1 00:00:05,235 --> 00:00:07,285 - This is the Becker's Healthcare Podcast, created 2 00:00:07,285 --> 00:00:08,445 by the team of Becker's Healthcare, 3 00:00:08,605 --> 00:00:10,325 a multimedia company devoted to the people 4 00:00:10,345 --> 00:00:11,645 who power us healthcare. 5 00:00:11,915 --> 00:00:14,765 Four new 15 minute episodes are released daily containing 6 00:00:14,925 --> 00:00:16,685 industry news analysis and thought leadership. 7 00:00:16,685 --> 00:00:19,605 From powerful healthcare decision makers Support our show 8 00:00:19,705 --> 00:00:22,525 by leaving it a five star rating and review on Apple Podcast 9 00:00:22,745 --> 00:00:24,005 or other platforms you use. 10 00:00:24,155 --> 00:00:26,005 It's a chance to tell us what you like about the show 11 00:00:26,025 --> 00:00:27,245 and act on your feedback. 12 00:00:27,265 --> 00:00:29,205 Thanks for listening. Now here's the episode. 13 00:00:30,315 --> 00:00:32,605 - This is Chris Sosa with the Becker's Healthcare Podcast. 14 00:00:33,265 --> 00:00:35,205 I'm Phil today to be joined by Niecy Sugo, 15 00:00:35,845 --> 00:00:38,045 MD Medical Director, women's Heart Center 16 00:00:38,765 --> 00:00:41,685 at Memorial Care Heart and Vascular Institute at Long Beach. 17 00:00:42,305 --> 00:00:44,685 Dr. Sgu, thank you so much for joining us today. 18 00:00:45,865 --> 00:00:48,135 - Thank, thank you so much for having me on your show. 19 00:00:49,395 --> 00:00:51,405 - Wonderful. Could you please introduce yourself 20 00:00:51,405 --> 00:00:52,685 and tell us a bit about your background? 21 00:00:53,555 --> 00:00:57,445 - Sure, sure. Hi everyone. I'm Dr. Nai Sgu. 22 00:00:57,745 --> 00:01:00,165 Um, as mentioned, I'm a medical director 23 00:01:00,225 --> 00:01:03,885 for Women's Heart Center at Memorial Care, um, heart 24 00:01:03,885 --> 00:01:06,725 and Vascular Institute, long Beach in California. 25 00:01:07,665 --> 00:01:09,965 Um, I completed my medical school. 26 00:01:10,145 --> 00:01:11,845 I'm, I'm originally from India. 27 00:01:12,005 --> 00:01:13,205 I completed my, uh, 28 00:01:13,205 --> 00:01:16,685 medical school training at SSR Medical College in Mauritius 29 00:01:17,265 --> 00:01:20,245 and went back to India to pursue an internship 30 00:01:20,705 --> 00:01:24,125 and worked at a cardiac hospital in my hometown ED 31 00:01:24,225 --> 00:01:28,845 for a few years before I moved to US to pursue, uh, 32 00:01:29,125 --> 00:01:30,445 residency in internal medicine. 33 00:01:31,425 --> 00:01:36,325 So, uh, al I've always wanted to, uh, be a cardiologist, 34 00:01:36,625 --> 00:01:40,005 um, having lost my mother to, uh, 35 00:01:40,005 --> 00:01:42,725 complications from rheumatic heart disease at 36 00:01:42,765 --> 00:01:43,805 a really young age. 37 00:01:44,145 --> 00:01:47,045 Um, and always grew up with this question 38 00:01:47,045 --> 00:01:50,205 that why didn't her physicians spend enough time to 39 00:01:50,715 --> 00:01:53,645 tell her about the options that she had 40 00:01:54,025 --> 00:01:56,765 or to convince her that that, that a surgery 41 00:01:56,865 --> 00:01:58,805 to fix her valve would've given her 42 00:01:58,905 --> 00:02:00,725 so many more decades in her life, 43 00:02:01,225 --> 00:02:04,045 or why the physicians did not involve my dad 44 00:02:04,105 --> 00:02:06,405 or the rest of the family in the decision making. 