February is American Heart Month, and today we are delighted to have experts, advocates, and innovators joining us for conversations about prevention, education, and lifestyle choices as well as the role that gender bias plays in health care.
First, my colleague, Yasmeen Abutaleb, will be joined by the CDC’s Janet Wright for a conversation about the disparities between men and women’s cardiovascular health. Then Frances Stead Sellers will be joined by three guests: Yale New Haven’s Hospital’s Alexandra Lansky, George Washington University’s Ramesh Mazhari, and Bloomer Tech CEO Alicia Chong Rodriguez. They will talk about how women can be their own best advocate in taking action to prevent heart disease. And last, Akilah Johnson will be joined by cardiac surgeon Jennifer L. Ellis and Cedars-Sinai’s Martha Gulati who will discuss how cardiovascular health impacts women of color.
Before we get started, I’d like to thank today’s sponsor for this event, Amgen.
Thank you all for coming. My colleague, Yasmeen, will take the stage after this short video.
MS. ABUTALEB: Good morning, and welcome to The Washington Post. I’m Yasmeen Abutaleb, a White House correspondent here at The Post.
Today I’m delighted to be joined by Dr. Janet Wright, the CDC’s director for the Division for Heart Disease and Stroke Prevention. Dr. Wright, thank you so much for joining us here today.
DR. WRIGHT: Truly a joy to be with you.
MS. ABUTALEB: So I will start by admitting I was a longtime health reporter and had no idea that heart disease was the number one killer of women in the U.S. So with that confession, I would like to ask the audience, how many of you knew before today’s event that heart disease was the number one killer of women?
MS. ABUTALEB: Okay, just me.
DR. WRIGHT: Making you feel bad, right?
MS. ABUTALEB: Yeah, exactly. I’m just trying to open it up.
MS. ABUTALEB: Well, Dr. Wright, I’m so happy that you’re here today to talk about your work on this issue.
So I think we’re supposed to have an infographic from your office that highlights some startling facts. Here we go.
Heart conditions kill more women in the U.S. every year than all cancers combined. Yet most women don’t understand that heart disease poses a significant health threat and is the number one killer. Why do you think that is?
DR. WRIGHT: I think–I think we have a certain amount of denial about this. I think the facts have been out there for quite some time, but the idea that our lives could be cut short or that we could be disabled by a condition is so abhorrent that we would suppress that information. We’re busy. We’ve got lots going on, and it’s hard for us to hear it. Hearing it, that heart disease is the number one threat, also means that we need to do something about it.
And before we get into what we can all do to make sure that we rewrite what has been the trend in this country, I just want to say that all of you who raised your hands, I want you to go out there and make sure that everyone you touch–male, female, everybody that you contact–also knows what you know about women’s number one health threat and what we can do to prevent it.
MS. ABUTALEB: Well, there are a number of risk factors that are shared by men and women from high blood pressure to obesity. What are some of the risk factors that are specific to women?
DR. WRIGHT: Yeah, there are specific risks for women, but what we are seeing is even a lack of control of those risk factors that are shared. So we know that physical inactivity, diets that are high in processed foods, diabetes, being overweight, and certainly high blood pressure apply to men and women. But throughout the life course, I guess–I guess I should say there is a news flash here in terms of the science. Women and men are different.
DR. WRIGHT: And not only are women and men different, but women are different across the life course. So a woman, a girl, is quite different from a woman in early ages, in teens and 20s, and then with aging, women continue to evolve. We’re just fascinating throughout the entire life course.
And so not only are we different than men, but we also are different, which has been a bit of an impediment to view us as a research subject because we’re constantly changing. That’s one of the reasons not enough women have been in clinical trials is that we’re a terrible research subject because we’ve got lots of variables going on. Thank goodness that is being resolved and through the work of many of you and the organizations that you may represent.
But we are continuing to explore what those differences are, and they extend beyond the biologic to how do we access care, how do we access care differently given the demands on our time and the responsibilities that we have, and so those are areas of discovery.
I’m just delighted to be on the panel today with experts in this field who have devoted their careers from the start to uncovering these differences and beginning to plug the gaps in research, including applied research, like actually how do we make what we know work, work for women?
MS. ABUTALEB: Well, we have an audience question from Jeanne in Texas who asks, what specifically is being done to address how women’s heart issues are different and equally important to those of men?
DR. WRIGHT: Yes. Lots of research going on, lots of adaptation. I’ll say that my division focuses a lot on what’s called “implementation science”–is again how to take what’s been proven to work in a clinical trial and make sure that it works in communities around the country. Does it work in care delivered by a federally qualified health center? Does it work in a big health system? Does it work in a large community? And so that research is going on, and not just as, again, clinical trial research, which was as critical, but this implementation science.
MS. ABUTALEB: Can you talk to us a little bit–oh, I’m sorry.
DR. WRIGHT: Maybe I can just give an example of that.
DR. WRIGHT: So we know that women, for example, who have had a heart attack or a stroke or they’ve had an angioplasty or surgery, all people who have had those kinds of events or procedures should be referred to cardiac rehabilitation. It’s a fabulous set of services that address lifestyle, address the risk factors, including stress, and help people. I’ve heard so many patients tell me they’re healthier after their heart attack than they were before.
What we know is that fewer women than men get referred to cardiac rehab. Of the women who are referred, fewer actually initiate cardiac rehab and fewer complete, and then when you look at women by race and ethnicity and even by age, the disparities get even worse. So what can we do to adapt the traditional cardiac rehab for a woman’s busy life, for the responsibilities where she may be taking care of others at home and trying to balance that life-giving service of cardiac rehab with her demands? Those adaptations are happening. Virtual can help.
MS. ABUTALEB: Well, that’s so fascinating, and I want to dive into it more, but I just first want to ask, because I think this is a question a lot of us have, which is, how do heart attacks look different for women than for men?
DR. WRIGHT: I’m so glad you asked me that question. How many people think that a woman has vastly different symptoms than a man when they have a heart attack?
No. So I’m glad we’re having this conversation.
MS. ABUTALEB: I didn’t raise my hand this time.
DR. WRIGHT: So if you look at big studies, 80 percent of people who are having a heart attack will complain of, quote, “chest pain,” 80 percent male and females, 80 percent. Maybe a little bit higher in men but not by much.
The problem is that, first of all, we do a very bad job of describing what heart pain really feels like. We call it “chest pain.” When you hear the word “pain,” I think of smashing my finger with a hammer or something that’s sharp. And pain that comes from a heart attack is pain of muscle that’s starved of oxygen. It’s similar to when you were a kid, maybe some of you still, run really hard or you run for a distance, and you feel a cramping kind of feeling in that muscle because it’s not getting enough oxygen. The same sort of feeling happens in the chest when someone has low blood flow, having angina or a heart attack. It is a pressure, a tightness, a heaviness. It feels oppressive. Many women will want to unhook their bras, and it doesn’t help.
But if you ask somebody if they’re actually having pain, some people will even say no because it’s not pain in the sense that most of us think of it. So it’s more chest pressure, tightness, or heaviness.
What we do know about women as a group is that women tend to have–describe more symptoms beyond chest pain. So they may describe feeling short of breath, or it’s hard to get a breath. Many will describe nausea. Sometimes the pain is radiating, but that can also happen–all those things can also happen in men.
I honestly wonder–and I don’t have any data in this regard, but we know that women, girls, start talking earlier than men. Women tend to be a little more verbal. Are we just more in tune with our bodies and more able to describe what we’re going through as opposed to really experiencing something that men don’t experience? I don’t know.
I’ve taken care of hundreds and hundreds of people, and most commonly, people will have that chest pressure or tightness. It’s not a different sensation.
MS. ABUTALEB: I didn’t know that.
