2023-06-28 08:05:02
More than 200 women die every day in France from cardiovascular disease, which has become the leading cause of female mortality. Researchers have recently focused on a particular form of myocardial infarction, spontaneous coronary artery dissection (SCAD), which affects mostly women around their forties. Explanations.
Women have different cardiovascular health than men
Women are more and more affected by cardiovascular diseases, and at younger and younger ages. Myocardial infarction is no exception to this rule with a 4.8% increase in hospitalizations for this reason between 2009 and 2013 among women aged 45 to 54 years. While they were previously more protected than men in the face of cardiovascular risk, the evolution of lifestyles leads to a rebalancing of cardiovascular morbidity figures between the two sexes.
But changes in lifestyle do not explain everything. Women often present with atypical symptoms during a myocardial infarction, delaying the diagnosis and therefore the management: a feeling of exhaustion, shortness of breath on exertion, acute pain in the upper back, sudden palpitations or recurrent digestive signs. In addition, women might be affected by a a special form of myocardial infarction, spontaneous coronary artery dissection, often denoted simply as SCAD.
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SCAD, spontaneous dissection of the coronary artery, a typically female infarction?
Of the reported cases of SCAD, 90% are healthy women in their mid-40s. This form of infarction might represent up to a third of female cases before the age of 60. But spontaneous coronary artery dissection is still poorly understood by scientists and often underdiagnosed. A recent international study, the results of which have just been published in the scientific journal Nature Genetics, investigated the genetic causes and biological mechanisms of SCAD. For this study, the genetic data of more than 1,900 patients and regarding 9,300 healthy people were compared. This comparison resulted in the identification of 16 genomic regions associated with a genetic predisposition to spontaneous coronary artery dissection.
In addition, genetic variants involved in the “cement” which surrounds the cells of the coronary artery have been found in women who have survived SCAD. One of the genes codes for a tissue clotting factor. Normally, it causes coagulation in the cells of the artery to absorb any hematomas. When the expression of this gene is reduced, the arteries would have altered repair mechanisms, and would therefore be more likely to tear spontaneously, causing SCAD.
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Cardiovascular monitoring of women different from that of men
This mechanism of poor resorption of the hematoma would thus be a genetic cause of myocardial infarction in women, a cause unknown until now. In addition, the study was able to highlight another risk factor for SCAD: high blood pressure. On the other hand, other known cardiovascular risk factors would have no impact on the occurrence of spontaneous coronary artery dissection:
Such a result is very interesting for better targeting cardiovascular monitoring in young women. Blood pressure monitoring would be a very relevant criterion. Finally, the genetic data suggest that the genetic causes and biological mechanisms causing SCAD in a young woman without risk factors would be opposed to those causing myocardial infarction linked to atherosclerosis in an older man with risk factors. Data that would lead to follow men and women in totally different ways. To date, the cardiovascular follow-up of women is set on that of men!
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Estelle B., Doctor of Pharmacy
Sources
– A major advance in genetics and risk factors for a form of heart attack that mainly affects women. presse.inserm.fr. Accessed June 9, 2023.
– An alarming progression of infarction in women. www.agirpourlecoeurdesfemmes.com. Accessed June 9, 2023.
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