45 00:02:06,825 --> 00:02:09,805 So that was always my desire to grow up 46 00:02:09,825 --> 00:02:11,245 and be a cardiologist, 47 00:02:11,305 --> 00:02:14,885 and especially to be able to, you know, treat women 48 00:02:15,115 --> 00:02:19,565 that don't understand or, um, need more explanation 49 00:02:19,825 --> 00:02:22,765 or understanding of their disease condition 50 00:02:23,145 --> 00:02:26,005 and help influence their decision in the right way 51 00:02:26,005 --> 00:02:29,045 to have better outcomes for their heart health. 52 00:02:30,005 --> 00:02:34,345 And then, um, so with that, uh, with that dream in my heart, 53 00:02:34,825 --> 00:02:38,305 I, uh, you know, pursued an internal medicine, uh, uh, 54 00:02:38,625 --> 00:02:40,865 residency at the Wright Center in Scranton, Pennsylvania. 55 00:02:41,485 --> 00:02:44,745 And after that, I was able to luckily cross paths 56 00:02:44,745 --> 00:02:47,825 with my mentor Dr. Barry Mers, who's the director 57 00:02:47,825 --> 00:02:49,985 for Women's Heart Center at Cedar-Sinai, 58 00:02:50,365 --> 00:02:53,545 and was able to pursue a two year fellowship learning 59 00:02:53,645 --> 00:02:55,985 and researching about women's heart 60 00:02:55,985 --> 00:02:57,585 health specific conditions. 61 00:02:58,045 --> 00:03:01,085 And after that, I completed a general cardiology fellowship 62 00:03:01,085 --> 00:03:03,245 at uc, Irvine, uh, California, 63 00:03:03,505 --> 00:03:06,765 and I'm currently working as medical director at, uh, 64 00:03:07,045 --> 00:03:10,045 Memorial Care, establishing this new Women's Heart Center. 65 00:03:11,785 --> 00:03:13,805 - I'm so glad you mentioned the Women's Heart Center, Dr. 66 00:03:14,115 --> 00:03:16,685 Togo, it launched a couple of months ago. 67 00:03:17,225 --> 00:03:19,205 That's obviously a tremendous achievement. 68 00:03:19,205 --> 00:03:21,565 Could you give us a little bit of insight as to how 69 00:03:21,565 --> 00:03:22,565 that project evolved? 70 00:03:23,975 --> 00:03:26,985 - Yeah, so Chris, like I mentioned, uh, it, 71 00:03:27,005 --> 00:03:31,105 it was always my desire to be able to cater 72 00:03:31,245 --> 00:03:33,025 to women's heart health needs 73 00:03:33,205 --> 00:03:37,025 and having that specialized training, understanding 74 00:03:37,625 --> 00:03:40,385 that women can present differently, not just 75 00:03:40,385 --> 00:03:41,385 with chest pain. 76 00:03:41,765 --> 00:03:46,665 And women also have various life cycle related, um, 77 00:03:47,305 --> 00:03:49,185 hormonal changes or pregnancies 78 00:03:49,405 --> 00:03:50,625 or other stress, 79 00:03:50,695 --> 00:03:53,065 anxiety related conditions other than the usual 80 00:03:53,215 --> 00:03:57,585 comorbidities that contribute to their heart health 81 00:03:57,645 --> 00:03:58,985 and heart health outcomes. 82 00:03:59,565 --> 00:04:03,025 Um, I wanted to use my knowledge 83 00:04:03,085 --> 00:04:07,385 and my specialization to help cater to, um, women 84 00:04:07,615 --> 00:04:08,825 with specific conditions. 85 00:04:09,365 --> 00:04:11,865 And, uh, as I, uh, during, as part 86 00:04:11,865 --> 00:04:13,865 of my training at uc Irvine, 87 00:04:14,385 --> 00:04:18,465 I also rotated at Memorial Care for my fellowship. 88 00:04:18,805 --> 00:04:21,745 So I knew a lot of the cardiologists that were here 89 00:04:22,325 --> 00:04:25,185 and that knew about my desire to 90 00:04:25,855 --> 00:04:27,985 establish a women's heart center 91 00:04:28,205 --> 00:04:30,185 or be associated with a hospital 92 00:04:30,185 --> 00:04:31,705 that has a Women's Heart center. 