15 Minutes Featuring: Nieca Goldberg, MD, talks about heart health awareness

15 Minutes Featuring: Nieca Goldberg, MD, talks about heart health awareness

Early in her medical career, Nieca Goldberg, MD, medical director of the Atria Institute in New York City, associate professor of medicine at NYU Grossman School of Medicine and member of the Women’s Health Advisory Council of HealthyWomen, realized realize that the health care industry didn’t believe women could have heart problems. She decided to change it because so many women and their symptoms are being ignored.

Goldeberg is also the author of the acclaimed book “Women Are Not Small Men,” which has since been updated and renamed “The Women’s Healthy Heart Program: Lifesaving Strategies for Preventing and Treating Heart Disease.”

Our interview follows, edited for clarity and length.

Healthy women: How did you get interested in women’s heart health?

Nieca Goldberg, MD: In my first few months as a general practitioner, I toured my hospital’s coronary unit. A woman I recognized as an employee of the hospital was a patient there and she said she had been to a number of doctors who told her things like “you’re stressed, take a vacation.” One of her prescribed some Valium. She called one of my colleagues and he suggested that she go to the emergency room, where she was hospitalized.

Luckily for her, she didn’t have a heart attack. At the time, I was running the Stress Test Lab and they asked me if you could do a stress test.

She started walking on the treadmill and less than a minute into the protocol, she started experiencing shortness of breath and tightness in her throat and was not feeling well, and her electrocardiogram (ECG) it was abnormal. So, these are all indications to stop testing, so we did.

We sat her down. She felt better and the EKG normalized. I called her cardiologist and explained that she had a really abnormal test, etc. I asked him if she could do more tests and he said, “Well, you know, she’s a woman.”

I told him she got on the treadmill, became symptomatic, ECG was abnormal, she is overweight and has a very high stress job. She was black, she was a single mother—all the things people hopefully now recognize put you at higher risk for heart disease—and it was a struggle to convince him.

The nurse who worked with me had been a nurse longer than I was a cardiologist. She then asked if she could talk to him, and after their discussion, she said, “You know what, we should do more testing.” The woman had a coronary angiogram, and had 99% blockage in the left anterior descending artery, which is an early branch of the left main artery that supplies the anterior part of the heart muscle. If she had a heart attack, she would have lost a lot of heart muscle.

I couldn’t understand why the doctor was so emphatic: “She’s a woman, she can’t have it.” So I started looking through medical journals. I have been involved with the American Heart Association.

A lot of the information about women and heart disease was actually in nursing medical journals because nurses were recognizing that women were having a harder time in their recovery after bypass surgery or heart attack symptoms.

This is just one symptom of how isolated our healthcare system is.

Healthy women: Women and their symptoms are often ignored in healthcare.

Doctor Goldberg: Somehow, we have to stop this. It’s really destructive. And often, qualities are attributed to women like they are hysterical, melodramatic, being a drama queen, mentally ill.

We need to reevaluate thinking about patient care. I think over time, as the healthcare system has become much busier with fewer resources, people have really moved away from the importance of the conversation that you have with your patient.

Healthy women: You said that because of all this you got involved in the American Heart Association. So how did you come to create their Go Red for Women campaign?

Doctor Goldberg: I served on committees and learned a lot about what was going on with women and started advocating for them. At one point, I was on the board of the New York City branch. Also on the board was Jane Chesnutt, who was editor of Woman’s Day at the time.

Jane has gone to many luncheons for various illnesses. She said, “I don’t understand why they don’t have one for women and heart disease.” So we worked together to start one in New York City called Women Take Heart Luncheon. We actually had the little room at the Plaza, but I think we raised $350,000 in our first year, and that’s without anyone knowing anything about women and heart disease.

It was also the time I started writing my first book, “Women Are Not Small Men”, which was published in February 2002.

That lunch got noticed by the national organization of the American Heart Association, and they invited us to come to Dallas to discuss women and heart disease, and that turned into Go Red. From the beginning, it was about raising awareness of cardiovascular disease.

They got corporate funding and branded it, and there were lunches all over the country. And I was privileged to be invited to speak at several of those lunches to see what women in their communities were doing to help save their hearts and those of their loved ones. It was truly an exciting time for cardiovascular disease and women’s issues.

