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Dr Stéphane Manzo-Silberman (Interventional Cardiologist)
According to a French study, the number of women under 50 admitted for myocardial infarction is clearly increasing. For what ? What are the factors involved? The author of this new study, Dr Stéphane Manzo-Silberman, answers our questions.
Heart attacks are not a male affair. On the contrary, numerous studies are gradually showing that not only are women also affected, but their numbers are increasing. For what reason? A French study recently published in JAHA (Journal of the American Heart Association) a few days ago revealed the factors most involved.
Tobacco, complicated pregnancy and contraception increase risks
To draw the typical factors, the prospective observational study included 314 women under the age of 50 admitted for myocardial infarction in 30 centers in France between May 2017 and June 2019). The primary endpoint was the combination of net adverse clinical events: all-cause death, cardiovascular death, recurrent myocardial infarction, stent thrombosis, any stroke or major bleeding occurring during hospitalization with 12 months follow-up.
Results ? First of all, the average age of women affected by a heart attack was around 43 years (which is young) and that most (91.6%) of the women presented with typical chest pain.
Several risk factors then emerged.
- 75.5% were current smokers;
- 31.2% had a history of complicated pregnancy;
- 55.1% reported recent emotional stress.
The study also highlights that among affected patients taking estrogen-containing contraceptives, 86.0% had at least one contraindication, which proves that the risk of a heart attack is not clearly mentioned when prescribing.
Traditional factors are also at the origin of female heart attacks
For Stéphane Manzo Silberman, cardiologist, author of the study and member of our committee of experts, this study must draw our attention to two facts, which we have avoided until now.
“The factors that we suspected are much more important than expected. When we designed the study in 2014, with many criteria, we thought that heart attacks in women were linked to pathologies autoimmunepost-cancer pathologies… In fact, we were extremely surprised to see that the vast majority of risk factors are common traditional factorsbut over-represented among women. It is not women with rarer or inflammatory pathologies who make the bulk of this increase in the incidence of heart attacks in women. These are factors that we know well, in men.”
The other point that emerges from this study is that pregnancy complications also have a confirmed role in heart attacks. “These pregnancy complications, which we know increase cardiovascular risk, concern 30% of these affected women while they only impact 20% of women in the general population. So there is also an over-representation there.”
Heart attacks kill 7 times more women than breast cancer
The fact that young women do not know their risks, or that unsuitable contraception is still prescribed despite contraindications, constitutes a real problem for the cardiologist.
“The lack of prevention is the key message of this study. There is still much to do, a call to action at all levels. Women must be informed that they are also exposed to the risk of heart attack, which kills 7 times more than breast cancer.
According to her, the entire chain must be made aware of this real risk, whether the woman herself, those around her and all health workers.
“There are still too many women who report real symptoms to whom we respond: “But no, you’re 35, you can’t have a heart attack.”
Unfortunately, if a heart attack in a woman is 35 or 45 years old, it is possible! But it is also avoidable with more prevention, which is why the message must get across.
Slide: 16 tips to prevent cardiovascular disease