93 00:04:32,605 --> 00:04:36,385 And I was lucky enough that Memorial Care at 94 00:04:36,385 --> 00:04:39,665 that time was very interested in establishing this women's 95 00:04:39,665 --> 00:04:42,745 heart health and helping me, um, uh, 96 00:04:43,285 --> 00:04:45,065 to establish one here. 97 00:04:45,565 --> 00:04:48,505 And I also had the luxury of having worked 98 00:04:48,505 --> 00:04:50,305 with all the interventionalists, uh, 99 00:04:50,405 --> 00:04:52,625 who are currently my support team 100 00:04:52,845 --> 00:04:57,025 to do the more specific invasive testing, uh, that's needed 101 00:04:57,165 --> 00:04:59,025 for microvascular dysfunction in women. 102 00:04:59,605 --> 00:05:03,185 And I also have the support of a new imaging specialist 103 00:05:03,185 --> 00:05:05,785 that we've hired to get the specific, uh, 104 00:05:05,785 --> 00:05:08,585 specialized cardiac testing as well for the same, 105 00:05:10,605 --> 00:05:13,295 - Well, congratulations on launching that project doctor, 106 00:05:13,435 --> 00:05:15,135 and we wish it continued success. 107 00:05:15,135 --> 00:05:17,415 Certainly. Uh, looking at a little bit 108 00:05:17,415 --> 00:05:20,575 of the bigger picture, so from your experience 109 00:05:20,715 --> 00:05:21,815 as a cardiologist 110 00:05:22,395 --> 00:05:24,055 and medical director there, uh, 111 00:05:24,055 --> 00:05:26,575 what are the top three issues for you in cardiology today? 112 00:05:28,645 --> 00:05:31,065 - Um, well, it is amazing 113 00:05:31,605 --> 00:05:34,665 how far we have come in the advancements in the field 114 00:05:34,665 --> 00:05:36,465 of cardiology, you know, there's 115 00:05:36,465 --> 00:05:39,465 so much more technology now, so much AI 116 00:05:39,605 --> 00:05:43,345 that's making it us achieve great things through easier 117 00:05:43,805 --> 00:05:45,265 or modified pathways. 118 00:05:45,365 --> 00:05:47,865 You know, national outfits like American College 119 00:05:47,865 --> 00:05:51,305 of Cardiology and American Heart Association are working 120 00:05:51,365 --> 00:05:54,705 around the clock to, you know, update guidelines 121 00:05:54,925 --> 00:05:59,365 for the best cardiac outcomes, um, and in general, but, 122 00:05:59,385 --> 00:06:02,565 but also they are including gender specific 123 00:06:03,085 --> 00:06:05,085 clinical guidelines for the treatment 124 00:06:05,085 --> 00:06:06,805 of cardiovascular disease. 125 00:06:07,305 --> 00:06:09,045 Um, and, which is great, right? 126 00:06:09,045 --> 00:06:12,485 Because a decade or two ago we were not talking about these 127 00:06:12,485 --> 00:06:15,885 gender specific clinical guidelines or differences 128 00:06:16,065 --> 00:06:18,165 or treatment guidelines, which spoke about 129 00:06:18,705 --> 00:06:20,445 how women presented differently 130 00:06:20,865 --> 00:06:24,445 and how, how there's different testing available to test 131 00:06:24,505 --> 00:06:26,845 for this differences in presentation. 132 00:06:27,315 --> 00:06:30,725 However, I do feel that there is still a large part 133 00:06:30,725 --> 00:06:32,565 of the nation that is still 134 00:06:32,945 --> 00:06:35,565 behind in accessing these advancements 135 00:06:35,625 --> 00:06:37,285 and guidelines, either 136 00:06:37,395 --> 00:06:38,925 because they are, 137 00:06:38,925 --> 00:06:41,205 there's limitation in the demographic location 138 00:06:41,825 --> 00:06:44,965 and accessibility to centers of excellence 139 00:06:45,075 --> 00:06:47,205 that provide this specialized care, 140 00:06:47,665 --> 00:06:51,245 or there is limitation in their ability to adapt 141 00:06:51,345 --> 00:06:54,525 to the newer guidelines or newer findings. 