This also spurred further research, acknowledging that this was a thing. I think when my book came out, doctors and researchers were taken aback. But whatever happened, it spurred a lot of research. One of my roles throughout this campaign is to get people talking about it.

Healthy women: Why did they think women weren’t the type to get heart disease?

Doctor Goldberg: This just shows you where medical research takes you and how long it takes to change course in medicine.

When the Heart of Framingham study came out, they looked at a population of men and women. They would ask me if you had chest discomfort. More men who answered yes to that question went on to have heart attacks. Women had far fewer heart attacks or hospital stays.

But what they failed to realize at the time, when they asked those questions, was that women were still relatively young to have heart attacks. But if they’ve come out 10, 20 years, they’ve seen the increase in women’s heart attack symptoms and heart attack diagnoses.

I think it’s like cutting a book in half and not getting to the end.

Healthy women: Did you have difficulty creating this program? You looked like you had this lunch and it was instantly popular.

Doctor Goldberg: The challenge is not so much the lunch as the fact that we were targeting women. The real challenge is for men who typically hold leadership positions in healthcare organizations or systems to join.

I really think now is the time to talk about how we can do this. Every 10 years, the American Heart Association conducts a survey of women’s awareness, and the most recent showed that women’s cardiovascular risk has decreased and women’s knowledge of heart disease risk has decreased by 25%.

I think what we need to look at now is what is a sustainable movement? How do we integrate it? Many women I meet want to talk to me because they want me to deal with it. Women’s health is a niche and I think it needs to be an assessment of overall health care because, you know, women make the majority of decisions about health care and their families.

And we should use it to leverage better health care for everyone, including women.

Healthy women: So is there still a need for heart health awareness among women?

Doctor Goldberg: I think there is, and particularly in women who are under 50.

If you look at that survey, women who are under 50, are Black and Hispanic were among the least aware. The message is getting through to women over 50. It’s not getting to younger women. And now we know much more.

It’s not just about high cholesterol, diabetes, smoking and hypertension. It also affects women who have pregnancy-related complications, such as pre-eclampsia, low birth weight babies and autoimmune diseases. And it’s important for us to make sure it’s part of the history.

Healthy women: How do you think the healthcare profession should get the word out about all of this?

Doctor Goldberg: I think messaging needs to be better for people, whether it’s about heart disease, vaccines, or new medical technology, to make sure people know if she’s ready for prime time or not.

I think it would be great if people doing research really partnered with people who talk to patients all day long to let them know what people are thinking. The average patient doesn’t want to know that more research needs to be done. They want to know what can be done now.

Healthy women: When you started the Go Red for Women campaign with Jane, did you ever imagine it would have the level of success it has?

Doctor Goldberg: No. I wasn’t thinking about that. Also, when I wrote my book, I didn’t think about what it would become, but I’m really happy. I’m really excited about what he’s done and what it’s led to, and there’s definitely been a lot of money raised to support the campaign, so I think it’s great. I think now is the time for those involved to think about how we can do this better.

Healthy women: Are you still into it?

Doctor Goldberg: I’m involved with the American Heart Association, but it’s been so long. The American Heart Association has many programs and they are working on new programs. I know lunches for Go Red have probably been less frequent over the past three years.

Healthy women: Do you think there is enough awareness of heart health in young women and are they susceptible to heart disease?

Doctor Goldberg: You cannot give the (same) message to older women that you give to younger women. It’s not just about messaging on social media because that’s where you think young women are; it’s about the words you use and how you convey information.

Healthy women: How would you communicate something to younger women versus women who have been hearing this message for some time?

Doctor Goldberg: I wouldn’t start by saying that if you have clogged arteries, you can have a heart attack. What I’d probably do is talk to them about choosing an active lifestyle because of its overall effect on your health, whether it’s improving bone density, lowering blood sugar or protecting your heart.

I think young people really like bullet points. So you really need to simplify the message. Make it more usable. I think people really want to know: How do you get started? How do I know if I don’t feel well? And that’s actually easy to do when you see patients because you’re talking to someone and you know them, and you make suggestions based on what you know about them. It’s time for doctors to ask questions.

Healthy women: Why is awareness of heart health, at any age, still so important today?

Doctor Goldberg: Because heart disease is the leading cause of death for both men and women, and if you follow previous studies, 80% of it is preventable.