Pioneers in Cardiology Lecture Series

Q:  How did you initially become interested in cardiology?

A:  I became interested in cardiology from the beginning of medical school. The time I was in medical school was the golden age of cardiology. We were in the beginning of translating laboratory data to the bedside. It was a very exciting time, and a month didn’t go by where something new wasn’t identified. It was a wonderful marriage of the science of medicine to the practice of medicine. And over the course of my career, there have been so many advancements to the field. That’s what makes our specialty so exciting: it is non-static.

Q: What prompted you to begin research in women’s cardiovascular disease?

A: I was inspired by my teachers in medical school and residency training. (Dr.) Louis Wolff (Harvard), and (Dr.) Hermann Blumgart (Harvard), and at Mount Sinai in NY I was the first fellow of Dr. Charles Friedberg’s when he took over as chief. People who are recognized by their name, I worked with them day in and day out. I learned the importance of learning the data, applying it at the bedside, and questioning where there was a gap in knowledge. And perhaps the most important reason was – as (Dr.) Hermann Blumgart told the Harvard entering class – “patient care is caring for the patient.” Everything we do, whether it’s in the research lab or clinically, any kind of investigation or advancement should be directed ultimately to the care of the patient. That’s why all of us went into medicine.

When I was at Emory, really as a junior and intermediate level faculty member, all I had learned about cardiac disease in women was that rheumatic disease was important. We had MS, the beginning of mitral valve surgery, but aside from rheumatic disease, everything was considered a disease of men. And this is what I had in previous publications called “bikini medicine.” The only issues addressed for women was the area covered by the bikini: breast and reproductive. And yet, in the clinic and in the hospital, I was seeing women with heart disease and women with bad heart disease. And as I looked to the literature for which I had been trained to do, there was nothing about women. It was all about men. I queried a number of my mentors and the professional associations (ACC, AHA, NIH…), and their approach was there are no differences, it’s not important. And yet I saw women having severe cardiovascular disease and dying from it. I continued to nag at our professional organizations and the NIH, and finally they agreed to do a workshop. It was my privilege to co-chair that workshop – usually there is 1-2 years between workshop and conference- this took 6 years. I kept nagging and the summary of the conference was the NEJM article (1993). This was the first time women’s cardiovascular disease had been linked in the title in a major journal. I expect that article intrigued a number of people and enrolled a number of people in my division. Are there differences, what are the differences, and how do we address the differences? It is an ongoing challenge, even though we’ve made major progress, women are under-researched, under-treated, but over-represented in adverse outcomes. The turning point was in 1993 with the NEJM article on cardiovascular health and disease in women. It was the first major publication to couple heart disease and women. CVD most common cause of death among US women and women fare worse than men. How much is this biology, how much is this is bias? I expect it’s a combination. The encouraging thing is now you look at the major medical meetings- AHA, ACC- you notice the change. If you look at the early 2000s, there were very few article titles discussing gender and sex differences, and now there are many. 

Q: Do you have any advice for early career cardiology fellows? And particularly, women in cardiology?

A: It is important to choose among the areas available where you would see yourself very happy and productive over the years. What will you enjoy coming to in the morning and feeling satisfied at the end of the day. That is very individual. Try to establish within that area a niche for yourself, in your practice group or academia. There are so many areas that remain to be explored.  Fellows and junior faculty should not be afraid of exploring the unknown and working in those areas.

As far as leadership is concerned, as a whole, when you look at leadership training materials, all you see are pictures of men. When I present on this topic, I like to show a panel of women in leadership roles instead. There is a cultural shift going on, and we have to have that cultural shift. I’m hoping that the women in cardiology will view themselves as potential leaders. Women often undervalue themselves and don’t choose to adopt leadership roles when they are ideally suited for those roles. And it is not likely related to the demands of the job. More women are drawn to heart failure, and that is a very demanding field. More women are going into interventional fields. Overall, there is a need for greater representation of women in leadership roles.