142 00:06:54,945 --> 00:06:56,365 So as we speak, um, 143 00:06:56,365 --> 00:07:00,285 because they're used to their way of, uh, the, the, 144 00:07:00,285 --> 00:07:02,285 their way of treatment modalities 145 00:07:02,785 --> 00:07:06,685 or their, their mentality of saying that, oh, we've, 146 00:07:06,775 --> 00:07:08,485 we've taken care of this for years 147 00:07:08,705 --> 00:07:11,485 and we've had good outcomes, why change now? 148 00:07:11,785 --> 00:07:14,685 You know, placing them in a position of catching up 149 00:07:14,685 --> 00:07:17,845 to these new policies and advancements that we are making. 150 00:07:18,395 --> 00:07:19,645 That would be my first one. 151 00:07:20,065 --> 00:07:22,445 My, uh, second one would be possibly 152 00:07:23,485 --> 00:07:25,285 research is the backbone for development 153 00:07:25,465 --> 00:07:28,725 and advancement of new therapies management 154 00:07:28,945 --> 00:07:31,605 and options, management options and so on. 155 00:07:31,915 --> 00:07:36,365 However, inclusion of women in research is still lagging. 156 00:07:37,155 --> 00:07:39,605 It's over two decades now since Dr. 157 00:07:39,605 --> 00:07:41,165 Bernadine Haley, uh, 158 00:07:41,265 --> 00:07:43,485 who became the first female NIH director 159 00:07:43,505 --> 00:07:46,285 and launched the Women's Heart Health Initiative 160 00:07:47,025 --> 00:07:49,405 way back in, uh, 1991. 161 00:07:50,025 --> 00:07:53,645 Um, and now 2, 3, 2 to three decades later, 162 00:07:53,775 --> 00:07:58,005 we're still falling behind enrolling women in, uh, 163 00:07:58,005 --> 00:08:00,005 cardiovascular specific studies. 164 00:08:00,345 --> 00:08:02,125 You know, uh, new England Journal 165 00:08:02,145 --> 00:08:06,245 of Medicine in 2018 looked at, uh, women in trials 166 00:08:06,805 --> 00:08:11,205 studying cardiovascular devices between 2010 and 2017. 167 00:08:11,475 --> 00:08:14,485 They saw that the, there was only 38% 168 00:08:14,705 --> 00:08:16,845 of participants in this trial were women. 169 00:08:17,385 --> 00:08:19,245 And another study from the American College 170 00:08:19,245 --> 00:08:20,885 of Cardiology in 2016, 171 00:08:21,135 --> 00:08:24,925 again looking at cardiovascular trials also saw there was, 172 00:08:25,185 --> 00:08:29,125 you know, less than 35% enrollment of participants in these, 173 00:08:29,225 --> 00:08:32,885 uh, less than 35% enrollment of women in these, 174 00:08:32,985 --> 00:08:34,565 uh, clinical trials as well. 175 00:08:35,145 --> 00:08:38,125 So I feel like this underrepresentation 176 00:08:38,145 --> 00:08:41,445 of women is limiting our understanding of the unique aspects 177 00:08:41,465 --> 00:08:43,525 of cardiovascular health in women, 178 00:08:44,185 --> 00:08:47,565 and it hinders the development of gender specific therapies 179 00:08:47,665 --> 00:08:48,925 and management options. 180 00:08:51,015 --> 00:08:54,715 And, um, for my third one, I would think that insurance 181 00:08:55,245 --> 00:08:57,965 companies are orchestrating the types of care 182 00:08:58,195 --> 00:09:00,245 that providers can give to patients 183 00:09:00,245 --> 00:09:04,125 because they put these patients in specific boxes, 184 00:09:04,545 --> 00:09:07,845 and we need to, they need to check off like specific number 185 00:09:07,845 --> 00:09:11,245 of boxes to approve a patient for, to be seen 186 00:09:11,345 --> 00:09:14,445 by a specialist or to get a special, uh, to, 187 00:09:14,465 --> 00:09:15,965 to get a specific test done. 188 00:09:16,545 --> 00:09:21,525 Um, especially in my field, I feel like, uh, patients 189 00:09:21,525 --> 00:09:25,085 with chest pain that ha that have had normal 190 00:09:25,705 --> 00:09:27,205 stress test findings 191 00:09:27,385 --> 00:09:30,245 or no obstructive disease on their angiograph, 192 00:09:30,705 --> 00:09:34,005 and they come to me with their ongoing symptoms 193 00:09:34,105 --> 00:09:37,245 and I have to get them to more specialized testing, 194 00:09:37,795 --> 00:09:40,325 like coronary functional testing, um, 195 00:09:40,495 --> 00:09:41,685 which is an invasive testing 196 00:09:41,785 --> 00:09:45,125 to find out if they have specific microvascular dysfunction 197 00:09:45,345 --> 00:09:47,045 or endothelial dysfunction. 