Well, this year marks the 60th anniversary of the start of American Heart Month. Despite improvements in cardiovascular mortality for women in the past two decades, heart disease in women continues to be understudied and underdiagnosed. What are some of the reasons for that?
DR. WRIGHT: Yeah. I think it has taken us a long time to recognize the differences and to realize the opportunities to actually improve women’s cardiovascular health by getting at the roots of the problem, and so ginning up those engines has taken a while.
There is an increase. And you’ll see today an amazing set of women who, again, have devoted their lives to women’s cardiovascular health, and they’ll be able to share their knowledge with you. But it’s taken a while for us to get more women into the field. It does make a difference.
We know in care, the more concordant the clinical person is with the person that they’re serving, the more likely they are to have a communion that results in therapeutic outcomes, better health outcomes. And so we think that getting more women into health care will also help improve the health of women.
I am very worried about trends that we’re seeing right now, particularly in the 35- to 64-year-old age group for women and men, but it’s for heart disease and stroke outcomes, stroke deaths and heart disease deaths. In that workforce, in those who are caring for children and often caring for their parents, we’re seeing death rates go up. We’re seeing heart attacks occurring in younger and younger people, including women, and in fact, the rate of rise is higher for young women than it is for men. We’ve got to get at the root causes of why this is happening and make sure that the care that we deliver is tailored to each sex.
Really interesting data show that women who are admitted, younger women who are admitted with a heart attack, are more likely to bounce back into the hospital. And in one particular study, the reason they bounced back in the hospital was more often for non-cardiac causes than for cardiac causes, and so you start to wonder, what’s happening in the home or that support structure that helps that woman stay healthy outside the hospital? Does she have the support that she needs? So getting at the social needs is increasingly important when you look at women’s health.
MS. ABUTALEB: I want to talk a little bit about how women are identified for heart disease. Most diagnostic tests and treatments are based on surveys and studies using men. How does that harm female patients, and how do you see that impacting diagnosis in women?
DR. WRIGHT: That’s a great question, and I think I actually live the problem I’m going to describe. I spent the first half of my professional career taking care of people as a practicing cardiologist. I am now–and very gratefully so–added this awesome opportunity to work in public health, try to get at the root causes and prevent things that I used to try to treat. What happens when you make a shift like that is that you go from taking care of one person at a time–and the family hopefully–to a population, thinking more broadly. What interventions could affect more people with a given approach?
And so I often worry that people who are on the front lines in emergency rooms and offices and clinics know the statistics that heart disease in–let’s take younger women–is less common in women than in men. If you just took the whole population, it’s a little less common in women than men, and so their index of suspicion that a heart problem could be happening in that woman at that moment is lower. They’re thinking in terms of the population.
And so what we want, of course, is for the index of suspicion to be high for women who might be experiencing several symptoms, and that those women are treated seriously, they’re listened to, and they are investigated.
One of the ways to make sure that happens is, of course, for the individual clinician to have a high index of suspicion. The other way, a complementary way, is to have protocolized care, a protocol. When someone has a certain symptom–in this case, chest pain, chest pressure–they get an EKG. Everybody gets an EKG, and that’s a first test. There are additional blood tests that can be done to confirm whether someone is indeed having a heart attack or at high risk for a heart attack.
Evaluating the risk factors–blood pressure, diabetes, elevated cholesterol–and then always asking about physical activity and dietary history as well as family history, all of those things go into the equation that a particular clinician will use to determine whether a woman, in this case, will need additional testing.
But we’ve got to make sure we’ve got systems in place so that no one falls below the cracks, beneath the cracks, through the cracks.
MS. ABUTALEB: Well, we have an audience question that I think very much relates to what you just laid out. This is from Colleen in Ohio, who asks, how frequently do cardiologists discount women’s heart concerns? What recourse do women have?
DR. WRIGHT: I don’t know how often it happens. There are multiple examples, and an organization that you’ll hear from a little later, WomenHeart, has been around for a long time and helped to lift up women’s good examples of good care and also episodes where women have had to fight to be heard and fight to be treated.
What I would say is–Yasmeen, I forgot the second part of your question. Can you ask the second part again?
MS. ABUTALEB: Of course. She says, how frequently do cardiologists discount women’s heart concerns, and what recourse do women have?
DR. WRIGHT: Yes, yes. Thank you. So the recourse, incredible question about recourse. What I would encourage is to trust your gut about your heart. I will tell you one of the most compelling things I’ve ever heard from a person, woman or man, is “It’s just not right. Something is not right.” And, in fact, if you all watched Latrice Baxter’s video, she actually says that, ”I just knew something wasn’t right.” And so if you feel something is not right, you have to keep seeking care. It’s a terrible thing to have to tell you, but that’s what you have to do. That is your burden to keep saying it’s not right, and then you’ve got to keep searching for someone who can hear what you’re saying and can at least start the process of finding out whether it is your heart.
MS. ABUTALEB: Well, you talked in the beginning about how women can be frustrating studies because their bodies change so much. So, related to that, I want to ask a pregnancy-related question, because there’s been a lot of reporting and attention in recent years over maternal deaths with a great focus on preeclampsia and other blood pressure-related complications. So how does everything that we’ve been talking about today with regard to how women are diagnosed and treated made more complicated during pregnancy?
DR. WRIGHT: Yes. First of all, I would say, in addition to being grateful to The Washington Post for featuring and talking about women’s heart health, I’m so grateful for the national conversation that’s going on now about maternal health. A large portion of what happens to cause death during pregnancy and following pregnancy and orders of magnitude more complications during pregnancy that are not fatal, a large proportion of those are cardiovascular disease, and most prominent among those is high blood pressure.
Currently, more women are going into pregnancy with existing high blood pressure, often undetected. We can get into why it is so often undetected, but undetected high blood pressure. Other women who may go in with a normal blood pressure can develop high blood pressure during that pregnancy. That hypertension of any sort during pregnancy marks a woman for a lifetime and early onset of cardiovascular disease, lifetime risk and early onset. It’s like a tattoo that you get. And then we all need to be watching that woman, and she needs to be watching herself for the development of risk factors in heart disease.
So what can we do about that? First of all, again, the national conversation about maternal death and maternal mortality has opened up opportunities for us to all learn more about something like hypertension, something entirely controllable, treatable, fixable. We just have to make sure that every woman has a monitor if she is at risk or has had high blood pressure and knows how to use it, and that she is in communion with a clinical team that can help her manage her blood pressure. She may find out that her blood pressure was only transiently elevated and doesn’t need any additional attention, but knowing what your blood pressure is, what things raise it and lower it, that puts the power in your hands to then have a dialogue with the clinical team and keep you out of harm’s way.
MS. ABUTALEB: Well, we have a couple minutes left, and so I want to get to the heart of your work, which is prevention. Your work is largely focused on prevention, helping women understand lifestyle factors and other steps they can take to not get to the step of being diagnosed. So when you look at the sort of landscape of cardiovascular deaths, do you think a lot of them are preventable, and if so, how?
DR. WRIGHT: Yes. In fact, statistics show that about 80 percent of heart disease and stroke are preventable, 80 percent, and that’s the number that just–it drives me, because if we know generally and even specifically what works–controlling blood pressure, controlling lipids, being a little physically active every day, fruits and vegetables in the diet, as much stress reduction as we can generate–if we know what works and we’re not delivering it, that’s not acceptable, and so–especially because we can prevent this misery of heart disease and stroke. So our division invests in state health departments all over the country, 50 state health departments and D.C. as well as the territories, to do the things at a community level that helps keep people healthy, and that’s true across all CDC in terms of physical activity in the community, connections, which are very important, dietary approaches, and also controlling blood sugar. There’s a whole diabetes division. So there’s a Center of Chronic Disease Prevention and Health Promotion, and we’re part of that.
