French Women and Heart Attack

Data published today shows that the death rate from acute heart attack (STEMI - ST Elevation Myocardial Infarction) has declined in France during the last fifteen years. These are results from the so-called FAST-MI registry that were published this morning at the Annual Meeting of the European Society of Cardiology in Munich, Germany. The same trend has been observed in many other European countries as well as the United States. This is attributed to better treatment as well as changes in patient profile and behaviour. What is, however surprising in the French data is an increase in the number of younger patients, particularly women. The proportion of women with heart attack, younger than 60 years increased from 12 to 26 percent within fifteen years. The prevalence of risk factors among these women is certainly worth thinking about. In fifteen years, smoking increased from 37 percent to 73 percent and obesity from 18 percent to 27 percent, among women younger than 60 years who had a heart attack. The proportion of young patients not having high blood pressure, diabetes, or high blood levels of cholesterol also increased markedly.

These results are quite striking for a number of reasons. Firstly, smoking stands out as a risk factor in this group of young patients. Secondly, obesity seems to play a stronger and more important role as a risk factor than before. Thirdly, traditional risk factors, such as high blood pressure, diabetes and high blood cholesterol seem to play a minor role.

Considering that the young women in the FAST – MI registry tended not to have high cholesterol levels nor high blood pressure, one has to wonder about a possible  role of inflammation. We do know that inflammation is involved in atherosclerosis and acute coronary events, although a causative role has yet to be defined and proven or unproven. Inflammation is certainly related to both obesity and smoking and could therefore, at least in theory, be a common link explaining the changes in risk profile among French women suffering a heart attack. I wonder if the French paradox is till alive and well.