“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