MS. ABUTALEB: Well, we’ve got about a minute left. So I think I’ll ask, what lifestyle changes would you recommend most to help prevent the onset of these diseases?
DR. WRIGHT: I’m really glad you asked that. The answer is in small steps sustained over time. While many of you may have run marathons or you’re triathletes or you’re doing some fantastic excessive form of stuff that I also have enjoyed in my life, the ticket to health is doing one or maybe two small things but sustaining it so that you’re doing it every day. It’s like those folks who talk about the interest accruing and some investment and, you know, over time. The same thing is true in health.
So if you’re not physically active at all, five minutes a day, just commit to five minutes a day, but keep that up, and pretty soon, five turns into seven, turns into ten. If you can do a low sodium, if you would reduce your daily sodium intake by a little, it makes a huge benefit over time. You get the point.
That’s the ticket to health, and it’s also a sort of sneaky way to sneak yourself into health.
MS. ABUTALEB: Well, Dr. Wright, I think we could sit here and talk about this all day, but I unfortunately have to leave it there. So CDC’s Dr. Janet Wright, thank you so much for joining us today.
MS. ABUTALEB: Please stay with us. My colleague, Frances Stead Sellers, will be out with our next guests after this video.
MS. STEAD SELLERS: Good morning, and welcome back. I’m Frances Stead Sellers, an associate editor here at The Washington Post, and I am delighted on this snowy morning to welcome my guests, Dr. Alexandra Lansky, who joins us from the Yale School of Medicine, Dr. Ramesh Mazhari, who comes here from GW, not so far, and Alicia Chong Rodriguez, who is the founder of Bloomer Tech. A very warm welcome to you all. Thank you for joining us.
I really want to start this morning with that intro video. There were some stunning numbers there. Alexandra, it said that less than a quarter of physicians and less than half of cardiologists feel equipped to assess the specific cardiovascular needs of women. How can that be, and should we be training physicians in these wellness–in wellness checkups to recognize things that they’re missing at the moment?
DR. LANSKY: Yeah. I think I think we need to–I want to put it in context. So rewind time about two decades, and if you look at the cardiovascular mortality trends between men and women, end of 1990s, early 2000s was when we saw the peak of mortality in women and far exceeding that of men. And what we’ve seen over the last two decades through these types of programs, through the American Heart Association, the societies, et cetera, we’ve seen a dramatic decline in the mortality of women; in fact, now very similar between women and men.
So what I would say is we still have a problem. There’s no question about it. But I think it’s important to put it in context how far we’ve come in the last decades, really to increase awareness of patients but also physicians.
So to address your question, you know, I think we still see disparities. There’s no question about it. When we see patients, women coming into the emergency room, we still see delays. We still see delays of women going to the cardiac catheterization laboratory when they’re coming in with a nasty elevation myocardial infarction.
MS. STEAD SELLERS: So that’s where it’s most likely. We have a very educated audience, but we have a broader audience too, so–
DR. LANSKY: And, you know, it’s something that we need to continue to work on.
MS. STEAD SELLERS: So these are women coming in with distinct signs of cardiac problems, but they’re still experiencing delays.
DR. LANSKY: And they’re still–we’re still seeing delays. We’re still seeing disparities.
MS. STEAD SELLERS: So, Ramesh, I’d love to show a cartoon that ran–and I think it’s going to come up–with a story we had in The Post before, which is just about those disparities, and I think you’ve taken a look at it. But this suggests that the women who visit the emergency room have to wait 29 percent longer than men for interventions. Tell me what’s going on here. Are we just not recognizing these symptoms in women, or women express their pain differently, or can you sort of tell me from a doctor’s point of view what’s going on?
DR. MAZHARI: So the issues are twofold. The first one is that there is lack of awareness on women’s side for recognizing the early signs of the heart attack.
MS. STEAD SELLERS: Right.
DR. MAZHARI: So they present a little late.
MS. STEAD SELLERS: Right.
DR. MAZHARI: They may not take symptoms of heartburn, jaw pain, arm pain as seriously, especially younger women. And when they decide to seek care, we in the emergency room don’t take those symptoms seriously, especially in the younger women. And I think that women younger than the age of 65 should be the target of awareness and education for both patients and physicians. I think that we have failed to recognize that the very traditional risk factors and the classic symptoms that apply to men do not necessarily apply to women.
We are learning that a lot of sex-specific risk factors should be taken into consideration when we assess risk, and the guidelines really advocate for incorporating a lot of non-traditional risk factors in assessing risk when we are treating patients.
MS. STEAD SELLERS: And make that just a little bit specific for me. When you see a patient coming in, how do you see a woman and think what should I be looking for in a way that’s different from what I look for in a man?
DR. MAZHARI: Women tend to present with–a lot of them tend to present with chest pain, but they also express a lot of associated symptoms that might mask the core symptom of chest pain.
The chest pain itself may not be the crushing chest pain, but it could be symptoms that resemble heartburn or indigestion. They may have jaw pain. They may be short of breath. They may simply just be really tired and fatigued.
And I think that if we think of women in–even in the reproductive age as high risk for coronary disease, we will have a much lower threshold for getting an immediate EKG, checking blood tests, and calling for consultation and really thinking of them having a heart attack as opposed to having atypical chest pain or non-cardiac chest pain.
MS. STEAD SELLERS: Alicia, I’m going to come to you in a minute to ask a little bit about the technology at work here, but before that, Alexandra, just back to you on this notion of misdiagnoses or missed opportunities. You’ve talked about progress and change, but can you pinpoint exactly how that’s coming about? Because women still, when they have heart attacks, are more than twice as likely, is that right, to die as men? I mean, that’s stunning to me, even–
DR. LANSKY: I mean, yes, that’s true. But my point was we have–we have come a long way.
MS. STEAD SELLERS: Right.
DR. LANSKY: We have made a difference. The differences and the disparities continue to be there, and I think we need to continue to work on this.
You know, one thing that you mentioned was the–what I call the “age paradox,” this whole issue of younger women coming in with symptoms, and that’s the group of women where we’re seeing the excess mortality. So when you’re talking about the twofold higher mortality rate, it’s really in the younger age group. It’s not in the older patients. In the older patients, we have come around to understanding that this is a disease that affects them, and we are doing the EKGs and we are doing the diagnosis. It’s in the younger women where we don’t–we don’t assume or we’re not thinking that this is a disease that affects them and where the symptoms–and young women don’t recognize this, right?
MS. STEAD SELLERS: Right.
DR. LANSKY: You know, you may be at home with your kids.
MS. STEAD SELLERS: Right.
DR. LANSKY: And, oh, I’ve got–you know, I’ve got this feeling in my chest, but let me keep on working on whatever I’m doing, and I’ll cook the meal, but–and you’re not coming in.
MS. STEAD SELLERS: Right.
DR. LANSKY: So we’re seeing the bigger delays–
MS. STEAD SELLERS: Right.
DR. LANSKY: –in the young patients. The differences in the symptoms are much more accentuated in the–in the younger patients, and all those delays really translate into worse outcomes.
MS. STEAD SELLERS: So, Alicia, here you are. You founded Bloomer Tech. It’s a perfect transition from this. What on earth took you to invest and innovate in this area as a young woman? I mean, what was the launchpad for Bloomer Tech?
MS. CHONG RODRIGUEZ: Yes. Thank you.
Well, my background is in electrical engineering and computer science, and I was part of MIT’s computational cardiovascular research group when I had access to huge data sets of all of the studies that are used today for clinical decision-making. So having access to that, seeing that everyone in my lab was using all of these data to generate AI tools, there was a moment in time when we realized, oh, my God, only one fourth of the data is female. Twenty five percent of the data is women’s data, and we’re training these algorithms with mostly male data. And that that was eye-opening.
