Continue to communicate, we healthcare professionals and the general public, around the 3 "A's" of Agir pour le Coeur des Femmes to save even more lives in our territories.

Dr Olivier Hoffman, Former President of the Collège National des Cardiologues Français CNCF
spokesman and head of communications for the CNCF, President of the Amicale des Cardiologues de Paris et sa Région and Ambassador for Agir pour le Cœur des Femmes, regularly delivers these preventive messages to the medical community, based on our three A's of the heart: Alert, Anticipate and Act.

Cardiovascular disease (CVD) has become the leading cause of death in women, with 200 deaths a day in France, six times more than breast cancer.

It's a medical and social emergency in France, but also in Europe, with almost one woman in two suffering from CVD: 20% ischemic heart disease due to disease of the heart's arteries, the coronaries, 14% stroke and 15% other CV diseases including arteritis of the lower limbs.

Increasing exposure to risk factors (hypertension, hypercholesterolemia, diabetes, smoking as early as the first cigarette a day, sedentary lifestyle and stress) is blamed, as is less access to cardiovascular screening than for men.
Cardiovascular risk factors linked to hormonal risk are also present in women, notably early menopause, endometriosis, hypertension and diabetes during pregnancy. Similarly, the combination of smoking and estrogen-progestin contraception multiplies the risk by 26 in women over 35.

A pathophysiologically different disease, the symptoms of infarction are often atypical (40% of cases): chest pain, not always constrictive, palpitations on exertion, dyspnea, fatigue and sometimes digestive signs such as nausea, vomiting or epigastric pain.

So how can we better identify these increasingly young women at risk of myocardial infarction?
Well, in addition to questioning and clinical examination, conventional laboratory tests and hormone status, a complementary approach is to study the coronary calcium score calculated from an injection-free thoracic CT scan. This provides a quantified assessment of the extent of calcified atheromatous deposits in the coronary arteries.
- If the calcium score is zero or less than 100, the risk of event is 1.5% at 10 years, with the exception of familial hypercholesterolemia.
- If the calcium score is between 100 and 400, there is incipient atheroma, the cardiovascular risk is higher by around 15% at 10 years, and statin treatment is indicated with a target of less than 0.7g/l LDL. Aspirin is also indicated if the calcium score exceeds the 300 threshold.

- If the calcium score exceeds 400, the CV risk is very high: 25% at 10 years, the LDL target will be even stricter, below 0.55g/l, and in this case there is an indication to look for myocardial ischemia by scintigraphy, stress echography or stress MRI. Depending on the results, revascularization by stent or bypass will be discussed.

Agir pour le Coeur des Femmes raises awareness and informs women about CVD: "Alert, Anticipate, Act" the three A's that will save 10,000 women in 5 years.

Well done to the "Bus du Coeur des Femmes" (Women's Heart Bus), which, in addition to the three A's of the Heart, enables women in vulnerable situations to be identified and taken care of, by putting them back on a coordinated care pathway, with the involvement of a territorial network of involved healthcare professionals, local authorities and the Caisse Primaire d'Assurance Maladie (Primary Health Insurance Fund) in each stopover town.

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