198 00:09:47,545 --> 00:09:49,725 And it takes, it takes time 199 00:09:50,025 --> 00:09:52,125 for the insurance companies to approve it. 200 00:09:52,185 --> 00:09:54,725 And sometimes I have to do peer to peer reviews 201 00:09:54,865 --> 00:09:57,045 and sometimes I fail getting the approval. 202 00:09:57,665 --> 00:10:00,885 And I feel like this delays the patients in getting the 203 00:10:00,885 --> 00:10:02,445 appropriate diagnosis 204 00:10:02,625 --> 00:10:05,765 and delays me providing the appropriate care for them. 205 00:10:06,345 --> 00:10:09,405 And until they get to that point, they're still struggling 206 00:10:09,405 --> 00:10:12,285 with their symptoms, there's issues with quality of life, 207 00:10:12,385 --> 00:10:16,045 and the more delay we do, the disease is more progressed 208 00:10:16,145 --> 00:10:20,085 and, you know, we're losing dollars in, in, in the form 209 00:10:20,085 --> 00:10:21,765 of healthcare numbers and stuff like that. 210 00:10:24,505 --> 00:10:28,255 - Thank you for laying out all those issues that are faced 211 00:10:28,255 --> 00:10:30,935 by cardiologists and health systems today, doctor. 212 00:10:31,175 --> 00:10:32,575 I mean, that's certainly very informative. 213 00:10:32,995 --> 00:10:36,335 On that note, uh, could you detail what it might take 214 00:10:36,395 --> 00:10:37,655 to improve some of those issues? 215 00:10:39,255 --> 00:10:44,225 - Yeah, surely. Um, I think research does contribute a lot 216 00:10:44,525 --> 00:10:48,665 to the outcomes of how the insurance come, how we can, 217 00:10:48,805 --> 00:10:51,825 as physicians convince the insurance companies, 218 00:10:51,825 --> 00:10:54,745 because research will provide us with hard evidence 219 00:10:54,845 --> 00:10:57,425 and hard evidence, trans from center guidelines 220 00:10:57,525 --> 00:11:01,945 and guidelines can teach these non-physician run, uh, 221 00:11:01,945 --> 00:11:05,145 insurance companies to be able to be more adaptive. 222 00:11:05,405 --> 00:11:06,665 And as we get more numbers, 223 00:11:07,075 --> 00:11:10,905 we'll be more confident in convincing the population as well 224 00:11:11,165 --> 00:11:13,145 to seek for or to, 225 00:11:13,845 --> 00:11:16,425 to put more pressure in getting approvals as well. 226 00:11:16,485 --> 00:11:18,065 That's, I think, one of the best ways. 227 00:11:18,125 --> 00:11:21,825 The other ways, uh, other, other ways that we can, uh, get 228 00:11:21,825 --> 00:11:23,785 through these obstacles, um, 229 00:11:24,155 --> 00:11:29,065 would definitely be educating like educational meetings 230 00:11:29,365 --> 00:11:31,465 for colleagues like physicians, 231 00:11:31,685 --> 00:11:35,665 but also in general populations just creating, um, awareness 232 00:11:35,795 --> 00:11:39,745 among general population to, especially in my field, 233 00:11:39,745 --> 00:11:43,745 like women, I wanna create awareness among women to, um, 234 00:11:43,975 --> 00:11:45,025 know their numbers. 235 00:11:45,295 --> 00:11:46,825 What, what's their cholesterol number? 236 00:11:46,825 --> 00:11:48,425 Like, what is their blood pressure number? 