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Why does heart disease most impact minority women?

A conversation with leading cardiologist Dr. Jennifer H. Mieres

Dr. Jennifer H. MieresIn recognition of American Heart Month, we are proud to be talking with Dr. Jennifer H. Mieres, a leading cardiologist, Chief Diversity Officer and Women’s Health Leader at Northwell Health in New York. Dr. Mieres is also an author and a spokesperson for the American Heart Association.

Q: In your recent interview about women and heart disease on the NBC Nightly News, you highlighted that minority groups are most at risk for heart attacks. Why do you think that is?

A: I think that when you look at the risk factors for heart disease, all women are at risk across their lifespan. Heart disease is the #1 cause of death for women in America. But there’s a disparity in awareness of how lethal heart disease is. The American Heart Association national surveys showed that 65% Caucasian women knew heart disease was #1 killer compared to 34% Hispanics and 36% black women.

There is also a higher prevalence for hypertension in African Americans, who have a higher genetic disposition to developing hypertension at a younger age. In terms of risk factors for heart disease, African American women have a greater prevalence of obesity, sedentary lifestyles, exposure to chronic stress, diabetes, and metabolic syndrome. Put all of those together with a lack of awareness and heart disease goes under-detected and undiagnosed. South Asian women are also at risk because of the unrecognized risk factors of abnormal cholesterol levels lower HDL and higher risk of diabetes. A higher prevalence of risk factors combined with a lack of awareness translates into women not taking their symptoms seriously, delaying a diagnosis, and then delaying their access to life-saving strategies.

As we have gained insights from the decade long research focus on the sex and gender differences in heart disease, a substantial body of evidence supports the fact that social factors, including culture, health beliefs, functionality, mobility, wellness influence the incidence, treatment, and outcomes of heart disease.

“In [the African-American and Hispanic] communities, there’s a high risk of hypertension, diabetes, obesity, inactivity, and exposure to chronic stress.”

– Dr. Jennifer Mieres
NBC Nightly News
January 25, 2016

Q: According to the American College of Cardiology, only about 10-15% of cardiologists are women – and the percent of minority women is even less. Why did you choose the field?

A: I first became interested in medicine for very personal reasons. When I was seven, my paternal grandfather died of a heart attack. Wishing that I could have saved him, I vowed that I would be a doctor. Cardiology intrigued me because of Dr. Alice Jacobs, an interventional cardiologist at Boston University, who sparked my interest. She is still one of my heroes. When I trained at St. Luke’s, Dr. Judith Hochman became my mentor and sponsor. My decision to become a cardiologist was really cemented by these women. Along the way, I became devoted to gender-specific studies. Dr. Nanette Wenger at Emory became an important friend and mentor. Dr. Sharonne Hayes (Mayo clinic), Dr. Leslee Shaw (who is one of the national/international leaders in clinical research), Dr. Kathryn Taubert (Dallas) and I have published together in the area of women and heart disease. We all have this sort of sisterhood. They are all colleagues and friends whom I can call for advice and guidance about my career and the challenges of daily life. I also feel lucky to have meet a few influential men in cardiology, such as Dr. Robert Bonow (Northwestern), Dr. Kim Williams (Rush Chicago), Dr. Robert Hendel (University of Miami), Dr. Clyde Yancy (Northwestern), Dr. Pat O’Gara (Brigham, Boston) and Dr. Gary Heller (New Jersey) all of whom have become mentors and sponsors.

Q: Who or what inspired you to become a health professional? And were there moments when you questioned your decision? If so, how did you overcome those doubts?

A: All of the women I mentioned have become mentors, colleagues and friends who have inspired me to advance my career. Cardiology is not an easy path but it is so rewarding. With four years of med school and three years of cardiology training, it’s unforgiving…and almost survival of the fittest, if you will. But we don’t believe it needs to be such a harsh training environment. We are working to change the clinical curriculum and the overall training of physicians of the future at the Hofstra-Northwell School of Medicine (formerly Hofstra North Shore – LIJ School of Medicine). For women, it is challenging because training to be a cardiologist is not conducive to being pregnant and training takes place in our peak years. I turned to my mentors, like Dr. Wenger, who told me not to delay having a family – because there was no ideal time, in any career. I built a strong sisterhood and I’m glad of that. I am committed to paying it forward and being a mentor to junior faculty and women in training. When I meet younger women, I offer to help with guidance on career advancement and the challenges of everyday life. I try to pass the advice on to the next generation.

RX - The Quiet RevolutionQ: To increase health equity, we support the focus on culturally-competent care and interprofessional training. What are your thoughts on those trends? Are they are beginning to impact the health professions. And if so, do you see their outcomes beginning to improve care?

A: We are working to change the model so that physicians are an important member of the medical team that is working together – in partnership with patients – to deliver culturally-customized healthcare. As we focus on outcomes, the evidence supports the fact that the century-old paternalistic model, where doctors make all of the decisions, does not create the best health outcomes. It’s not just doctors and nurses, but all of the medical staff – as well as the patient – that need to be part of the team. The patient as a partner is key. When a patient is part of team, it adds an important component to the diagnosis, treatment and prevention strategy for managing and improving disease outcomes. The information that patients provide about their family history, past treatment, and lifestyle is so important to improving outcomes.

In medical school, we need to change the way we train doctors. The traditional training of medical students focused on coming up with the correct diagnosis and treatment plan. There was a focus on the acute situation. A contemporary model of healthcare delivery is one in which the doctor partners with the patient for all aspects of their health and wellness journey. As Dr. David Nash has said, 85 percent of health outcomes are determined by factors outside of the medical encounter. For example, with heart disease, it’s important to know the family history (i.e. if a mother, or father, or uncle had heart disease)and there needs to be a collaboration with the patient and their doctor and medical team to discuss the risk factors and a customized strategy for the sustainability of the lifestyle changes, medication adherence if needed to control and reduce risk.

RX - Doctors of TomorrowQ: The Sullivan Alliance is focused on encouraging more minority students to go into the health professions. What advice would you give to students who may be considering careers in healthcare?

A: I would encourage early exposure to all of the sciences – so we can build the pipeline in middle and high school. Healthcare is a personally rewarding field but not everyone needs to be a doctor or nurse. It’s important to educate students about all career options. Pairing students with mentors along their education journey is essential too. At Hofstra Northwell School of Medicine, there is a summer program that gives high school students exposure to and first-hand experience with clinical and basic science research, a hospital environment, and the medical school experience.

Q: The Jackson Heart Study and Framingham (Massachusetts) Heart Study are now working together to improve our understanding of heart disease in minority populations. What more can we do to expand this research?

A: We will be most effective if we create partnerships with communities and media to share the stories of people who have been part of research and clinical trials. We need to build trust with minority communities and the only way to do that is to let them see people connected to research that look like them. With trust and an understanding of the importance of clinical research, their participation in research will expand.

Recognizing that there needs to be an expanded approach to translating the scientific advances into health literate information, we need more partnerships with the media. About 70% of people get their health information online, as well as from TV, radio, and magazines. (Source: AHA survey 1999).

Overall, I think we have made significant advances in the diagnosis and treatment strategies for heart disease and we have seen about a 30 percent decrease in the number of men and women dying from heart disease. As we focus on prevention, I think for improved outcomes, we must adopt a patient-centered partnership and the integration of the social determinants of health to include one’s culture and religious beliefs and the tenets of health literacy into our health care delivery system,

About Jennifer H. Mieres, M.D., FACC, FASNC, FAHA Linked In

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