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- This is Chris Sosa with the Becker's Healthcare Podcast.
I'm Phil today to be joined by Niecy Sugo,
MD Medical Director, women's Heart Center
at Memorial Care Heart and Vascular Institute at Long Beach.
Dr. Sgu, thank you so much for joining us today.
- Thank, thank you so much for having me on your show.
- Wonderful. Could you please introduce yourself
and tell us a bit about your background?
- Sure, sure. Hi everyone. I'm Dr. Nai Sgu.
Um, as mentioned, I'm a medical director
for Women's Heart Center at Memorial Care, um, heart
and Vascular Institute, long Beach in California.
Um, I completed my medical school.
I'm, I'm originally from India.
I completed my, uh,
medical school training at SSR Medical College in Mauritius
and went back to India to pursue an internship
and worked at a cardiac hospital in my hometown ED
for a few years before I moved to US to pursue, uh,
residency in internal medicine.
So, uh, al I've always wanted to, uh, be a cardiologist,
um, having lost my mother to, uh,
complications from rheumatic heart disease at
a really young age.
Um, and always grew up with this question
that why didn't her physicians spend enough time to
tell her about the options that she had
or to convince her that that, that a surgery
to fix her valve would've given her
so many more decades in her life,
or why the physicians did not involve my dad
or the rest of the family in the decision making.
So that was always my desire to grow up
and be a cardiologist,
and especially to be able to, you know, treat women
that don't understand or, um, need more explanation
or understanding of their disease condition
and help influence their decision in the right way
to have better outcomes for their heart health.
And then, um, so with that, uh, with that dream in my heart,
I, uh, you know, pursued an internal medicine, uh, uh,
residency at the Wright Center in Scranton, Pennsylvania.
And after that, I was able to luckily cross paths
with my mentor Dr. Barry Mers, who's the director
for Women's Heart Center at Cedar-Sinai,
and was able to pursue a two year fellowship learning
and researching about women's heart
health specific conditions.
And after that, I completed a general cardiology fellowship
at uc, Irvine, uh, California,
and I'm currently working as medical director at, uh,
Memorial Care, establishing this new Women's Heart Center.
- I'm so glad you mentioned the Women's Heart Center, Dr.
Togo, it launched a couple of months ago.
That's obviously a tremendous achievement.
Could you give us a little bit of insight as to how
that project evolved?
- Yeah, so Chris, like I mentioned, uh, it,
it was always my desire to be able to cater
to women's heart health needs
and having that specialized training, understanding
that women can present differently, not just
with chest pain.
And women also have various life cycle related, um,
hormonal changes or pregnancies
or other stress,
anxiety related conditions other than the usual
comorbidities that contribute to their heart health
and heart health outcomes.
Um, I wanted to use my knowledge
and my specialization to help cater to, um, women
with specific conditions.
And, uh, as I, uh, during, as part
of my training at uc Irvine,
I also rotated at Memorial Care for my fellowship.
So I knew a lot of the cardiologists that were here
and that knew about my desire to
establish a women's heart center
or be associated with a hospital
that has a Women's Heart center.
And I was lucky enough that Memorial Care at
that time was very interested in establishing this women's
heart health and helping me, um, uh,
to establish one here.
And I also had the luxury of having worked
with all the interventionalists, uh,
who are currently my support team
to do the more specific invasive testing, uh, that's needed
for microvascular dysfunction in women.
And I also have the support of a new imaging specialist
that we've hired to get the specific, uh,
specialized cardiac testing as well for the same,
- Well, congratulations on launching that project doctor,
and we wish it continued success.
Certainly. Uh, looking at a little bit
of the bigger picture, so from your experience
as a cardiologist
and medical director there, uh,
what are the top three issues for you in cardiology today?
- Um, well, it is amazing
how far we have come in the advancements in the field
of cardiology, you know, there's
so much more technology now, so much AI
that's making it us achieve great things through easier
or modified pathways.
You know, national outfits like American College
of Cardiology and American Heart Association are working
around the clock to, you know, update guidelines
for the best cardiac outcomes, um, and in general, but,
but also they are including gender specific
clinical guidelines for the treatment
of cardiovascular disease.
Um, and, which is great, right?