Then we saw all of these statistics that have been discussed today, and with them, I ask, oh, my God, so many women get heart disease. Is there someone in my family that had heart disease? And I am proudly named Alicia after my grandma. I’m the youngest granddaughter, and my grandma had dedicated her life to women’s health as an obstetrician, back in a time when women were rarely allowed to obtain medical degrees. And my mom, as an adult, told me, oh, yes, my mom–her mom–died from a heart attack. And I knew that she had died when I was 13 years old, but it was eye-opening. Oh, my God, my grandma that I am so proud to being–like I have pictures of her, you know, in a room full of men. And I studied engineering. I was typically two women in a class of 40, of 40 students. So learning this as an adult, it’s a huge eye-opening moment for me that this needs to make progress.
One of my co-founders, she actually lost her mom when she was 12 years old–and her mom was 44–to a stroke. So these are life-altering things that need better technology because for such a long time we’ve had evidence. We have the science that shows physiological differences. Now we need the tools, and as technologists, we decided to do something about it.
MS. STEAD SELLERS: And you’ve come up with a tool, the Bloomer Bra.
MS. CHONG RODRIGUEZ: Yes.
MS. STEAD SELLERS: Tell us about that, because it’s a very exciting, very specific idea.
MS. CHONG RODRIGUEZ: Yes. So we created a garment that has sensors. We call it the “Bloomer Tag,” and the Bloomer Tag has the ability to continuously and remotely acquire physiological data. And by wearing this bra, you can track symptoms and patterns, and it gives women an easier way to collect data and create an automated journal on her phone. It can integrate to any type of bra, a sports bra, maternity bra, a post-surgical bra, and it collects huge amounts of data, physiological data from her body. We have heart rhythm, breathing, posture, temperature, movement, and it generates reports for better communication with her doctor. It can be used for early detection management and to generate new digital biomarkers that are specific to all of these decisions, conditions that we are seeing that where there’s lack of patterns that we can track with this to accelerate progress in women’s cardiovascular care.
MS. STEAD SELLERS: It’s just fascinating.
Alexandra, we’re getting audience questions, and I want to read you one that’s just come in. It says–it comes from Donna in Washington State who asks, what parts of the health care system act as barriers to women’s cardiovascular health as opposed to men? It’s a great question. It seems to me it’s from the beginning to the end. [Laughs]
DR. LANSKY: I think it’s all along the way.
MS. STEAD SELLERS: All along the way.
DR. LANSKY: I mean, we see it, and you know, I–what we don’t want to do is blame anyone–
MS. STEAD SELLERS: Right.
DR. LANSKY: –in that, in that journey, I think, but it’s from the patient to–we see delays from symptom onset to presentation to the hospital.
MS. STEAD SELLERS: So let me follow up on that question. Women are the caregivers, right? Women go to hospitals more with their children, with their families.
DR. LANSKY: They do. They do.
MS. STEAD SELLERS: They arrange, they make the appointments for their husbands. Why are women–
DR. LANSKY: Women take care of everybody else around.
MS. STEAD SELLERS: Uh-huh. Not themselves.
DR. LANSKY: But they don’t take care of themselves–
DR. LANSKY: –is the problem, right?
MS. STEAD SELLERS: Right.
DR. LANSKY: So if you have your laundry list of things you have to do that day, that’s what you’re going to do before taking care of your own symptoms. So that’s number one.
But I think once they come to the emergency room, that first diagnosis–we’ve seen this time and time again, EKGs not being done, women coming in with heart attacks where it’s–you know, they’re in early shock. We’re seeing less lactate levels, less troponin levels, et cetera. So we’re making that diagnosis. Even 15 minutes counts. So it’s every minute is counting, and then the time it takes to get to the cath lab. I think once the patient is in the cath lab, whether you’re a male or female, you know, you’re there.
MS. STEAD SELLERS: You’re there.
DR. LANSKY: You’ve reached your destination, and I think the care is the same. But I think it’s really all along, all along the way.
MS. STEAD SELLERS: And, Ramesh, you’ve been working on minimally invasive surgeries for women. Tell me what progress you’re making there and what you see as the future.
DR. MAZHARI: I think minimally invasive approaches to a lot of cardiovascular diseases is the way to go. We have come a long way over the last 50 years when we first started doing angioplasty. We needed bigger devices, which came with a price, which was complications related to the bigger devices. But the minimally invasive approach has actually served women very well, because in most of the cardiovascular trials, women have been the subject of increased complications, bleeding complications, device-related complications. And part of it has to do with the fact that the earlier trials are biased. Women are underrepresented in trials.
MS. STEAD SELLERS: Right.
DR. MAZHARI: And we have always believed in equality in medicine, which means to provide the same thing to everybody. But we really need to focus more on equity, which means that you go an extra mile and provide the support that’s needed for the ones needing the most support.
MS. STEAD SELLERS: Right.
DR. MAZHARI: In the cardiovascular space, we really need to enhance women’s enrollment in trials because there is so much we don’t know.
MS. STEAD SELLERS: Right.
DR. MAZHARI: Maybe women had increased bleeding risk because the same antiplatelet and anticoagulant and blood thinning regimen–
MS. STEAD SELLERS: Right.
DR. MAZHARI: –for men was too much for women. Maybe we don’t understand the way women metabolize these medications. So minimally invasive approaches at least have eliminated any large device-related complications in women. They reduce the recovery time, and in general, they are much safer. We’ve seen that in angioplasty space. We now see it in treatment of structural heart disease, where we replace open-heart surgery with catheter-based interventions. So it is the future of cardiovascular care.
MS. STEAD SELLERS: And talking about the future, Alicia, what you’re doing is gathering data that, of course, can inform the future. I’d love to know about some of the findings you’re getting from the Bloomer Bra other work that you’re doing in fem-tech.
MS. CHONG RODRIGUEZ: So for us, it’s very rich to realize that some of the existing technologies that doctors use, how they have demonstrated to already be biased, right? We hear different sensors that depend on a color or tone of the skin because they’re imaging technologies. So they will have technical influences. We hear in the standard of care when people are having a heart attack, they will get a troponin test, and this troponin test is based on biotin technology. And biotin technology will be affected if you’re taking vitamins for hair and nails with biotin. So the FDA has issued warnings around this, but it’s systematic issues that we need to change.
So we are aware, that we’re designing something since its inception, thinking about female bodies, thinking about her lifestyle, right, and thinking about gathering all of these data so that we can generate the future of digital biomarkers, because unlike traditional biomarkers like blood or weight or blood pressure that are just a picture in time, a digital biomarker has the power of being continuous, right? Like, you can see when there was a shift, and if that shift makes sense with your lifestyle, it makes sense with your genetic markers or if we have to look into it and talk with the doctor. So we have that power of personalizing health care for her because we can see in a continuous way when things are changing.
MS. STEAD SELLERS: So, Alicia, actually, there’s an audience member who’s asked this question, and this question is very much on my mind. It’s about AI and the bias that can come with using AI. So let me ask the question. It comes from Sabrina in D.C. who says, with the increasing use of AI, what tools and programs are being used or developed as proactive measures for women to track and measure their heart health risks? So AI, right, very useful but also potential…
MS. CHONG RODRIGUEZ: Well, it’s like they say, garbage in, garbage out. It all depends on what you’re using to train.
MS. STEAD SELLERS: [Laughs] Garbage in, garbage out.
MS. CHONG RODRIGUEZ: And I do think that there’s an importance to realize, okay, we already know that there’s a gap in the data.
MS. STEAD SELLERS: Right.
MS. CHONG RODRIGUEZ: We need to do an extra effort so that we can accelerate progress using AI instead of perpetuating problems that we already have on a systemic level.
MS. STEAD SELLERS: Right.
