At Porterium Magazine, we are preparing a wellness feature focused on
cardiovascular prevention, women’s health, and proactive longevity strategies in today’s environment. Given your expertise at the Centre Cardio-Thoracique de Monaco and your focus on women’s cardiovascular health, we would be honored to include your insights.

Below is a curated selection of questions exploring prevention, early detection, and lifestyle approaches. Please feel free to adapt the questions or add any important aspects that you believe should be addressed and answer to your free style we would adapt it later to the interview format, considering your tight schedule – we would greatly value your perspective.

• Preventative cardiology is becoming increasingly important — how is your centre approaching early detection, particularly for women over 40?

The Centre Cardio-thoracique de Monaco is a key contributor to early detection of coronary artery disease and valvulopathies. Thanks to our dedicated medico-surgical team and to our outstanding multi-modality imaging that consists of latest generations echocardiographies, cardiac MRI and a remarkable photon-counting CT, we are able to play an important role in cardiovascular assessment for individuals of any age, both male and female.

• There is growing discussion around implementing regular cardiovascular screening (including imaging and biomarker testing) for women after 40. Do you see this becoming a standard practice to anticipate potential cardiovascular disease?

Cardiac prevention is shifting towards a more precision and individualized medicine with the aim to detect atherosclerosis earlier before symptoms occur. Due to major advances in cardiac imaging, we are able to detect coronary atherosclerosis earlier and to implement specific targeted therapies in case of high cardiovascular risk.

Concerning biomarquer testing, it is already recommended to test a specific biomarquer : lipoprotein (a) at least once in every adult’s life, particularly in younger individuals with premature atherosclerotic cardiovascular disease (ASCVD), or with a family history of premature ASCVD.

• What are the early indicators of heart related issues in women that are frequently ignored or misdiagnosed ?

Persistant or unusual fatigue and shortness of breath can be signs of heart disease and can sometimes be mistaken for stress or anxiety , aging or burnout especially in women, who are historically considered to express more mental health issues.

Palpitations or digestive symptoms can also be misdiagnosed as stress or anxiety while they may be the first symptoms of a heart attack.

These atypical symptoms differ from the classical ones that are more common in men which can lead to under recognition of heart disease in women.

• Women’s heart health has historically been under-recognized. What are the key differences in how cardiovascular disease presents in women compared to men?

As explained in the previous answer, women may experience different symptoms compared to men.  

If we take the exemple of myocardial infarction, we know that 50% of women who undergo a myocardial infarction experience atypical symptoms (such as nausea or vomiting, unusual fatigue, palpitations, shortness of breath or dizziness) compared to the classical ones that men more typically present (chest pain radiating down the left arm).

In addition to different symptoms, women also have different manifestations of cardiovascular disease. Men are more likely to have obstructive coronary disease (large coronary artery blocked) whereas a woman has more microvascular dysfunction, non obstructive coronary disease (INOCA) or SCAD.

• What role does hormonal change (especially during perimenopause and menopause) play in cardiovascular risk?

Menopause is a key moment in a woman’s lifespan that is characterized by increased cardiovascular risk.

With the loss of estrogens at menopause, the woman’s body goes through many physiological changes such as increased arterial stiffness (that contributes to hypertension), pro-atherogenous lipid profile (with increased LDL-cholesterol, apo-B lipoproteins, decrease in HDL-cholesterol), changes in metabolism with increased visceral fat (with increased insulin resistance, increased inflammation). All these factors contribute to a higher risk of coronary artery disease, stroke and other cardiovascular events.

• Are there specific lifestyle or nutritional strategies that have the strongest impact on preventing cardiovascular disease long-term?

Not smoking (or smoking cessation) is probably the most powerful preventive action for cardiovascular disease, especially in women. Women who smoke have 25% more risk than men to develop myocardial infarction.

Having a healthy diet, mainly a mediterraneen diet with plenty of plant based food, fruits, vegetables, nuts, legumes, healthy fat (olive oil), fish , with important limitations to refined oils, sufary foods and drinks, highly processed food, red and processed meat.

• How does chronic stress and mental health issues contribute to heart health, and what can be done to mitigate these effects?

Chronic stress and mental health issues like anxiety or depression can have a major impact on heart health and is often underestimated.

Stress releases cortisol, an hormone that contributes to high blood pressure, increased blood sugar, increase in visceral fat, and increased inflammation which overall contributes to atherosclerosis.  

Chronic stress also leads to poor lifestyle behaviour like smoking, alcohol abuse, physical inactivity or poor sleep quality. Psychological stress is more prevalent among women.

Many of those effets can be mitigated with lifestyle chnages, medical support and stress management strategies.

• For someone who feels “healthy,” how often should they realistically undergo cardiovascular screening?

It depends on multiple factors. If they have symptoms (shortness of breath, palpitations, chest pain, unusual fatigue etc), it is necessary to do a cardiovascular checkup.

Also, family history and risk factors should be taken into account. A person with family history of early heart disease should be screened earlier than a normal person.

Concerning women, It is strongly recommended to have a cardiovascular screening around the (peri-)menopause period and earlier if there are any specific risk factors or pregnancy related disorders (like gestational diabetes or gestational hypertension).

• Are there specific supplements or nutrients that have strong evidence for supporting heart function and prevention?

It is important to precise that very few supplements have strong evidence for cardiovascular prevention. Most data either show small effects or no benefit at all, compared to diet, wich has a true evidence based effect. It is therefore more important to prioritize a balanced healthy diet over supplements.

However, if you want to take supplements, there is no harm in doing so and those with the best evidence would be the Omega-3 fatty acids found in fatty fish may lower triglycerides and reduce inflammation.