Clinical Innovators | Nieca Goldberg, MD is a cardiologist and a nationally recognized pioneer in women’s heart health. She is medical director of the Joan H. Tisch Center for Women’s Health and The Women’s Heart Program at NYU Langone Medical Center and clinical associate professor of medicine in the division of cardiology at the NYU School of Medicine. She is a national spokesperson and board member of the American Heart Association’s “Go Red” for women campaign. Dr. Goldberg is the author of Dr. Nieca Goldberg’s Complete Guide To Women’s Health. She has also authored the award winning and highly acclaimed book, Women Are Not Small Men, which was updated and entitled, The Women’s Healthy Heart Program – Lifesaving Strategies for Preventing and Healing Heart Disease, published by Ballantine Books. A graduate of Barnard College and SUNY Downstate Medical Center, Brooklyn, she completed her medical residency at St. Luke’s-Roosevelt Hospital Center and a cardiology fellowship at SUNY Downstate. Dr. Goldberg has won many prestigious awards and has been on New York Magazine’s “Best Doctors” list since 2000.

How did you become interested in women’s’ health?

Throughout medical training, I was surprised that despite the obvious differences between men and women, most therapies and treatments were based on research done in men—except for pregnancy and child birth.

The decision to focus on cardiovascular disease in women came during my first month as an attending cardiologist while rounding in the CCU. A woman was admitted and told us that she had been to five doctors for a range of symptoms that included throat tightness and shortness of breath. Those doctors suggested that she was stressed out and needed a vacation.

She was ruled out for a myocardial infarction and I was asked to do a stress test on this patient. She was only on the treadmill for a minute when she developed throat tightness, shortness of breath and ECG changes. I stopped the test and called her doctor. When I suggested an angiogram he said, “Women don’t get heart disease.” The nurse assisting me with the stress test also helped me convince him that this patient needed an angiogram. She had a severe LAD obstruction and underwent percutaneous intervention.

This experience sent me on a mission to learn more about heart disease in women.

What differences in cardiovascular health between men and women are often overlooked by physicians?

Symptoms of heart attack in women are frequently more subtle and not the “Hollywood” heart attack showing someone clutching their chest. Doctors need to ask open-ended questions. We need more women included in cardiovascular research. There is only 20% representation of women in cardiovascular disease research.

Why is there such underrepresentation of women in cardiovascular research?

The under representation of women in cardiovascular research is a multifaceted problem. Women are balancing many roles—parent, spouse/significant other, and work outside the home. Additionally, they may be part of the sandwich generation and caring for sick parents. They may not have the time to participate in research trials. The research community should look at streamlining research. It also has to be easier for women to learn about the trials—perhaps by following up electronically after discharge from the hospital or using social media to engage the primary care cardiologist to deliver the research message. The research community should work more collaboratively with clinicians because that is where you find the patients—in the outpatient setting with their doctors.

How do signs and symptoms of acute coronary syndromes differ between men and women?

Both men and women can have chest tightness or pressure. Women often report shortness of breath, fatigue, and lower chest pressure that they mistake for a stomach ailment. They also experience more upper back pressure.

What messages do you promote to women for the prevention and treatment of heart disease?

Physical activity—it can be as simple as taking a walk. I recommend a Mediterranean Diet with plenty of fruits, vegetables, and grains. Stress reduction is also important—whether that is through relaxation tapes, Yoga, Thai chi, or cognitive behavioral therapy, if appropriate. If you have heart symptoms act quickly – call 911.

Your face was featured on the back of more than 3 million boxes of Wheat Chex and Multi-Brain Chex cereals as part of a public education campaign. Could you tell us more about that?

I was contacted by General Mills because they were interested in promoting women’s heart health. When I met with them they showed me a cereal box with the cover of my book, Women Are Not Small Men. Health information has been placed on the back of cereal boxes for a very long time. I was very honored to have this opportunity.

How do you think America’s carb-free diet trend has affected cardiovascular health?

Carb-free, just like fat-free, is not a viable diet plan—people usually follow it for a few weeks.

A heart healthy eating plan has good nutrients from all food groups. America does eat too much sugar. This is why I recommend a Mediterranean diet to my patients, friends, and family.

Could you tell us a bit about the new Joan H. Tisch Center for Women’s Health and NYU’s Women’s Heart Program?

The women’s center opened in 2011 and it is 20,000 square feet of one-stop shopping for women’s health. It is also an opportunity for doctors of all specialties to have heightened awareness for women and heart disease.

What obstacles are there to providing optimal cardiovascular care to women? What changes do you hope to see in the future?

We need more research on women and treatment for microvascular coronary artery disease. Additionally, research needs to be done on interventions for stress in women and to see whether those interventions improve ischemic symptoms.

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Interviewer: Katlyn Nemani is a physician at New York University.

Keywords: CardioSource WorldNews, ACC Publications

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