The number of deaths following a heart attack has been decreasing for the past fifteen years. Good news that masks a reality much less enjoyable: long spared than men, women are now on the front line.
Increasingly, myocardial infarction also occurs at a younger age: in women under 50, the number of cases recorded tripled in fifteen years.
The “feminine” symptoms remain poorly known: diffuse pain, difficulty breathing and nausea sometimes hide a serious heart trouble and are not detected in time by the caregiver.
Ignored or misinterpreted, these symptoms do not only concern the heart attack, since all cardiovascular diseases are concerned. While this type of accident is the leading cause of death among women, and the third among men, it remains much better supported by them.
Why? Because stroke has long been considered a male disease, with women being a priori protected through menopause through estrogen. But with the equalization of lifestyles, the deal has changed. The aggravating factors of smoking and alcohol are no longer the preserve of men.
Brain attack is all the more misdiagnosed as the symptoms differ from one sex to another. The famous left arm pain, for example, is absent in almost 43% of women, who show signs of fatigue, persistent back pain, shortness of breath or severe nausea. Less easily detectable, these signals can be confused with auscultation with other disorders, including anxiety.
For Claire Mounier-Vehier, president of the French Federation of Cardiology (FFC), ” we are facing a worrying epidemiology “. Especially since women are more likely to have lasting after-effects following a stroke, their arteries being thinner, taking longer to revascularize.
This public health problem is being tackled by the FFC, which conducts awareness campaigns among health professionals and the general public. In 2015, the federation even offered the services of the director Maïwenn for a clip denouncing the sexist prejudice surrounding the heart attack.
This difference in treatment between women and men has a name: the “Yentl syndrome”, referring to the eponymous heroine of the writer Isaac Bashevis Singer , a young Ashkenazi Jew forced to disguise himself as a man to study the Talmud, whose reading is forbidden to women.
This expression is due to Bernadine Healy , an American cardiologist precursor to the fight against discrimination, who invented it in the early 1990s. Became first woman head of the National Institutes of Health , the equivalent in the United States of America. the Inserm , she labored with determination against the problem of the treatment of female heart disease, particularly in hospitals.
Barbara Streisand, who played Yentl on the big screen , is also a longtime activist. In 2008, she created the Women’s Heart Center , dedicated to research in cardiology. In an interview with the Washington Post in 2015, the singer said, ” We must mobilize minds around the battle for the hearts of women.”
Standard and exception
Discrimination starts early, as early as the stage of clinical trials in the laboratory, before the marketing of a pharmaceutical treatment.
Few people know, but in these labs, 80% of subjects, most often rats or mice, are males. If the molecule passes the test, it is then administered to human volunteers, of which again only 25% are women .
To explain it, the laboratories highlight the hormonal cycles and the risks of pregnancy, likely to disrupt the smooth running of the clinical tests. As a result, some side effects are more persistent in women, especially when taking sleeping pills or cholesterol-lowering drugs.
This prevalence of the masculine on the feminine sometimes provokes surrealist situations: in 1993, an American study on the relationship between obesity and cancers of the breast and the uterus was carried out on a panel of exclusively male subjects ! Since then, the US Congress has passed legislation to require laboratories and research organizations to include more women in their clinical trials.
If the problem is not new, it is only a few years that it is discussed in France, where things evolve slowly but surely. At least that was suggested last December at the microphone of France Inter , Catherine Vidal , neurobiologist at Inserm, and Murielle Salle , lecturer in history at the University Claude Bernard of Lyon, especially specialized in kind in medicine. Come to present their book Women and health, still a business of men? , The two women have denounced prejudice and unequal treatment, which they say “may become a major public health problem” if they are not resolved in time.
More than the responsibility of laboratories and scientists, Murielle Salle emphasizes the deleterious role played by social stereotypes, recalling that “there is a manufacturing of medical knowledge that takes the masculine as the norm and that always conceives the feminine as the exception “ .
With a long history behind them, gender-related stereotypes still influence our relationship to the medical world, with women being considered more “snug”, while men would be more reluctant to consult.
Impact on men’s health
Because of stereotypes and social roles, gender discrimination also affects men’s health.
Osteoporosis, which weakens the bone capital, is generally less well detected in the latter. While lowering the density of bones, it increases the risk of fractures and can lead to repeated accidents if it is not detected in time. Today, nearly a third of femoral neck fractures in men are thought to be caused by osteoporosis.
In an article in the Swiss Medical Journal, Drs. Emmanuel Biver and Brigitte Uebelhart of the Geneva Medical University estimate that 20% of men report an osteoporosis-related fracture after their fifties, a figure that is constantly increasing.
Another example is that of depression: women, more prone to illness, usually consult much earlier than men. For the psychiatrist Théodore Hovaguimian, author of numerous publications on the question, the symptoms of depression are usually diminished in the man, which makes that ” his depression is too often misunderstood, starting with himself “.
Sudden aggression, constant irritability or risky behavior may be the warning signs of depression and should not be taken lightly. Because male depressive episodes often have tragic repercussions: ” Men commit suicide up to four times more than women,” recalls Hovaguimian.
Recent women’s speeches and the late recognition of endometriosis, a chronic, usually recurrent disease of the uterus affecting one in ten women of reproductive age, point to further advances in treatment.
Against “standard” medicine, the still-new idea of a differentiated treatment can not be born without the global will of the medical profession, patients and patients. True equality of treatment can only be achieved with respect for each other’s differences.