Because a decade or two ago we were not talking about these
gender specific clinical guidelines or differences
or treatment guidelines, which spoke about
how women presented differently
and how, how there's different testing available to test
for this differences in presentation.
However, I do feel that there is still a large part
of the nation that is still
behind in accessing these advancements
and guidelines, either
because they are,
there's limitation in the demographic location
and accessibility to centers of excellence
that provide this specialized care,
or there is limitation in their ability to adapt
to the newer guidelines or newer findings.
So as we speak, um,
because they're used to their way of, uh, the, the,
their way of treatment modalities
or their, their mentality of saying that, oh, we've,
we've taken care of this for years
and we've had good outcomes, why change now?
You know, placing them in a position of catching up
to these new policies and advancements that we are making.
That would be my first one.
My, uh, second one would be possibly
research is the backbone for development
and advancement of new therapies management
and options, management options and so on.
However, inclusion of women in research is still lagging.
It's over two decades now since Dr.
Bernadine Haley, uh,
who became the first female NIH director
and launched the Women's Heart Health Initiative
way back in, uh, 1991.
Um, and now 2, 3, 2 to three decades later,
we're still falling behind enrolling women in, uh,
cardiovascular specific studies.
You know, uh, new England Journal
of Medicine in 2018 looked at, uh, women in trials
studying cardiovascular devices between 2010 and 2017.
They saw that the, there was only 38%
of participants in this trial were women.
And another study from the American College
of Cardiology in 2016,
again looking at cardiovascular trials also saw there was,
you know, less than 35% enrollment of participants in these,
uh, less than 35% enrollment of women in these,
uh, clinical trials as well.
So I feel like this underrepresentation
of women is limiting our understanding of the unique aspects
of cardiovascular health in women,
and it hinders the development of gender specific therapies
and management options.
And, um, for my third one, I would think that insurance
companies are orchestrating the types of care
that providers can give to patients
because they put these patients in specific boxes,
and we need to, they need to check off like specific number
of boxes to approve a patient for, to be seen
by a specialist or to get a special, uh, to,
to get a specific test done.
Um, especially in my field, I feel like, uh, patients
with chest pain that ha that have had normal
stress test findings
or no obstructive disease on their angiograph,
and they come to me with their ongoing symptoms
and I have to get them to more specialized testing,
like coronary functional testing, um,
which is an invasive testing
to find out if they have specific microvascular dysfunction
or endothelial dysfunction.
And it takes, it takes time
for the insurance companies to approve it.
And sometimes I have to do peer to peer reviews
and sometimes I fail getting the approval.
And I feel like this delays the patients in getting the
appropriate diagnosis
and delays me providing the appropriate care for them.
And until they get to that point, they're still struggling
with their symptoms, there's issues with quality of life,
and the more delay we do, the disease is more progressed
and, you know, we're losing dollars in, in, in the form
of healthcare numbers and stuff like that.
- Thank you for laying out all those issues that are faced
by cardiologists and health systems today, doctor.
I mean, that's certainly very informative.
On that note, uh, could you detail what it might take
to improve some of those issues?
- Yeah, surely. Um, I think research does contribute a lot
to the outcomes of how the insurance come, how we can,
as physicians convince the insurance companies,
because research will provide us with hard evidence
and hard evidence, trans from center guidelines
and guidelines can teach these non-physician run, uh,
insurance companies to be able to be more adaptive.
And as we get more numbers,
we'll be more confident in convincing the population as well
to seek for or to,
to put more pressure in getting approvals as well.
That's, I think, one of the best ways.
The other ways, uh, other, other ways that we can, uh, get
through these obstacles, um,
would definitely be educating like educational meetings
for colleagues like physicians,
but also in general populations just creating, um, awareness
among general population to, especially in my field,
like women, I wanna create awareness among women to, um,
know their numbers.
What, what's their cholesterol number?
Like, what is their blood pressure number?
Like, what is it, what is the right amount of blood pressure
to have or cholesterol to have?
What does a premature coronary artery disease in their
family means to their individual risk?
Or why do they need to see a cardiologist
or when do they need to see, see a cardiologist
and to understand their, that women can have different kind
of presentations apart from just chest pains that, that,
and they need specialized care for that.