237 00:11:48,455 --> 00:11:51,465 Like, what is it, what is the right amount of blood pressure 238 00:11:51,485 --> 00:11:53,065 to have or cholesterol to have? 239 00:11:53,195 --> 00:11:56,245 What does a premature coronary artery disease in their 240 00:11:56,245 --> 00:11:59,565 family means to their individual risk? 241 00:11:59,785 --> 00:12:02,285 Or why do they need to see a cardiologist 242 00:12:02,465 --> 00:12:05,285 or when do they need to see, see a cardiologist 243 00:12:05,425 --> 00:12:09,445 and to understand their, that women can have different kind 244 00:12:09,445 --> 00:12:13,165 of presentations apart from just chest pains that, that, 245 00:12:13,585 --> 00:12:15,285 and they need specialized care for that. 246 00:12:15,425 --> 00:12:18,445 So different, like creating this awareness among patients 247 00:12:18,625 --> 00:12:21,165 and physicians is also going to help us, um, 248 00:12:21,635 --> 00:12:23,685 make a change in these challenges. 249 00:12:25,355 --> 00:12:27,225 - Thank you again, Dr. That's very helpful. 250 00:12:27,965 --> 00:12:29,985 So next thing I wanted to ask you about, 251 00:12:30,825 --> 00:12:32,265 shifting gears just a little bit. 252 00:12:32,285 --> 00:12:35,065 You mentioned some of the technology, ai, et cetera, 253 00:12:35,515 --> 00:12:38,545 along those lines, what makes you really excited 254 00:12:38,835 --> 00:12:40,225 about your field today? 255 00:12:42,185 --> 00:12:44,765 - Um, I think the, the fact 256 00:12:44,765 --> 00:12:47,285 that we have more specialized testing 257 00:12:47,705 --> 00:12:50,165 for microvascular dysfunction 258 00:12:50,465 --> 00:12:53,445 and endothelial dysfunction, which is one of the, one 259 00:12:53,445 --> 00:12:58,045 of the conditions that affect women with chest pain or, 260 00:12:58,625 --> 00:13:00,685 or chest pain like presentation 261 00:13:01,155 --> 00:13:03,765 that do not have obstructive disease 262 00:13:03,785 --> 00:13:07,165 or disease that is closing down a blood vessel 263 00:13:07,185 --> 00:13:08,325 of their heart completely, 264 00:13:08,745 --> 00:13:12,285 but rather affecting the smaller blood vessels within the 265 00:13:12,285 --> 00:13:15,485 muscles of the heart that are not functioning appropriately. 266 00:13:16,265 --> 00:13:20,485 And, and with time, we have found ways 267 00:13:20,745 --> 00:13:24,685 to look at the response of the, the smaller blood vessels 268 00:13:24,865 --> 00:13:27,085 and the lining of the smaller blood vessels. 269 00:13:27,085 --> 00:13:29,605 We call it the microvasculature of the heart. 270 00:13:30,025 --> 00:13:33,205 So it helps us identify if there's any abnormality, 271 00:13:33,395 --> 00:13:36,845 understanding the specific pathway that's involved 272 00:13:36,845 --> 00:13:38,685 with the microvascular dysfunction 273 00:13:39,185 --> 00:13:41,565 and, uh, treat these patients appropriately. 274 00:13:41,745 --> 00:13:44,845 So I think the technology and, and, 275 00:13:44,865 --> 00:13:48,485 and research has made these, um, this kind 276 00:13:48,485 --> 00:13:49,725 of testing more available 277 00:13:49,945 --> 00:13:53,325 and also not just the invasive coronary functional testing, 278 00:13:53,505 --> 00:13:58,045 but also, um, non-invasive testing like stress, cardiac, 279 00:13:58,425 --> 00:13:59,525 uh, MRIs 280 00:13:59,625 --> 00:14:03,485 and, uh, pet cardiac studies where we are able 281 00:14:03,505 --> 00:14:07,085 to do more quantitative analysis, um, 282 00:14:07,455 --> 00:14:10,565 where we measure the flow through the muscle of the heart 283 00:14:10,825 --> 00:14:11,925 and be able 284 00:14:11,925 --> 00:14:14,805 to understand if there's microvascular dysfunction. 