For over a year, starting in late 2021, the Women's Heart Bus chugged around France, offering cardiac and gynecological screenings to thousands of patients living in precarious situations or unable to travel to a doctor.
There's good reason the bus was checking both heart and reproductive-organ health.
Cardiovascular disease is the leading cause of death among women worldwide. And for decades, we've known there's a connection between heart health and gynecological issues.
Reproductive health history can provide some of the earliest clues that a woman is at elevated risk of cardiovascular diseases – and gynecologists may be in an unusually good position to spot them.
A new review paper brings these threads together, detailing the variety of connections between cardiovascular and reproductive health and looking at three examples of how heart-gyno health programs can work.
Women share many of the classic cardiovascular risk factors with men, including high blood pressure, diabetes, smoking, and high cholesterol.
But women also have a collection of risk factors that men simply don't have, and some of those particular clues can show up years or even decades before a heart attack or stroke.
Pregnancy, for example, can act as a kind of cardiovascular stress test.
The researchers write in their review that previous work "confirms the strong association between preeclampsia, gestational hypertension, premature birth, gestational diabetes, and an increased risk of subsequent cardiovascular disease in women."
Other conditions offer similar clues. Polycystic ovary syndrome, or PCOS (recently renamed PMOS), is an endocrine disorder that can involve metabolic problems, such as unhealthy cholesterol levels. A meta-analysis involving more than a million women found an increased risk of cardiovascular disease among women with PMOS.
Endometriosis also seems to be connected to heart health. The chronic condition affects about 10 percent of women of reproductive age and is associated with inflammation and the buildup of fatty plaques in the arteries. The review points to evidence linking endometriosis with increased risks of stroke and heart attack.
Women with migraine with aura have about twice the risk of ischemic stroke, and their risk of heart attack is also increased. Migraine and endometriosis also appear to be intertwined, with women who have one condition more likely to experience the other.
Then there's menopause.
Women who go through menopause before age 45 have a significantly higher cardiovascular risk, with particularly strong associations for very early natural menopause and menopause caused by ovarian removal surgery. The review also highlights research suggesting that severe or frequent hot flushes may themselves be associated with cardiovascular risk.
Clearly, there are a lot of connections between these two parts of women's health – so it makes sense to suggest that the gynecologist's office is also a place to catch warning signs of cardiovascular diseases.
Three French programs described in the review offer a glimpse of what that could look like.
At one hospital in Paris, women attending gynecological care for premature ovarian insufficiency, perimenopause, or menopause were offered a cardiovascular assessment.
Among 197 women, 34 percent were newly diagnosed with hypertension, diabetes, or dyslipidemia. More than half of those who already had hypertension needed their treatment adjusted, as did more than half of those with known dyslipidemia.
Overall, 58 percent of the women either received a new diagnosis of a major cardiovascular risk factor or needed an existing treatment changed – even though these were women without a previous major cardiovascular event.
A second program at a menopause center in Toulouse found that 70 percent of more than 1,000 women aged 45 to 60 had at least one cardiovascular risk factor, while 35 percent had two or more.
The review authors argue that perimenopause and menopause may be an especially useful window for checking in on women's heart health since many show up for care for these issues at precisely the age when cardiovascular risk factors are becoming more common.
Related: Ovaries Begin Aging Decades Before Menopause – And The Implications Go Far Beyond Fertility
And then there was the Women's Heart Bus. Among 4,300 participants, 90 percent had more than two cardiovascular or metabolic risk factors, yet more than 70 percent had no cardiac follow-up.
Of course, not every hot flash, migraine, or difficult pregnancy means a woman is destined for heart disease. These are associations and risk markers, not crystal balls.
But together, this research makes a compelling case for connecting two parts of women's healthcare that have historically operated in separate lanes.
The review has been published in the journal Maturitas.
This article was fact-checked by Rachel Garner and edited by Clare Watson. While we pride ourselves on our process, we are only human. If you spot a mistake, please let us know.