An American study published in the Journal of the American College of Cardiology Today highlights a long -known phenomenon: in women under the age of 65, more than half of the heart attacks would not be caused by traditional factors. These results could transform the way in which infarction are diagnosed and supported.
Symptoms but also different causes in women
Medicine had already established that signs of infarction were diffracting according to sex. But this new American study reveals that, in more than half of young women, infarction are not caused by traditional factors, namely the obstruction of the arteries, but by three main main causes.
Mayo Clinic researchers have analyzed 1,474 patients of patients under 65 who suffered from a heart attack between 2003 and 2018 in the county of Olmsted, in the United States. Thanks to the study of medical records and imaging, other physiological causes of infarction have been identified and their long -term mortality evaluated.
If a clot forming on a lipid plate in a coronary artery explains certain heart attacks, this is only one in two infarction in women (47 % more precisely). In more than half of women, the infarction were due to other mechanisms: spontaneous dissection of the coronary artery (DSAC), embolism, or physical stress factors such as anemia or infection.
“This research highlights historically underestimated causes, especially in women”, explains Dr Claire Raphaël, cardiologist at Mayo Clinic and the first author of the study. “A poor understanding of the deep cause of a heart attack can lead to less effective, even harmful treatments.”
The importance of knowing your own risk as a woman
For Dr Claire Mounier-Véhier, head of the vascular medicine service and high blood pressure at the Coeur Institut lung of Lille CHRU, the study corresponds to what it observes on the ground.
“We know that young women, especially those under the age of 50, often do not have a classic atheromatous disease. Except certain special cases, such as family hypercholesterolemia, the coronary young young woman presents itself in non -obstructive, typical forms.”
- Spontaneous coronary dissection :: “that we observe in slender, stressed women, with a significant mental charge. It is the illegitimate ‘infarction of women: often, they do not have a risk factor, do not smoke, and yet they undergo a infarction, sometimes during pregnancy or postpartum”;
- Coronarian spastic disease :: “Frequent in migraine women or with vascular disorders, aggravated by tobacco or hormonal contraception”;
- Erosion or ulceration of soft plates in the arteries :: “Who can trigger coagulation and form a clot, even without visible obstruction on a classic coronarography.”
Better suitable prevention and diagnosis expected
Today, tools such as the dosage of ultrasensible troponin and the coronary scanner allow a more precise diagnosis. But if medicine refines its science, Dr Mounier-Véhier, also at the origin of the initiative Act for the hearts of womeninsists on the importance of patient education:
“Women must know these causes more, recognize the alert symptoms and prepare their consultation. This allows the doctor to be guided towards a diagnosis that he would not necessarily have considered. Preventing rather than undergoing our priority.”
Self-assessment questionnaires and information campaigns, such as those of the association Act for the hearts of womenhelp better understand and detect atypical symptoms.
A study that changes the situation
One thing is certain: this study written black on white a reality that is still too little known. “With its important cohort and its fine distinction between the classic and non -classic causes of infarction, this study highlights the need to adapt cardiovascular management to the specificities of women”, Insists Claire Mounier-Véhier. It also recalls the importance of attentive monitoring and personalized prevention for these often silent, but potentially fatal heart attacks.