285 00:14:15,095 --> 00:14:16,885 Those studies also help us. 286 00:14:16,985 --> 00:14:21,165 So I think technology has brought to us the ability to test 287 00:14:21,265 --> 00:14:25,685 for things that we really can't see with the, uh, with the, 288 00:14:25,995 --> 00:14:28,445 with the testing that was available mostly 289 00:14:28,865 --> 00:14:31,245 for obstructive coronary artery disease in the past. 290 00:14:33,635 --> 00:14:34,955 - Absolutely fascinating doctor, and I hope 291 00:14:34,955 --> 00:14:36,835 that all continues to improve very much. 292 00:14:37,415 --> 00:14:39,235 Uh, lastly, let me ask you, 293 00:14:39,305 --> 00:14:41,515 what makes you a bit nervous about your field 294 00:14:41,515 --> 00:14:42,835 moving forward here, doctor? 295 00:14:44,095 --> 00:14:46,385 - Well, there are two things that make me nervous. 296 00:14:46,795 --> 00:14:50,985 First, that I'm still nervous that women make up 50% 297 00:14:51,065 --> 00:14:52,445 of the world population 298 00:14:52,745 --> 00:14:56,725 and yet we don't make up to 50% of all the cardiovascular 299 00:14:57,285 --> 00:14:58,325 research that's happening. 300 00:14:58,985 --> 00:15:00,365 And that makes me nervous 301 00:15:00,365 --> 00:15:03,285 because it's going to affect how we come up 302 00:15:03,285 --> 00:15:05,525 with management options and treatments 303 00:15:05,585 --> 00:15:07,845 and outcomes for this specific population. 304 00:15:08,105 --> 00:15:09,725 But it's a work in progress. 305 00:15:10,065 --> 00:15:13,005 We are making progress and, um, it's evolving. 306 00:15:14,065 --> 00:15:16,565 My second, um, the, the second aspect 307 00:15:16,565 --> 00:15:18,685 that makes me nervous is how people 308 00:15:19,205 --> 00:15:21,285 perceive women's heart health, uh, 309 00:15:21,355 --> 00:15:24,085 including my own colleagues or peers 310 00:15:24,425 --> 00:15:27,085 or, you know, people that I went to medical school with 311 00:15:27,295 --> 00:15:30,805 where I hear comments that they say, oh, it's so nice, 312 00:15:30,805 --> 00:15:32,245 you're a female cardiologist. 313 00:15:32,405 --> 00:15:35,445 I can send all my female patients to you . 314 00:15:35,785 --> 00:15:38,525 I'm glad to see all, all patients with cardiac issues, 315 00:15:38,705 --> 00:15:40,845 but I also want people to understand 316 00:15:40,985 --> 00:15:42,885 and recognize women's heart health 317 00:15:42,945 --> 00:15:46,965 as a truly necessary subspecialty in the field of cardiology 318 00:15:47,545 --> 00:15:51,405 and understand how women can present differently, understand 319 00:15:51,545 --> 00:15:54,125 how hormones, pregnancy and stress 320 00:15:54,225 --> 00:15:57,405 and anxiety can affect women's heart health differently. 321 00:15:58,145 --> 00:16:00,765 And how it is important for us, a specialist 322 00:16:00,765 --> 00:16:03,285 to prioritize women's heart health education 323 00:16:03,785 --> 00:16:06,005 for all other providers included. 324 00:16:06,835 --> 00:16:09,365 Also, um, it's important, um, 325 00:16:09,635 --> 00:16:12,645 that we don't tell our female patients that, 326 00:16:12,705 --> 00:16:13,765 oh, this is stress. 327 00:16:14,385 --> 00:16:16,685 It needs to, you need to see your primary care for this. 328 00:16:16,685 --> 00:16:19,285 There's something I can do rather understand 329 00:16:19,595 --> 00:16:23,685 what an important role the non-com comorbidities 330 00:16:23,825 --> 00:16:27,885 for cardiovascular risk outcomes can play in the outcomes 331 00:16:27,945 --> 00:16:29,925 for cardiovascular disease. 