Ramesh, we’re talking about hospitals, lots of data collecting, but some of the changes that we can make are lifestyle changes. What do you see, Ramesh, in terms of helping women deal with diabetes, smoking, exercise and other factors that can help promote heart health? What kinds of changes do you see happening or do you promote yourself?
DR. MAZHARI: We have no choice but to leverage technology in the future of cardiovascular care, and I think what’s really important is to make sure that it’s accessible to our target population. If we’re targeting women, we need to make sure that whatever technology we’re incorporating into their care is accessible to them. Sometimes we need to meet women where they are, and then there is room for educating both women and their doctors about where they are along the spectrum of risk and what needs to be done to eliminate their risk and how the technology can help us achieve that goal.
I think that one interesting point about AI and technology and cardiovascular care is that we need to be mindful of the fact that the population we’re interested in targeting might be the one that’s resistant to embrace the technology. So we have to make it easier for women who, as we mentioned, are taking care of the entire family to have access to the remote monitoring. Then they need to have education as to what we’re looking for–
MS. STEAD SELLERS: Right.
DR. MAZHARI: –in the remote monitoring, a lot of education about seeking medical attention with the early signs of cardiovascular disease.
One idea that the awareness campaigns are really focused on is use the technology, but also recruit the community organizations and existing networks–
MS. STEAD SELLERS: Right.
DR. MAZHARI: –to help us implement the–
MS. STEAD SELLERS: Right, public health approaches–
MS. STEAD SELLERS: –we learned so much about during covid.
MS. STEAD SELLERS: We also have this great potential game changer. You tell me, Alexandra, if it is a true game–well, they are a true game changer, the weight loss drugs we now have, Ozempic and Wegovy. I mean, from your point of view, is this–do you walk in the morning and think, well, my job is going to be changed looking ahead, [unclear] are gone or not?
DR. LANSKY: I think–I think these drugs are remarkable. I mean, if you if you if you realize that 70 percent of the U.S. population is obese, right, based on–
MS. STEAD SELLERS: Seventy percent.
DR. LANSKY: –that 70 percent of our population–
MS. STEAD SELLERS: And it’s moving around the world. This is something that’s–
DR. LANSKY: And it’s all over the place.
MS. STEAD SELLERS: Right.
DR. LANSKY: And honestly, these drugs, from what I have seen, are game changers. I have seen patients coming in that I’ve been following for years. They go on the drug. Six months later, I have my follow-up appointment. They’re on less cholesterol–their cholesterol has come down. The blood pressure has improved. We can come off of some of the blood pressure medications. I mean, obviously, it’s not everyone, but it’s very impressive. Very impressive results. So to me, this is definitely a game changer in terms of, you know, new treatments and compliance, because we always have issues with compliance.
I mean, the best patients, the ones that come in, it’s a wake-up call, and they, you know, go back to exercising and taking their medications. But that’s a minority of our patients.
MS. STEAD SELLERS: Right.
DR. LANSKY: You know, most of our patients are actually–it’s very difficult to change, to change their habits.
MS. STEAD SELLERS: Yeah, habits.
DR. LANSKY: It gets–and time is against us, right?
MS. STEAD SELLERS: Right.
DR. LANSKY: As you get older, it gets more and more difficult. So honestly, I think these drugs are really definitely a game changer.
MS. STEAD SELLERS: So we’re getting close to the end, running out of time. But I want to ask you about role models in this area. I think fewer than 4 percent–am I right?–of interventional cardiologists are women. What does that mean for–and, Alicia, you’re right at the heart of this question too. What does that mean to have fewer women role models in these key areas, even though we now have a female head of NIH and women at the top of the CDC? Still in practicing medicine, we don’t have a lot of female role models. I’d love to hear just quickly from each of you what it means to see women in these positions and what it would mean to have a growth of women in leadership positions.
DR. LANSKY: We need more women. We need more women representation in our field. We need more women leaders. We’ve seen–again, we’re slowly seeing a change in the shift, but we have such a long way to go. And I think having leaders in the field will help with the disparities that we’ve seen. I think it’s going to help with the enrollment of women in clinical studies. It’s going to help with better understanding and focusing the research questions that we need to–
MS. STEAD SELLERS: Right.
DR. LANSKY: –address. Four percent is unacceptable.
MS. STEAD SELLERS: Ramesh?
DR. MAZHARI: I have to remind the audience that the major breakthrough in having women-focused research studies date back to early 2000s, and that had to do with the fact that we had the first female head of the NIH, Dr. Bernadine Healy–
MS. STEAD SELLERS: Right.
DR. MAZHARI: –and the and Dr. Vivian Penn, who was leading the women research at the time. And the breakthrough was that they funded Women’s Health Initiative.
MS. STEAD SELLERS: Funded Women’s Health–
DR. MAZHARI: For the first time, we had real data collected on women, not just in the cardiovascular space, but other women-related diseases. And that was a breakthrough. So having women in powerful position–
MS. STEAD SELLERS: Makes a difference.
DR. MAZHARI: –will make a difference.
MS. STEAD SELLERS: Alicia, you started a fem-tech company. A quick word on that.
MS. CHONG RODRIGUEZ: Yeah. So for me, I’m a result of opportunities. I came to the U.S., thanks to the scholarship, and having 4 percent of women, the only thing is I get to meet with them.
MS. STEAD SELLERS: [Laughs] Get to meet them.
MS. CHONG RODRIGUEZ: I get to be in these places with all of the cardiologists moving forward the needle, that my work is inspired by the work of women cardiologists that have–
MS. STEAD SELLERS: What an inspiration.
MS. CHONG RODRIGUEZ: –moved the needle forward, that are doing the work, that have open women’s heart programs, that are talking to patients every day and teach us as technologists, what is–what is it that we need, and we’ve heard a lot of what we need here in this discussion today, which is so exciting. And yes, I was a fan, like a fan.
MS. STEAD SELLERS: I just love finishing on that, that fan message, that inspiring message. And I want to thank you all so much for joining us today. Dr. Lansky, Dr. Ramesh, and Alicia Chong Rodriguez, thank you, all three, for joining us today.
MS. STEAD SELLERS: Don’t go away. We’ll be back soon with more of this fascinating topic. Thank you.
MS. GORRE: Well, hello, everybody. My name is Celina Gorre, and I am the CEO of WomenHeart. We are the only patient-centered organization focused exclusively on women and heart disease, and this year is our 25th anniversary. So I invite all of you to celebrate this very special year with us.
I’d like to introduce a very special person, a passionate patient advocate, a wife, a mother, a hiker, a kayaker, and my friend, Latrice Baxter from Nashville, Tennessee.
Before we start, I’d like to set the stage a bit. You know, we’ve heard this morning that heart disease is the number one killer of men and women. It is the cause of death for one in five women every year. Sixty million women, or about 44 percent, of the female U.S. population has some form of heart disease. But those numbers don’t really give you what it’s like to live with heart disease every day.
So I’d like to invite Latrice to join the conversation and start with your start to heart disease, so this heart disease journey. It was a funny start, wasn’t it, Latrice?
MS. BAXTER: Yeah, absolutely. It’s a funny in a not-so-funny kind of way. So I had a doctor prescribe me hibiscus tea for elevated LDL-C. Yes, tea. And back then, I didn’t think much about it. But now, you know, I see how concerning that is because that doctor also knew my family medical history, because I shared that, of course. My dad passed from a massive heart attack at 57. My mom battled diabetes until she passed at 65. My grandfather had multiple strokes. I lost an aunt and very recently a cousin to heart failure. So it’s like heart disease has been like a shadow that kind of follows the family around for generations, and it became even more personal to me when I started having my own symptoms. I started to have shortness of breath and an extreme numbness in my left arm from the shoulder like to the fingers.
And of course, I’m freaking out. So I contact my doctor, my new doctor. I contact my doctor.
