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[Stratification of cardiovascular risk in women: Optimize the medical care]
Claire Mounier-Vehier1, Phenicia Nasserdine2, Anne-Laure Madika1
1CHU Lille, institut cœur poumon, médecine vasculaire et HTA, 59000 Lille, France; Université Lille, EA 2694 - santé publique : épidémiologie et qualité des soins, 59000 Lille, France.
Insights
Cardiovascular disease (CVD) risk in women is underestimated due to unique factors like hormonal changes and certain conditions. New risk stratification adapted for French women aims to improve cardiovascular risk management, especially during contraception and menopause.
Area of Science:
- Cardiology
- Women's Health
- Preventive Medicine
Background:
- Cardiovascular diseases (CVD) are the leading cause of death in women, with specific risk factors often underestimated.
- Women face unique cardiovascular risks, including hormonal influences (contraception, pregnancy, menopause) and conditions like endometriosis and polycystic ovary syndrome.
- Traditional risk scores often fail to account for these female-specific factors, leading to underestimation of CVD risk.
Purpose of the Study:
- To highlight the underestimated cardiovascular risk in women due to specificities not captured by traditional risk scores.
- To emphasize the importance of considering hormonal and emergent risk factors in women's cardiovascular health.
- To introduce a new expert-proposed cardiovascular risk stratification tailored for French women, particularly addressing contraception and menopause.
Main Methods:
- Review of existing literature on cardiovascular risk factors in women.
- Analysis of traditional cardiovascular risk scores (e.g., SCORE, Framingham) and their limitations in women.
- Description of a recently proposed cardiovascular risk stratification by French experts for women.
Main Results:
- Traditional risk factors like hypertension, tobacco use, diabetes, and psychosocial stress appear more detrimental in women and are less controlled compared to men.
- Women are uniquely exposed to hormonal risk factors and emergent conditions that increase cardiovascular risk.
- Existing risk scores inadequately assess women's cardiovascular risk, necessitating specialized approaches.
Conclusions:
- Optimized evaluation and management of cardiovascular risk in women require consideration of their unique specificities.
- Lifestyle interventions are highly effective for primary and secondary CVD prevention in women.
- A new expert-driven cardiovascular risk stratification adapted for French women, focusing on hormonal periods, is proposed to aid practitioners.
Abstract:
Cardiovascular diseases are become the primary cause of death in women. The cardiovascular risk of the woman has unknown specificities and remains underestimated. At equal age, women have more cardio vascular risk factors than men. All these specificities must be taken into account for an optimized evaluation of cardiovascular risk and for improvement of CV management in women. Some traditional risk factors are more deleterious in women such as hypertension, tobacco, diabetes or psycho-social stress and they are less well controlled compared to men. Women are also exposed to hormonal risk factors (contraception, pregnancy and menopause) or to emergent risk situations (migraine with aura, endometriosis, polycystic ovary syndrome, auto-immune diseases…). Conversely, lifestyle measures (regular physical activity, no smoking, healthy diet, stress management) are extremely effective in primary and secondary prevention in women. Predicting the risk of cardiovascular events in women is difficult because the classic risk scores (SCORE, Framingham…) do not take into account hormonal CV specificities and underestimate the women CV risk. Until then, only the specific women AHA stratification of CVR allowed for appropriate care for them. Recently, at the initiative of the French Society of hypertension, a consensus of experts proposed a stratification of CVR adapted to French women, to help practitioners in their care, especially for the two hormonal periods as contraception and menopause.
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