332 00:16:30,155 --> 00:16:32,605 Like the recent study that came out with, uh, 333 00:16:32,605 --> 00:16:34,925 that the American Heart Association published 334 00:16:35,255 --> 00:16:37,685 where cumulative stress was linked 335 00:16:37,745 --> 00:16:40,965 to a 20 person higher risk of cardiovascular disease, 336 00:16:41,395 --> 00:16:43,805 including coronary artery disease and heart failure. 337 00:16:44,145 --> 00:16:47,485 And this was higher among women, younger age group, 338 00:16:47,485 --> 00:16:51,485 between 18 to 45 lower income and education levels 339 00:16:51,705 --> 00:16:54,245 and people identified as Hispanic of or black. 340 00:16:54,265 --> 00:16:56,725 And oh my God, this study really blew my mind 341 00:16:56,725 --> 00:17:00,005 because, you know, as cardiologists, we knew that, uh, 342 00:17:00,005 --> 00:17:01,765 depression and anxiety played a role, 343 00:17:01,985 --> 00:17:05,085 but this is like quite evidence, like numbers telling us 344 00:17:05,515 --> 00:17:08,005 that this group of patients with depression 345 00:17:08,065 --> 00:17:12,245 and anxiety, um, have have a 20% chance 346 00:17:12,545 --> 00:17:15,885 of higher risk of having cardiovascular disease and high 347 00:17:16,105 --> 00:17:19,645 and earlier onset of the comorbidities that lead 348 00:17:19,645 --> 00:17:20,645 to worser outcomes. 349 00:17:21,305 --> 00:17:24,405 So we can't just, you know, when it comes 350 00:17:24,505 --> 00:17:28,685 to cardiovascular disease in a woman, I think it's important 351 00:17:28,865 --> 00:17:32,285 to look at them holistically instead of considering 352 00:17:32,385 --> 00:17:35,125 or breaking them down into individual smaller aspects. 353 00:17:36,765 --> 00:17:39,305 - Doctor, thank you so much for being so generous 354 00:17:39,305 --> 00:17:40,705 with your time and insights today. 355 00:17:40,765 --> 00:17:42,545 We cannot wait to share them with our audience, 356 00:17:42,645 --> 00:17:44,345 and we look forward to connecting with you soon. 357 00:17:45,465 --> 00:17:47,615 - Thank you, Chris. Thank you for this opportunity. 358 00:17:47,875 --> 00:17:51,365 And before, before saying goodbye, I just want to end 359 00:17:51,365 --> 00:17:53,405 with this line from Dr. 360 00:17:53,405 --> 00:17:57,085 Nanette Wenger, who's a pioneer in women's heart health. 361 00:17:57,265 --> 00:17:59,405 And she said, we need 362 00:17:59,405 --> 00:18:03,005 to help women develop a lifetime approach to their health 363 00:18:03,335 --> 00:18:04,685 where they are empowered 364 00:18:04,685 --> 00:18:08,125 to proactively manage their disease risk in 365 00:18:08,215 --> 00:18:09,445 every life stage. 366 00:18:09,745 --> 00:18:12,365 And I truly believe that. Thank you once again. 367 00:18:13,955 --> 00:18:16,565 - It's so important for leaders at the top of organizations 368 00:18:16,565 --> 00:18:19,045 to keep learning, stay sharp, grow their networks, 369 00:18:19,475 --> 00:18:21,765 help our audience better do this in a more simplified, 370 00:18:21,765 --> 00:18:23,365 personalized, and meaningful way. 371 00:18:24,045 --> 00:18:26,645 Becker's Healthcare has launched my BHC, 372 00:18:27,155 --> 00:18:29,125 it's your trusted Becker's healthcare experience 373 00:18:29,125 --> 00:18:31,325 and more with content, connections, events 374 00:18:31,385 --> 00:18:32,405 and learning opportunities. 375 00:18:33,115 --> 00:18:34,205 Join the community free 376 00:18:34,205 --> 00:18:38,965 of charge@www.my dot becker's hospital review.com 377 00:18:39,065 --> 00:18:39,805 and we'll see you there.