MS. GORRE: Not the tea doctor.
MS. BAXTER: No, not the tea doctor at all. So I contact my doctor, and he straight away refers me to a cardiologist. Went to the cardiologist. He’s like, go take a stress test. I went to take the stress test, failed it immediately, and I found myself later that night being driven by ambulance to Nashville to have open-heart surgery, and I ended up having to have a double bypass surgery because I had a major blockage in my left main artery.
MS. GORRE: Wow. And you said to me before that that actually wasn’t when you realized you had heart disease.
MS. BAXTER: No, I didn’t realize I had heart disease until maybe a few weeks to maybe a month or two later when I went back for my follow-up appointment. I thought that maybe it was like some fluke thing that had happened to me. I don’t know. Covid-related. I wasn’t sure. But yeah, I was told I actually had heart disease then. So I knew this journey was going to continue potentially, so–
MS. GORRE: So along with the risk factors that Dr. Wright shared with us this morning–blood pressure, diet, exercise, stress management–obviously cholesterol management is one of the most important things we can do to improve our everyday heart health, which is what we talk about at WomenHeart. We talk about everyday heart health as opposed to prevention. So can you share with us some specifics about how you finally got your–the certain type of cholesterol, LDL-C, under control?
MS. BAXTER: Absolutely. So basically, we talked–they talked about cardiac rehab earlier. I kind of put my own cardiac rehab together because I was one of those people who didn’t go, and that was because the covid numbers were so heavy. This was September 2020.
So I put together my own plan. First was dietary changes. I decided to add more leafy greens and reduce my salt and sugar intake, and back then, I panic-ly switched to being a vegan. So it was just beans, beans, beans, but now it’s more lean proteins.
MS. BAXTER: And the second thing was moving more. I was already active before, but after, you know, I had to just take it slow through in the healing process. So I started walking in my backyard. I would have my husband just peek out and make sure I hadn’t fallen out or anything, and then I started walking at the park. And then I found some trails, and I’ve been on the trails ever since.
And then the third thing was reducing my chronic stress.
MS. BAXTER: So what helped me with that was–and we know stress can be a killer.
MS. BAXTER: So yoga, meditation, and walking, honestly. So now I’m just regular stress, not chronic stress, and–
MS. GORRE: Everyday stress.
MS. BAXTER: Yeah, just regular everyday stress. And then it was getting the proper medication. So, you know, you leave the doctor after heart surgery with a big stack of prescriptions, but luckily, now I only have to take a few things. I take a blood pressure medication, a blood thinner, and I started on a statin therapy, but my doctor and I seen that my LDL-C wasn’t coming down very well. So he put me on non-statin therapy, and I’m having a lot of success with that.
And finally, was creating my care team. So my primary care doctor is like my health coach. He takes the time. We talk back and forth. He listens well. And my nurse practitioner at my cardiologist’s office, she’s who I go to for my–just my standard checkups. And then I have my cardiologist who I see at least once a year or if I’m having some concerns. And thankfully, I have them, and they all work well together. And they were able to help me navigate the insurance because–just because you get prescribed a non-statin therapy or certain treatments doesn’t mean you just get to roll up and get it from the pharmacy.
MS. GORRE: Unfortunately, that’s right.
MS. BAXTER: Unfortunately.
MS. BAXTER: So my insurance company, of course, they had things in place to kind of slow me down, I guess. So the doctor’s office was able to help me to go between those organizations to get my medicine. And in January, I switched insurance, and we had to do it all over again. But now I have everything, and I’m back in control of that.
MS. GORRE: You know, I mean, clearly you have successfully navigated what is a very complex health care system in this country, and now I know that you advocate for others, with others. You’ve used your story. You’ve used your experience in a way that I don’t think you thought you were going to use at the very start of it.
MS. GORRE: So I’d love for you to share with us, what are some ways that you have used that story to help others, and what are the platforms that you’ve used to do that?
MS. BAXTER: Absolutely. So yeah, I basically started my advocacy journey by accident. So I was just sharing my heart disease journey and kind of talking about my medicines and giving myself a shot on Instagram and TikTok, just talking to my little corner of the internet, and I was recruited to actually come to Washington and spend a whole day in like a patient advocacy bootcamp where we–I learned about all kinds of patient advocacy things that I didn’t know existed, right, ultimately, ending up with us having an opportunity to go to the Hill and actually speak to policymakers about the very things that I was going through with step therapies and prior authorizations and things like that. So I was able to talk to policymakers from my state, the great state of Tennessee, and so yeah, I’d just–I like to say I share inspiration and information on my–on my pages, just from a patient perspective to kind of make it all seem more relatable.
MS. GORRE: Yeah. And what was the experience like being with other patients? That was the first time presumably you did that.
MS. BAXTER: Amazing, amazing. I actually have some longstanding friends from that meet-up when they come to Nashville, because one of them, he comes to one of the hospitals in my town. And when they come to town, we go have Mexican food. We make good choices, but we go have Mexican food.
MS. GORRE: Beans, beans, beans, right?
MS. BAXTER: Beans, beans, beans. You can’t go wrong there.
MS. GORRE: So, Latrice, you are a perfect candidate to become a WomenHeart Champion.
MS. GORRE: Now, you probably don’t know what that is yet, so let me explain. So WomenHeart Champions are women with heart disease who are fierce advocates for themselves, for others. They take their messages far and wide, including to Capitol Hill, where they were just two weeks ago, advocating for policies to improve heart health of women just like you and me. They even advocated for a day, a special day, recognizing and raising awareness around LDL-C.
MS. GORRE: So, you know, this is a group of women that I think you would be a perfect–
MS. BAXTER: I’m excited to accept.
MS. GORRE: So I’m going to pin you.
MS. BAXTER: Oh, she’s pinning me. Absolutely. I accept. [Applause]
MS. GORRE: So, Latrice, can you please share with us, what is your–if you had one wish that you could–please pin yourself. Go ahead. If you had one wish that you could share with all the women in this country, all the women around the world actually, who are living with heart disease, what would that–what would that one wish be?
MS. BAXTER: My one wish would be that women understand that you can–you can change your doctor. A lot of times, we want to be so polite. We’re too polite to say, “Hey, something’s not right here with you, with our relationship. I don’t feel like you’re listening to me or taking me seriously, or you think I have some other motivations or whatever.” So if you’re not getting what you need from your health care team, then just be aware that you can change. You can fire them, and you can find somebody else.
MS. BAXTER: There’s thousands of really, really amazing doctors for us to choose from, and you don’t have to be stuck with someone who won’t take you seriously. It’s that important.
MS. BAXTER: Yeah, I think about–the word “partner,” that comes to mind.
MS. GORRE: I think we see in our WomenHeart community that when they realize that they can be empowered to advocate for themselves, that they can hold their health care providers accountable so that they can get the care that they deserve, that we all deserve.
MS. GORRE: You used the phrase yesterday when we were speaking about what your journey is today from what it was before.
MS. BAXTER: Well, for me, instead of just surviving, I’m thriving now. As the director mentioned before, some patients seem like they’re much better after they have their heart event, and I feel that way.
MS. BAXTER: I feel like I’m, in some ways, living a better life than I did before.
MS. GORRE: You know, you’re truly a testament to the fact that heart disease doesn’t have to be the death sentence that I think many people think it is. You’re thriving, and we are going to go hiking together after this, by the way.
MS. BAXTER: Oh, we have to.
MS. GORRE: And that is really, truly the spirit of WomenHeart. So I’m very excited to invite you into the sisterhood.
I want all of us to thank Latrice for being so generous and sharing her story with us today, and we look forward to, again, celebrating this special year with Latrice and with all of you. So thank you very much.
MS. BAXTER: Thank you. Thank you.
