15 minutes with Nieka Goldberg, MD, talks about the Go Red for Women campaign

Early in her medical career, Nieka Goldberg, MD, medical director of the Atria Institute in New York, associate professor of medicine at NYU Grossman School of Medicine, and member of HealthyWomen’s Women’s Health Advisory Board, realized that the health care industry did not believe: women may have heart problems. She decided to change that because so many women and their symptoms had been neglected.

Goldeberg is also the author of Women Are Not Little Men, which has been updated and titled The Women’s Healthy Heart Program: life-saving strategies for the prevention and treatment of heart disease”.

Our interview follows, edited for clarity and length.

Healthy women. How did you become interested in women’s heart health?

Nieca Goldberg, MD. During my first few months as a doctor, I was doing rounds in the coronary care unit at my hospital. A woman I recognized as a hospital worker was a patient there, and she mentioned seeing a number of doctors who told her things like, “you’re stressed, take a vacation.” Someone gave him a prescription for Valium. He called one of my colleagues and she suggested he go to the emergency room where he was admitted to the hospital.

Lucky for him, he didn’t have a heart attack. At the time I was working for a Stress Testing Lab and they asked me if he could be stress tested.

He started walking on the treadmill and less than a minute into the protocol, he began to experience shortness of breath and tightness in his throat and was not feeling well, and his electrocardiogram (ECG) was abnormal. So those are all indications to stop the test, so we did.

We sat him down. She felt better and the EKG came back normal. I called her cardiologist and explained that she had a really abnormal test and so on. I asked if he could do more research and he told me. “Well, you know, she’s a woman.”

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

The nurse working with me has been a nurse longer than I have been a cardiologist. So he asked if he could talk to her, and after their discussion she said, “You know what, we need to do some further testing.” The woman had a coronary angiogram and she had a 99% blockage in the left anterior descending artery, one of the first branches of the left main artery that feeds the front part of the heart muscle. If he had a heart attack, he would lose a lot of heart muscle.

I could not understand why the doctor was so emphatic. “She’s a woman. She can’t have that.” So I started looking through medical journals. I got involved with the American Heart Association.

Much of the information about women and heart disease was actually in nursing medical journals because nurses recognized that women had a harder time recovering from bypass surgery or heart attack symptoms.

This is just a symptom of how screwed up our health care system is.

Healthy women. Women and their symptoms are often overlooked in healthcare.

Dr. Goldberg. Somehow, we have to make it stop. It’s really devastating. And often women are attributed such qualities as being hysterical, melodramatic, drama queens, mentally ill.

We need to re-evaluate how we think about patient care. I think over time, as the health care system has become much busier with fewer resources, people have really gotten away from how important the conversation you have with your patient is.

Healthy women. You mentioned that you got involved with the American Heart Association because of all of this. So how did you come up with their Go Red for Women campaign?

Dr. Goldberg. I was on committees and learned a lot about what was happening to women and started to advocate for them. At one point I was on the board of the New York branch. Also on the board was Jane Chesnutt, then editor of Woman’s Day.

Jane went to many lunches due to various illnesses. He said. “I don’t understand why they don’t have one for women and heart disease.” So we worked together on a startup in New York called Women Heart Lunch. We actually had a small room at the Plaza, but I think we raised $350,000 in our first year, and that was when no one knew anything about women and heart disease.

It was also when I started writing my first book, Women Are Not Little Men, which was published in February 2002.

That luncheon got noticed by the American Heart Association National, and they invited us to come to Dallas to discuss women and heart disease, and that turned into Go Red. It was originally about raising awareness about cardiovascular disease.

They got corporate funding and branded it and had lunches all over the country. And I was honored to be invited to speak at some of those dinners to see what women in their communities are doing to help save their hearts and the hearts of their loved ones. It was truly an exciting time for cardiovascular disease and women.

It also spurred more research into realizing that this was a thing. I think when my book came out, doctors and researchers were surprised. But whatever happens, it did spur a lot of research. One of my roles in this whole campaign is that I got people talking about it.

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

Dr. Goldberg. This just shows where medical research is taking you and how long it takes to change the course of medicine.

When the Framingham Heart Study was published, they looked at the male and female populations. They asked if you had chest discomfort. More men who said yes to that question went on to have heart attacks. Women were much less likely to have heart attacks or be hospitalized.

But what they didn’t realize at the time when they asked those questions was that women were still relatively young to have heart attacks. But if they went out for 10, 20 years, they saw an increase in heart attack symptoms and heart attack diagnoses in women.

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

Healthy women. Having trouble building this app? It looked like you had this meal and it was instantly popular.

Dr. Goldberg. The challenge is not so much the lunch and the fact that we were targeting women. The real challenge is whether men, who are typically in leadership positions in organizations or health systems, can accept this.

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

I think what we need to look at now is what is a sustainable movement. How do we top it? A lot of women I meet want to talk to me because they want me to be into it. Women’s health is one place, and I think it should be an assessment of overall health because, you know, women make most of the decisions about health care and their families.

And we must use it to provide better health care for everyone, including women.

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

Dr. Goldberg. I think there is, and especially in women under the age of 50.

If you look at that survey, women under 50 and blacks and Hispanics were among the least informed. The message reaches women over 50. It doesn’t reach younger women. And now, we know a lot more.

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

Healthy women. How do you think the health profession should communicate this?

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

I think it would be great if the people who do the research actually partnered with the people who talk to patients all day to actually let them know what people are thinking. The average patient does not want to know that more tests need 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?

Dr. Goldberg. No. I didn’t think about that. Also, when I wrote my book, I had no idea what it would turn into, but I’m really happy. I’m really excited about what it’s done and what it’s led to, and of course a lot of money has been raised to support the campaign, so I think that’s great. I think now is the time for those involved to think about how we can do it better.

Healthy women. Are you still doing it?

Dr. 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 some new programming. I know the Go Red lunches have probably been less frequent in the past three years.

Healthy women. Do you think young women have enough heart health awareness and are they susceptible to heart disease?

Dr. Goldberg. You can not give [same] message to older women that you give to younger women. It’s not just about sending messages 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 do you communicate something to younger women as opposed to women who have been hearing this message for quite some time?

Dr. Goldberg. I wouldn’t start by saying that if you have clogged arteries, you can have a heart attack. What I would probably do with them is about choosing an active lifestyle because of the global impact it has on health, whether it’s improving your bone density, lowering your blood sugar, or protecting your heart.

I think young people are really obsessed with bullets. So you really need to simplify the message. Make it more usable. I think people just want to know how you got started. How do I know if I’m not feeling well? And that’s actually easy to do when you’re seeing patients because you’re talking to somebody and you’re getting to know them, and you’re making recommendations based on what you know about them. It is time for doctors to ask questions.

Healthy women. Why is heart-healthy awareness, at any age, still so important today?

Dr. Goldberg. Because heart disease is the leading killer of men and women, and if you go by previous studies, 80% of it is preventable.

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