Cardiovascular disease remains stubbornly underprioritized in women's healthcare, partly because clinicians still default to male-centric risk models. A coordinated clinical review from France now illustrates just how much undetected vascular burden accumulates by the time women reach perimenopause — and why integrated gynecological-cardiological care pathways may catch what standard practice misses.
This review, published in Maturitas, examines three operational French care programs blending gynecological and cardiovascular screening. At Cochin-Hôtel-Dieu Hospital in Paris, more than half of women assessed walked away with either a new diagnosis — hypertension, diabetes, or dyslipidemia — or a meaningful treatment adjustment, suggesting routine care had left significant pathology unaddressed. A Toulouse-based menopause center serving women aged 45 to 60 found that 70% carried at least one traditional cardiovascular risk factor, with half of that group bearing two or more. Perhaps most striking, a mobile screening unit covering 20 French cities found that over 90% of women in socioeconomically precarious situations had more than two cardiovascular risk markers simultaneously. The review also catalogs female-specific risk factors now gaining recognition — premature ovarian insufficiency, polycystic ovary syndrome, hypertensive disorders of pregnancy, gestational diabetes, endometriosis, and migraine — all of which appear to independently elevate long-term vascular risk.
This work lands against a backdrop of growing evidence that reproductive history is a powerful, yet chronically underutilized, cardiovascular risk signal. Large cohort studies, including UK Biobank analyses, have associated conditions like preeclampsia with two-fold increases in future coronary artery disease risk. Despite this, no standard cardiology risk calculator routinely incorporates these variables. The French model described here offers a practical structural answer: co-locate expertise rather than wait for primary care to bridge the gap. The limitation is real — these are observational program evaluations, not randomized trials, so causal inference about outcomes is premature. Still, the sheer magnitude of undetected risk found across all three programs makes a compelling case that current siloed care is systematically insufficient for perimenopausal women.