MS. GORRE: And I want to say a special thanks to Amgen and The Washington Post for this incredible opportunity to share a little bit about the patient experience and, you know, obviously a really important topic.
So now I will hand it back over to The Washington Post, and thanks again.
MS. JOHNSON: Hi, everyone. Welcome back. My name is Akilah Johnson. I’m a national health disparities reporter here at The Washington Post. It is my pleasure to introduce my guests today, Dr. Jennifer Ellis and Dr. Martha Gulati. Thank you both for being here with us.
DR. GULATI: Thanks for having us.
MS. JOHNSON: So, Dr. Ellis, we’re going start with you. You are a cardiac surgeon, and you are also the co-chair of the Association of Black Cardiologists’ Health and Public Policy Committee. A quick note to our audience that ABC, which is the Association of Black Cardiologists, and today’s sponsor, Amgen, have partnered on some of their research on this issue.
So my question for you is, only 60 percent of women know that heart disease is the number one killer for women in minoritized communities. What is minoritized? That is Black, Latinx, women from Asian communities. I don’t like saying “ethnic minority,” so we say “minoritized communities.” This figure drops to about third–one third for those groups. Can we talk about why there is this kind of information gap within specific communities?
DR. ELLIS: Well, heart disease is actually much worse than people actually think about, you know. So if there are about 50,000 women who die a year from breast cancer, 500,000 die from heart disease, and if you have breast cancer, you are more likely to die from heart disease than you are from breast cancer. So we don’t really–no one understands that heart disease is the number one killer in every group that you look at: Black, White, male, female. Unfortunately, gun violence is now hitting our teens. But before that, it was accidents. But once you hit, like, 20 and above, it is the number one killer.
And we don’t want to hear about it. We don’t want to think about it. We think of heart disease as a White disease. It’s actually greater in Blacks. It’s actually greater also–we think of it as a male disease. It’s actually greater in men. So if you have a White male versus a Black female, she is at much greater–higher–much greater risk, but she’s also going to get less care.
MS. JOHNSON: You know, you said she’s at a higher risk, and so I was in a conversation with some friends this weekend. And one of the things that we’re talking about when it comes to risk–this was an older woman who was sharing her particular story with heart disease–is that she had gone to the doctor short of breath. And she had said that she’s kind of embarrassed because she just thought, you know, maybe I just need to work out, like I’m always short of breath, right? Who isn’t short of breath sometimes? And that when she finally mentioned it to her primary care provider–and thank goodness the primary care provider took her serious–next thing she knows, it was a rash of tests and specialists and all sorts of things.
So I guess, can we talk a little bit too about stigma or maybe disbelief when it comes to what we should be looking out for in these symptoms of–you know, if heart disease is the number one killer for everybody, why is it something that people just don’t kind of recognize the symptoms? Dr. Gulati, can you maybe address that?
DR. GULATI: Yeah. I think, again–I think it’s the same point that women don’t recognize themselves at risk, and I think we’ve not done a great job of educating our public. And particularly when it comes to people of color, I think that is a group that we’ve really let down.
You know, we talk about these statistics every year during Heart Month. I feel like I’ve spent the last two decades doing this, but often the people at the table are not the people that should be at the table. We need to be in the communities. We need to be educating women about their risk and particularly for Black women. So for Black women after the age of 20, really more than 50 percent of women have some form of cardiovascular disease if you include hypertension in that.
And so how women don’t know, it’s surprising. Obviously, we’re in the field, and we think everything has to do with the heart. But our patients seem always shocked. So I think we need to do far more education.
MS. JOHNSON: Let’s stay on that topic for a second. We have a question from the audience that kind of falls right into this, and it’s from Imelda in Illinois who wants to know, how can we ensure that underrepresented groups get tested? And then how can we get them the help that they need to ensure that their hearts are healthy? So how do we make sure that they know they need to be tested for heart health, and then how do we make sure they get the health that they need? So start with you, Dr. Gulati, and then I’m interested to hear what you have to say, Dr. Ellis.
DR. GULATI: So I think the way, we need it to be forefront in the health care community because everybody deserves screening. Women know. They know if they need a Pap smear. They know if they need a mammogram. We’ve done a good job at educating women about that.
Why haven’t we helped women understand what it means to have your heart assessed? I think that’s where we need a campaign. We need to help our lay public understand it, and we need our health care community to be putting that at the forefront. When people come for their well visit, why aren’t they leaving understanding their heart? Why aren’t they leaving knowing if they’re at risk? Because we now have great ways to assess risk, and yet most women will tell me they haven’t been assessed.
We meet them in the emergency room or in the cath lab or in the operating room. That’s where we meet them. It’s too late then. I mean, it’s not too late–we can treat them, but why not prevent it? Eighty percent of heart disease is preventable, and we are not doing good there.
MS. JOHNSON: So let’s stay on that, on that topic of lack of education or lack of resources and why folks in these underrepresented groups don’t know that–and then what is a test for your heart? Like, we say how to get your heart tested. What does that even mean, you know, for folks who are maybe thinking, “Okay. I’m here. I’m hearing that if I’m over 20, I’d probably have a 50 percent risk of, like, having this issue”? What should folks even be asking for or talking about when they go to their–when they go to their doctor?
DR. ELLIS: Well, I like to–when I talk to my groups and whatnot, I like to them to have this mantra of could it be my heart, because especially if you go to the emergency room with some chest pain or whatever and they go, “Oh, you’re fine,” if you use the words, “Could it be my heart?” and they go, “Oh, I don’t think it’s your heart,” and then you go, “Well, but could it be my heart?” All of a sudden, sometimes that ER doc goes, “Ah. Maybe it’s your heart”–
DR. ELLIS: –and then looks at–you know, for testing, it’s a little bit different for women than men. I mean, you know, one of the things that it’s more of a stress echo rather than a standard stress test.
Going back to the very first talk about the CDC, the initial study was done–like, one of the most famous studies was done only on men because it’s easier. Men don’t get pregnant. They don’t go–they don’t have menopause. So you can avoid some of these issues. That’s–when that’s–the treadmill test was great for men. It is not as great for women. So a stress echo is a little bit better for women.
But, you know, when you say, “Could it be my heart?” that’s when you know what your cholesterol is, you know what your blood pressure is, you know what your good cholesterol and your bad cholesterol is, you know what your family history is. These are the things that are at the absolute minimum.
DR. GULATI: And could I add to that?
DR. GULATI: So we do risk assessment. Not everybody gets a stress test. I don’t want people to leave thinking they all need a stress test. So they–but it starts with knowing if you’re at risk, and so by taking your blood pressure, your cholesterol, knowing if you’re diabetic or not, knowing your age, knowing your race, we put that into an equation that tells us your short-term risk, like in the next 10 years, and then your lifetime risk.
So if you don’t know your risk for heart disease, either one of those, then nobody’s calculated your risk. It starts there for people to actually, before they have symptoms, to know if they’re at risk. That’s what they need done.
MS. JOHNSON: So let’s stay on the topic of risk a little bit. And so, you know, Dr. Ellis, most coronary artery disease can be prevented or managed through lifestyle changes and treatment if caught early. But the health care system has done a poor job of identifying those at risk, especially women and people of color. So let’s talk about specifically kind of what are the cardiovascular risks for Black women in particular. Dr. Ellis?
DR. ELLIS: So family history, diabetes, cholesterol, smoking–and a lot of family history actually is cholesterol–and then also weight and overall condition.
One of the things about the African American community, we have a different body image, and some think it’s healthier or not, but, you know, anorexia is not as prevalent in the African American community. I mean, you know, if you–could you imagine going to your grandma and throwing up her good cooked food on purpose?
DR. ELLIS: You wouldn’t–you might not live through that.
MS. JOHNSON: I’m dodging a wooden spoon right now, the thought of it.
