Better understand the differences between a man’s heart and a woman’s

After three years of living with chest pain that worsened over time, Guylaine Pinet was finally able to get her diagnosis after consulting at the Cardio F clinic, the first center specializing in women’s cardiovascular health in Quebec. According to the centre’s co-founder, Dr. Jessica Forcillo, a shift is taking place in women’s heart health research.

Cardio F has been in place for five years at the Centre hospitalier de l’Université de Montréal (CHUM). “But it was an effort since 2018. In our field — I am a cardiac surgeon — we were seeing inequities in terms of women’s cardiovascular health. […] Being a woman is an independent predictor of mortality, even in an era that is very contemporary,” says Dr. Forcillo. She reminds us that cardiovascular disease is the leading cause of death among women worldwide.

In Canada, “Everyone in Red” is a national day on February 13 to raise awareness of heart disease in women, which is often underdiagnosed.

In the clinic, we deal with diseases specific to women and we are interested in risk factors specific to the woman’s life trajectory. By this we mean hormones, pregnancy, menopause, menarche, etc. Researchers will follow some of them who have agreed to participate in the research.

Dr. Forcillo explains that from a macroscopic point of view, when you look at the hearts of men and women, there is no difference. “It’s when a heart becomes damaged, when it develops the disease, that’s when the differences happen. That is to say, we think that there are cardiometabolic, hormonal or inflammatory differences,” she explains.

Guylaine Pinet, a retired nurse, says that Cardio F gave her life back. “I find that sometimes, when I say that, it’s a big word […] But it’s a bit like that because I was at the point where I always had pain,” she says.

The message that Ms. Pinet wants to convey is that women must be attentive to their symptoms and insist on being listened to. “It’s hard to insist,” she says, “because we’re not the ones who are doctors.”

Better recognize women’s unique symptoms

The trigger for Ms. Pinet was when she lost consciousness while at rest. She had several symptoms afterwards, such as tension in her jaw and tightness in her chest “like a vice”.

“The more it went, the more it deteriorated,” she recalls. Ms. Pinet says she was very well taken care of at the Montreal Heart Institute, but the tests she had did not give conclusive results, before she was referred to Cardio F where the diagnosis was made: vasospastic angina.

Ms. Pinet is now taking exceptional medications that suit her well, although imperfect. “I don’t think I’ll ever get back to the shape I was in before, but at least I’ve been given back a quality of life that I had lost,” she says.

Ms. Pinet’s case is not isolated. Dr. Forcillo says that the symptoms of women and men can be the same for a heart attack, but the way they are expressed will be different. Women also have other symptoms that can be confusing, such as sweating, hot flashes, nausea, abdominal pain. “Often, it can be seen as something else, such as menopausal symptoms or indigestion,” says the surgeon.

Léa Berbach, a cardiology student, believes that women must learn to recognize their own symptoms. “I think we should get women to know better the symptoms that are said to be more atypical, even if it’s not atypical because it’s their own symptoms. Maybe we should put this forward more and do more prevention with women so that they understand a little better.”

Women’s health research is improving

Research has historically been based on the “bikini approach,” or the reproductive system. “What we’ve seen over the last 40 years is that there has been an increase in the prevalence of cardiovascular disease. It may be due to the modernization of women over the years, which means that a woman is as affected by heart disease as men,” says Dr. Forcillo.

To better understand, Berbachis researching biomarkers, which are small molecules found in the blood. “We’re trying to see what could predict the disease and help a little bit in the directions, the interventions we would like to go to,” explains the cardiology student.

With a specialized machine, the researchers are trying to see if they can identify differences in the sexes. “Are there more pronounced, more dominant markers in women, in men, and also in interventions?” she wonders.

Ms. Berbach conducted an epidemiological study on a Quebec database and her results show that non-traditional factors (specific to women’s life trajectory) have an impact on the development of the disease. “But I think we need to push even more and do more analysis. Now, we want to bring these results from databases into our clinical projects with patients,” she says.

Dr. Forcillo is encouraged by the fact that research among women is improving. “There is clearly something happening because there are more and more groups that are interested in it. […] We are really in the era of a medicine that is personalized, individualized, and that’s where we’re going,” she points out.

The surgeon points out that in congresses there are now specific sessions on women’s heart health. “Just that’s something. It’s done around the world too. There is really an alarm signal that has been sounded in relation to this,” she concludes. However, it remains difficult to recruit women into clinical trials to do research.

–This report by La Presse Canadienne was translated by CityNews