ther­apy (HRT) is recom­men­ded. This is often the case for women who have had assisted preg­nan­cies and under­gone fol­licu­lar stim­u­la­tion. They have there­fore lost their oocyte cap­it­al earli­er, res­ult­ing in an early hor­mon­al defi­ciency. If car­di­ovas­cu­lar risk increases dur­ing the per­i­meno­pause, it also increases in the case of POI!

Yes, they are linked to more fem­in­ine dis­eases, such as breast can­cer. Women who have been through this have a great­er risk of car­di­ovas­cu­lar prob­lems, par­tic­u­larly because of the treat­ments. Chemo­ther­apy dam­ages the heart muscle to a great­er extent in women, radio­ther­apy accel­er­ates the age­ing of the arter­ies and, finally, anti-aro­matases – which are very power­ful anti-oes­tro­gens – accen­tu­ate the early effects of the men­o­pause. When it comes to pre­vent­ing breast can­cer, almost 40% of women don’t have a mam­mo­gram: so, get screened!

There are also oth­er emer­ging risk factors, such as endo­met­ri­os­is and poly­cyst­ic ovary syn­drome, migraine (includ­ing migraine with aura), mam­mary artery cal­ci­fic­a­tions, etc. Inflam­mat­ory dis­eases are also more pre­val­ent in women: rheum­at­oid arth­rit­is, Crohn’s dis­ease, mul­tiple scler­osis, etc. These have the effect of boost­ing the age­ing of the artery.

Finally, we often for­get to con­sider the impact of psy­chos­is and depres­sion, par­tic­u­larly post­partum depres­sion, on women. Treat­ments for these ill­nesses such as anti­psychot­ics and anti­de­press­ants also have an appalling meta­bol­ic impact, increas­ing the risk of myocar­di­al infarction.

Stu­dents are receiv­ing more and more train­ing, and cross-dis­cip­lin­ary train­ing ses­sions are being held at con­gresses. The most import­ant thing is for every­one to work togeth­er to get a 360° view of women’s health. That’s what we’re doing in the Women’s Heart Bus screen­ings with our found­a­tion Agir pour le Cœur des Femmes. We also work a lot with gyn­ae­co­lo­gists and obstet­ri­cians on car­dio-gyn­ae­co­lo­gic­al path­ways, but there’s still a lot of train­ing and com­mu­nic­a­tion work to be done. I recently did a train­ing course at the Lille med­ic­al school with 3rd year stu­dents. Look­ing at the man­nequins, I asked: “Is there any­thing that shocks you?” There were only male mod­els. so I explained to them how to use their steth­o­scopes and do an aus­culta­tion with the breasts present: the stu­dents were really pleased!

No, because thera­peut­ic research is para­lysed by the idea of giv­ing risky drugs to a preg­nant woman. Research­ers want at all costs to avoid tera­to­gen­ic risks that could cause foet­al mal­form­a­tions. Women are there­fore only included in the stud­ies if they have a neg­at­ive preg­nancy test, are using effect­ive con­tra­cep­tion or, more simply, if they are already men­o­paus­al. Over­all, the ratio of women to men in these inter­ven­tion tri­als is 30% to 70%.In epi­demi­olo­gic­al regis­tries, how­ever, the ratio is closer to 50/50.

No, not always, and that’s a prob­lem. In women, the symp­toms are largely ignored, hence the cre­ation of an infograph­ic on the Agir pour le Coeur des Femmes web­site. They often com­plain of a feel­ing of tight­ness in the chest, pal­pit­a­tions, cold sweats, mal­aise or naus­ea, atyp­ic­al pain between the shoulder blades or in the jaw.

Almost 40% of women don’t have a mam­mo­gram: so, get screened!

Some patients also feel dis­com­fort in the pit of their stom­ach and have the impres­sion that they are hav­ing dif­fi­culty digest­ing. Patients often tell you after­wards: “it was­n’t like usu­al” and describe a feel­ing of unease and anxi­ety along­side these atyp­ic­al and recur­ring symp­toms. Unfor­tu­nately, how­ever, all too often doc­tors fail to take these symp­toms into account or do not link them to a heart problem.

Of course. Viol­ence is the third most com­mon risk factor for myocar­di­al infarc­tion in women. When I talk about viol­ence, I include verbal, mor­al and phys­ic­al abuse. Most viol­ence against women is per­pet­rated by men. What’s more, women are also sub­ject to a great­er men­tal bur­den and stress.

A healthy life­style is also a key factor in the pre­ven­tion of car­di­ovas­cu­lar dis­ease in women. In par­tic­u­lar, we are see­ing an increase in the con­sump­tion of ultra-pro­cessed foods, tobacco, can­nabis, recre­ation­al drugs and alco­hol by women, coupled with more sedent­ary occu­pa­tions, where they sit behind a com­puter. Doing sport twice a week doesn’t solve everything. A sedent­ary life­style means sit­ting for at least six hours a day. Today, I’d say it kills as much as undrink­able water did in the last century.

Yes, women do neg­lect their health. In an AXA Préven­tion sur­vey of a mixed gender pan­el pub­lished in Septem­ber 2021, 80% of women said that they put the health of their loved ones before their own, 75% put off their med­ic­al appoint­ments and 80% self-medicate.

Access to health­care is also very unequal in France, and we con­tin­ue to be pen­al­ised by med­ic­al deser­ti­fic­a­tion. Hence the import­ance of ini­ti­at­ives such as the Bus du Cœur des Femmes and Agir pour le Cœur des Femmes! The Women’s Heart Bus is made up of 1,300 health pro­fes­sion­als who volun­teer their time every year. The bus and its mobile med­ic­al centre stop off in a town for 3 days, and nev­er stop. Dur­ing the 17 stops, car­di­ovas­cu­lar and gyn­ae­co­lo­gic­al screen­ing is offered to an aver­age of 250 to 300 women per stop. Nearly 9 out of 10 women screened have at least two car­di­ovas­cu­lar risk factors… and nearly half of them (46%) have a com­bin­a­tion of gyn­ae­co­lo­gic­al and obstet­ric risk factors. The women’s data is col­lec­ted by the Obser­vatoire nation­al de la santé des femmes.

The import­ant thing to remem­ber is that we women need to take bet­ter care of ourselves and pro­tect ourselves. Act rather than suf­fer a car­di­ovas­cu­lar acci­dent! Let’s not for­get again: we can avoid the dis­ease in 8 out of 10 cases by effect­ive pre­ven­tion, identi­fy­ing risk factors and adopt­ing a health­i­er lifestyle.

Interview by Sophie Podevin