So different, like creating this awareness among patients
and physicians is also going to help us, um,
make a change in these challenges.
- Thank you again, Dr. That's very helpful.
So next thing I wanted to ask you about,
shifting gears just a little bit.
You mentioned some of the technology, ai, et cetera,
along those lines, what makes you really excited
about your field today?
- Um, I think the, the fact
that we have more specialized testing
for microvascular dysfunction
and endothelial dysfunction, which is one of the, one
of the conditions that affect women with chest pain or,
or chest pain like presentation
that do not have obstructive disease
or disease that is closing down a blood vessel
of their heart completely,
but rather affecting the smaller blood vessels within the
muscles of the heart that are not functioning appropriately.
And, and with time, we have found ways
to look at the response of the, the smaller blood vessels
and the lining of the smaller blood vessels.
We call it the microvasculature of the heart.
So it helps us identify if there's any abnormality,
understanding the specific pathway that's involved
with the microvascular dysfunction
and, uh, treat these patients appropriately.
So I think the technology and, and,
and research has made these, um, this kind
of testing more available
and also not just the invasive coronary functional testing,
but also, um, non-invasive testing like stress, cardiac,
uh, MRIs
and, uh, pet cardiac studies where we are able
to do more quantitative analysis, um,
where we measure the flow through the muscle of the heart
and be able
to understand if there's microvascular dysfunction.
Those studies also help us.
So I think technology has brought to us the ability to test
for things that we really can't see with the, uh, with the,
with the testing that was available mostly
for obstructive coronary artery disease in the past.
- Absolutely fascinating doctor, and I hope
that all continues to improve very much.
Uh, lastly, let me ask you,
what makes you a bit nervous about your field
moving forward here, doctor?
- Well, there are two things that make me nervous.
First, that I'm still nervous that women make up 50%
of the world population
and yet we don't make up to 50% of all the cardiovascular
research that's happening.
And that makes me nervous
because it's going to affect how we come up
with management options and treatments
and outcomes for this specific population.
But it's a work in progress.
We are making progress and, um, it's evolving.
My second, um, the, the second aspect
that makes me nervous is how people
perceive women's heart health, uh,
including my own colleagues or peers
or, you know, people that I went to medical school with
where I hear comments that they say, oh, it's so nice,
you're a female cardiologist.
I can send all my female patients to you .
I'm glad to see all, all patients with cardiac issues,
but I also want people to understand
and recognize women's heart health
as a truly necessary subspecialty in the field of cardiology
and understand how women can present differently, understand
how hormones, pregnancy and stress
and anxiety can affect women's heart health differently.
And how it is important for us, a specialist
to prioritize women's heart health education
for all other providers included.
Also, um, it's important, um,
that we don't tell our female patients that,
oh, this is stress.
It needs to, you need to see your primary care for this.
There's something I can do rather understand
what an important role the non-com comorbidities
for cardiovascular risk outcomes can play in the outcomes
for cardiovascular disease.
Like the recent study that came out with, uh,
that the American Heart Association published
where cumulative stress was linked
to a 20 person higher risk of cardiovascular disease,
including coronary artery disease and heart failure.
And this was higher among women, younger age group,
between 18 to 45 lower income and education levels
and people identified as Hispanic of or black.
And oh my God, this study really blew my mind
because, you know, as cardiologists, we knew that, uh,
depression and anxiety played a role,
but this is like quite evidence, like numbers telling us
that this group of patients with depression
and anxiety, um, have have a 20% chance
of higher risk of having cardiovascular disease and high
and earlier onset of the comorbidities that lead
to worser outcomes.
So we can't just, you know, when it comes
to cardiovascular disease in a woman, I think it's important
to look at them holistically instead of considering
or breaking them down into individual smaller aspects.
- Doctor, thank you so much for being so generous
with your time and insights today.
We cannot wait to share them with our audience,
and we look forward to connecting with you soon.
- Thank you, Chris. Thank you for this opportunity.
And before, before saying goodbye, I just want to end
with this line from Dr.
Nanette Wenger, who's a pioneer in women's heart health.
And she said, we need
to help women develop a lifetime approach to their health
where they are empowered
to proactively manage their disease risk in
every life stage.
And I truly believe that. Thank you once again.
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