Women's Heart Bus Shows Why Reproductive Health Can Reveal Cardiovascular Risk

For more than a year from late 2021, the Women's Heart Bus travelled across France, providing cardiac and gynaecological checks to thousands of patients in precarious circumstances or unable to get to a doctor.

There was a clear rationale for the bus to assess both cardiac and reproductive health.

Cardiovascular disease is the leading cause of death for women worldwide. Researchers have also understood for decades that heart health is linked with gynaecological conditions.

A woman's reproductive health history can offer some of the earliest clues that her risk of cardiovascular disease is raised, and gynaecologists may be particularly well placed to identify those signs.

A new review paper draws these strands together. It sets out the many links between reproductive and cardiovascular health, and examines three examples of how combined heart-gynaecology health programmes can operate.

Cardiovascular and reproductive health risk factors

Women have many of the established cardiovascular risk factors also seen in men, such as high blood pressure, diabetes, smoking, and high cholesterol.

However, women also face a set of risk factors that men do not have. Some of these distinctive signals can emerge years, or even decades, before a heart attack or stroke.

Pregnancy, for instance, may function as a form of cardiovascular stress test.

The researchers write in their review that earlier research "confirms the strong association between preeclampsia, gestational hypertension, premature birth, gestational diabetes, and an increased risk of subsequent cardiovascular disease in women."

Other disorders can provide comparable warning signs. Polycystic ovary syndrome, or PCOS – recently renamed PMOS – is an endocrine disorder which can involve metabolic issues, including unhealthy cholesterol levels. A meta-analysis covering more than a million women found a higher risk of cardiovascular disease in women with PMOS.

Endometriosis likewise appears to have links to heart health. This chronic condition affects roughly 10 percent of women of reproductive age, and is associated with inflammation and the accumulation of fatty plaques in arteries. The review cites evidence associating endometriosis with greater risks of stroke and heart attack.

Women who experience migraine with aura have approximately double the risk of ischaemic stroke, and also face an increased heart-attack risk. Migraine and endometriosis also seem to be connected: women with either condition are more likely to have the other.

Menopause is another relevant factor.

Women who enter menopause before 45 have a substantially higher cardiovascular risk. The associations are especially strong for very early natural menopause and menopause resulting from surgical removal of the ovaries. The review further draws attention to research indicating that severe or frequent hot flushes may themselves be linked to cardiovascular risk.

Gynaecological care as a cardiovascular health checkpoint

The breadth of these connections across women's health makes the gynaecologist's surgery a logical setting in which to identify warning signs of cardiovascular disease.

Three French initiatives described in the review illustrate how this approach might work.

At a Paris hospital, women seeking gynaecological care for premature ovarian insufficiency, perimenopause, or menopause were offered a cardiovascular evaluation.

Menopause. (NIH)

Of 197 women, 34 percent received a new diagnosis of hypertension, diabetes, or dyslipidaemia. More than half of participants with existing hypertension required their treatment to be altered, as did more than half of those with previously known dyslipidaemia.

In total, 58 percent of the women either gained a new diagnosis of a major cardiovascular risk factor or needed a change to existing treatment – despite having had no prior major cardiovascular event.

A second programme at a menopause centre in Toulouse found that 70 percent of more than 1,000 women aged 45 to 60 had at least one cardiovascular risk factor, and 35 percent had two or more.

The review's authors argue that perimenopause and menopause could provide a particularly valuable opportunity to assess women's heart health. Many women seek care for these concerns at exactly the age when cardiovascular risk factors are becoming more prevalent.

Related: Ovaries Begin Ageing Decades Before Menopause – And The Implications Go Far Beyond Fertility

What the Women's Heart Bus found

Then came the Women's Heart Bus. Of its 4,300 participants, 90 percent had more than two cardiovascular or metabolic risk factors, but more than 70 percent had received no cardiac follow-up.

Naturally, a difficult pregnancy, migraine, or hot flush does not mean that a woman is certain to develop heart disease. These are associations and risk markers, rather than crystal balls.

Taken together, however, the research presents a strong case for joining two areas of women's healthcare that have traditionally worked separately.

The review was published in Maturitas.

This article was fact-checked by Rachel Garner and edited by Clare Watson. Although we take pride in our process, we are only human. If you notice an error, please tell us.