Women as the first targets
Frentiously, she dances, party favors swirl around her. Fifteen seconds of magic for the young woman who drags an older, much more corpulent man onto the dance floor, who struggles to keep up with her movements. "Every day, four hundred people in France die from cardiovascular disease. In more than half of the cases, the victims are... of women," says the voice chosen to embody the French Federation of Cardiology. In 2015, the association asked director Maïwenn to put her talent at the service of prevention. The goal was to pull out all the stops to make women aware that their hearts, too, could fail. Eight years later, it must be acknowledged that preconceived ideas remain tenacious in the face of cardiovascular diseases, and myocardial infarction in particular.
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With 6,700 deaths per year, the latter is the third leading cause of death after stroke (13,107 deaths per year) and breast cancer (about 12,000 deaths per year) (1). "When a woman collapses in the street, we think of vagal discomfort; When a man collapses, it's a heart attack. The difference is that cardiac massage will be performed immediately on the second floor, and not on the first," says Professor Claire Mounier-Vehier. A cardiologist and doctor, co-founder with Thierry Drilhon of the Women's Cardiovascular Healthcare Foundation/Agir pour le cœur des femmes endowment fund, she launched the Heart-Arteries-Women coordinated care pathway at Lille University Hospital ten years ago. "It takes a very long time to change people's minds," she concedes. Every day in France, two women die from a car accident, thirty-three from breast cancer and two hundred from cardiovascular disease. But we've never had a national plan dedicated to the heart, even though there have been plans against obesity, cancer and even Lyme disease!" she said.
Warning signs not to be overlooked
The numbers speak for themselves. According to an AXA Prevention study on women's health in France (2021), 42% of women never monitor their heart. However, it is now known that 30% of myocardial infarction victims under the age of 55 are women (compared to 13% in 1999). And that their hospitalization, between the ages of 45 and 54, is increasing by 5% per year. What has changed? What does it take, above all, for women, when they are affected by overweight, a repeated feeling of tightness, regular unexplained fatigue, palpitations, or even a cough accompanied by chest burning, in short when their body sends significant signals, what does it take for them to be taken seriously and trigger a consultation? Not only do women, given their lifestyles, share with men risks related to daily hygiene - stress, smoking, sedentary lifestyle, poor eating habits - but they also add risk factors related to hormonal flows, from menstruation to menopause.
During pregnancy, there is also a hundred-fold greater risk of maternal mortality when the woman is a carrier of cardiovascular disease. "70% of maternal deaths are preventable: if you are short of breath during pregnancy, if you have high blood pressure, overweight or diabetes and are over 35 years old, you need to consult for your heart," insists Claire Mounier-Vehier. She also mentions specific risk factors related to genital life (polycystic ovaries, endometriosis, taking contraceptive pills over many years), treatments for breast cancer, which can damage the heart muscle, ovarian insufficiency before the age of 40 (for example related to IVF) or the onset of menstruation before the age of 11 and after 15.
On the road to prevention
Going out into the field, in remote and/or disadvantaged neighbourhoods in large cities, to meet women of all ages with the aim of integrating them into a care pathway: since 2021, at the initiative of cardiologist Claire Mounier-Vehier and entrepreneur Thierry Drilhon, the Bus du Cœur has combined screening for cardiovascular and gynaecological pathologies, in association with the National Federation of Colleges of Medical Gynecology (one in six women in France has no gynaecological follow-up). Twenty-eight cities have already been visited, from Lille to Marseille, from Avignon to Saint-Étienne, local caregivers benefit from accelerated training: "Each time, we raise awareness among doctors, midwives, educators, dieticians, and firefighters about women's overexposure to cardiovascular risks," says Professor Claire Mounier-Vehier. Burned down last June in Bondy, near Paris, in a context of urban violence, the bus restored this autumn will be back on the road thanks to the energy of its founders, and the donations collected via an online fundraiser this summer. Ambition? Saving the lives of 10,000 women over five years.
Deploring the fact that women do not know how to recognise a heart attack when it occurs, the cardiologist insists: "When the artery suddenly becomes blocked, the pain radiates in a vice from the arm to the jaw, passing through the chest which tightens. But women can also feel small spasms that come and go (discomfort in the chest, a pinch in the left breast or in the pit of the stomach), all associated with palpitations, abnormal shortness of breath, digestive discomfort."
Every year, 75,000 women still die in France from cardiovascular disease. Health education and regular medical follow-up, in confidence, with sufficient time and listening, summarize the action to be taken to enable the detection of risk factors and avoid accidents. The Agir pour le cœur des femmes endowment fund has also put online a series of practical sheets, very well done, in order to take your heart in hand, in an individualized way.
*Source Santé publique France 2016, DRESS 2021.agirpourlecoeurdesfemmes.com.