The challenge in Internal Medicine seems clear: put the focus on the female-specific vascular risk factors, for a long time made invisible by mere apriorisms resulting from a heterocentric vision of the world. Not in vain, science has shown that exclusive aspects such as pregnancy They give rise to vascular risks that, therefore, are also exclusive. To alleviate its incidence, a concept is making its way strongly as a therapeutic alternative: fourth quarter.
“Pregnancy is a test of physiological stress“, of effort, that women go through and that acts as a predictor of future vascular risk,” he stated. Eva Carmona Dominguez, midwife of the Gynecology and Obstetrics Service of the Virgen Macarena Hospital, in Seville, at the XX Vascular Risk Meeting of the Spanish Society of Internal Medicine (SEMI), held in Malaga and one of whose great pillars is the specific study of health cardiovascular in women. In fact, six of the tables have focused on this topic.
Regarding this, Pascual Císcar Fernándeza fifth-year Internal Medicine resident at the Hospital de la Fe, in Valencia, has highlighted that there is an “increased incidence of hypertensive disorders of pregnancy and other adverse outcomes in women” which, according to various studies, “have cardiovascular effects in both the medium and long term.”
| Pascual Císcar: “There is an increased incidence of hypertensive disorders during pregnancy” |
“That is, a maternal cardiovascular continuum is established in which the cardiovascular alterations that appear during pregnancy are maintained after childbirth and, in the long term, entail an increased risk of suffering from vascular disease,” he stated in the table moderated by Maria Abad Cardielphysician at the Hypertension and Cardiovascular Risk unit of the San Carlos Clinical Hospital, Madrid.
Faced with this, the idea of introducing a ‘fourth’ trimester after the three of pure pregnancy in the treatment of pregnant women, seeks to “open the eyes of all internists and leaders in cardiovascular risk that women deserve follow-up.” and special attention in order to reduce the incidence of cardiovascular morbidity and mortality attributed to adverse cases of pregnancy,” according to Císcar.
To talk about the fourth trimester of pregnancy, therefore, is to talk about a paradigm shift in the care of women after they give birth. “Traditionally, the postpartum visit of the midwife was based on a review of the stitches or staples of the cesarean section, on the collection of results of the heel test and in checking the development of lactation. The concept of the fourth trimester consists of giving importance to the opportunity we have to reevaluate vascular risk,” summarized Carmona.
For Císcar, at a time when the mother “focuses all her concern on the newborn,” it is necessary that there be “someone to look after her and control the vascular risk factors that may have appeared or been triggered as a result of the gestational process”.
The challenge of making women’s cardiovascular care visible
Despite the scientific evidence, experts still consider that there is a lot of work to be done regarding the study and specific approach to vascular risk in women. “It is a challenge, a lot of awareness is needed,” he said. Ana Maestre Peirointernist at the Vinalopó Regional University Hospital, in Elche, at the table dedicated to this and moderated by the president of the SEMI, Juana Carretero Gómez.
The expert has regretted that cardiovascular diseases in women continue to be studied, recognized, diagnosed and treated “little.” In fact, she has indicated that sex and gender are the “main determinants” in healthcare inequality. To solve it, “we have to involve all agents: doctors, academic institutions, scientific societies and society as a whole, not just women,” she added.
| Ana Maestre: “Sex and gender are the main determinants of health care inequality” |
As proposals for improvement, it has precisely referred to equitable access to healthcare as a first step, in addition to early diagnostic. To achieve this, the basis, according to Maestre, is to commit to a “shared responsibility” that brings together specific training for health professionals, but also for patients, to guide the path towards “precision medicine by sex and gender.”
In that sense, Dolores Lopez Carmonaan internist at the Regional University Hospital of Málaga, has regretted that, currently, specialists in the field base their work on risk scales in which women “are not well represented”: “In these guidelines, women’s vascular risk ‘explodes’ when they reach the eighth decade of life, but is non-existent in the previous seven decades,” he highlighted.
The fact that there are specific risk factors for women that are not taken into account in these scales means that “we lose the opportunity to work on them early.” According to the expert, women “have smaller and more elastic arteries, and much more vegetative courtshipwe are more sensitive to increases and decreases in blood pressure, and to vasodilation and vasoconstriction.”
“All this gives rise to a series of symptoms that accompany all the cardiovascular eventsThat is to say, they are a fundamental part of the treatment that we are not seeing or perceiving,” he stated.
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