DR. ELLIS: Right? So–and it also has to do with poverty. You know, if you go back 50 years, if you were thin, it was because you were poor. It wasn’t a fashion statement. So we have a different image, and so to tell people that they need to lose some weight and then not really give them any tools or reasons for it and so, you know, that goes towards the diabetes. And that also then goes towards the family history because of the survival.
But then the cholesterol and the blood pressure, blood pressure is such an undertreated issue. I mean, how many patients do you have that don’t take their blood pressure pills until they can feel it? And I say to them, if you can feel like your head is about to pop off, take your med. You know, “Well, I don’t like the way it makes me feel.” Well, that’s when you need to have a further conversation with your doctor.
What I tell my patients is that you–when you take your medicine, it should feel like you’re eating Tic Tacs, and if you said if you eat these 12 Tic Tacs a day, you will live longer, people will be “Sure, I don’t care.” If you feel it, instead of just stopping your meds, which is something that happens in the African American community, tell your doc, “It made me feel bad.”
There are 25 different cholesterol medications. There are probably 50 blood pressure medicines. There are now so many different ways to treat diabetes. We can find something that it should feel like you’re eating pebbles. But the only way we know that your cholesterol is good is when we do the test.
MS. JOHNSON: And so then when we think about women in the Latinx community, right?–we’ve talked a lot about kind of gaps in education and kind of what the risks that Black women need to know. Dr. Gulati, what are some of the these kind of same conversations that need to happen in other communities of color, with Latinx women, with other folks who are at risk for coronary heart disease?
DR. GULATI: Well, we need to be targeting everyone because it is the leading killer. It doesn’t really matter what your race is, and for certain races, the risk is high. For Black women, it’s high. For South Asian women, it’s high. And we’ve ignored a lot of these communities, and I think that’s where we need to be talking to them, talking in their language. If we need to be speaking the language, then we need to be there. We need to be communicating with examples that they identify with in their community, and I think the more that our health care community looks like the people we care for, the better it will be, because right now, you know, we know that there’s not very many, for example, Black cardiologists. We need way more, and we know that that’s how we create trust in the community when we look like you.
And that’s really been a problem in cardiology and for women. I mean, we don’t have enough women in cardiology, and then we don’t have enough people from diverse backgrounds.
And I think when we–as we’re changing that, we are able to go to our communities, and we know where to access our communities as well. And going to trusted places, whether it’s places of worship or community centers, that’s the way that we will be more trusted in these communities that often have barriers to accessing health care too. I mean, you know, if they don’t have insurance or inadequate insurance, people only go to the hospital when they’re really sick. And so we don’t get a chance to be proactive and prevent heart disease.
MS. JOHNSON: Yes. Mm-hmm.
DR. ELLIS: I just wanted to add to that. It’s also some cultural competency.
I had a very–a very nice fellow. He was not in any way mean or–he was just a good guy, but he went and said to a patient, “Mabel.” I took him aside, and I said, “She will never listen to you now. She is a Black woman of a certain age, and you called her by her first name.” And he was like, “Oh, I was just trying to be friendly.” And it’s like–“I know. I’m not mad at you. I’m not–you didn’t–you weren’t being–doing this in any way with a mean spirit, but I’m letting you know, it is a more formal society. I mean, you don’t do that. You will call her by her first name forever. You do not sit on her bed.” You know, sometimes people do that thinking that they’re being friendly. If she tells you that you can, that’s one thing, but you go in there–and if you want, you could have called her “Miss Mabel.” That would have been okay. But once you called her “Mabel,” she is now not hearing you. She will look at you in the eye. She will be polite, but you are no longer her physician.
MS. JOHNSON: It’s interesting, because you’ve touched on a few things, right? So, one, don’t sit on people’s beds with your outside clothes on talking about cultural competency is one of the things I heard.
MS. JOHNSON: But also, it sounds like, you know, this is, you know, bias, conscious or unconscious, but also microaggression. So as we’re talking about risk factors and we’re talking about the way that that plays a role in in health–and I’m thinking specifically about a study that recently came out from Boston University, that it’s tied experiences of racism to increases in Black women’s heart disease risk, I’m wondering if we could talk a little bit about how you all think weathering and some of these kind of external stressors also pose a risk factor when we’re thinking of heart health in addition to the behaviors of individuals. So, Dr. Gulati, I’ll let you start.
DR. GULATI: Yeah. So, you know in our new risk score that just got–came out in the last few weeks, it actually puts into the risk assessment, social determinants of health, and social determinants of health is part of the risk factors for heart disease. And experiencing racism is part of an experience that does elevate risk. That study, in particular, did show that people who experienced racial–racism, they were at a much higher risk of cardiovascular disease.
For example, if a woman experienced, you know, the inability to get a loan for a house that they want, that–they can live then in a certain neighborhood, so they’re in a certain zip code, exposed to pollution potentially, but also the experience of being denied or being treated differently than somebody who might be of a different race and able to get a better loan, knowing that you’ve been treated differently results in chronic stress and ultimately can increase the risk of heart disease.
And I think we under-appreciate that in many of our patients.
MS. JOHNSON: And so then how do we–as we’re also talking about the lack of diversity in the provider pool, right? So you are–Dr. Ellis, you are a cardiothoracic surgeon, board-certified?
MS. JOHNSON: How many Black women are board-certified cardiothoracic surgeons out there in the United States?
DR. ELLIS: Well, I was the third, and the board was founded in 1947.
MS. JOHNSON: I think that deserves a round of applause. She said she was the third, and the board was founded in 1947?
DR. ELLIS: Right now, there are about eight, eight of us. We know each other.
DR. ELLIS: So–and I was–there was also a book came out, just wanted the name–but just talking about–“Legacy.” It just came just came out, you know, where we at one point had seven Black medical schools for the HBCUs, and now it’s down to two, Meharry and Howard. And, you know, it talks about all those docs that weren’t created taking care of all those people.
And yes, I was the third, but had I known I was going to be the third, I probably wouldn’t have done it, because, you know, I really was the only woman. I was the first woman, first Black women in my program to finish, and they didn’t really know how to deal with me. I mean, you know, they couldn’t treat me like one of the boys, and I made them be gentlemen, which kind of threw him a little bit.
But, you know, you don’t really always want to be out there at the point, and so that–you know, you need to have a critical mass so people are comfortable. And I don’t think we’ve reached that in cardiology and–or for sure not in surgery and for sure not in cardiac surgery. And so, you know, when I say I can name them, I can name all eight.
MS. JOHNSON: And, Dr. Gulati, final–I’m going to pose this final question to you because we’re running out of time. What do you think we need to do to increase kind of a critical mass and diversify the health care workforce in this particular area?
DR. GULATI: Well, we need to be proactively recruiting women, telling women from diverse backgrounds, they need to be here. It’s the leading killer. The only way we’ll enter the community is with them, and so we need to be front–more female friendly, which really we’ve done a bad job of really making it seem like you’re welcome here. And I think it’s the greatest job so–you know, that we need to have more women at the table so that we can change the statistics, so we can change research, so that we can get more women into trials. All the changes that have happened in the recent years, I will say a big portion of it has been a result of having women at the table. But we’re not invited to every table, and we really need to change that.
MS. JOHNSON: Thank you so much, Dr. Ellis, Dr. Gulati. We are just about out of time, and so we’ll have to leave it there. I could ask many more questions and talk to you all for many more minutes, but unfortunately, that’s not what’s going to happen today.
MS. JOHNSON: So I want to thank you for joining me and the audience.
MS. JOHNSON: And thank you to all of you for watching here in person and online. That concludes our program today. For more of these important conversations, sign up for Washington Post subscription, get a free trial, by visiting WAPO.st/live. I’m going to say that one more time in case anybody didn’t catch it: WAPO.st/live. Thank you.
