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Anita Radhakrishnan, MD: Role of Gender, Social Determinants in Cardiovascular Health

Strategic Alliance Partnership | <b>Allegheny Health Network</b>

Dr. Radhakrishnan discusses both the effects of gender bias and why women don't get screened for heart disease.

In an interview with HCPLive, Anita Radhakrishnan, MD, AGH McGinnis Cardiovascular Institute, Allegheny Health Network, candidly discussed her views on issues in the field of women’s cardiovascular disease prevention, particularly in regards to gender bias and what needs to be done to close that gap.

She additionally highlighted the differences in the way cardiovascular disease presents in women and necessary improvements that can be made to improve screening. Radhakrishnan also spoke to the effects of stress and pain on women’s heart health and the ways social determinants of health play a role in education and management of CVD.

Check out the interview below.

The full transcript has been edited for clarity.

Could you tell me a little bit about yourself and your expertise in cardiology and women's heart health?

I am a non-invasive cardiologist at Allegheny General Hospital. I've been working for about eight years, almost, out of fellowship, I specialize in advanced cardiac imaging. But, I have been taking care of women and been part of the Women's Heart Center at AGH for eight years. We have a wide population of women anywhere from young with primary cardiac risk factors to pregnancy patients, to our cardio-oncology patients, and then obviously, our women with known cardiac history that come to our clinic.

Speaking specifically to Wear Red Day, could you describe the importance of spreading the message or spreading awareness of cardiovascular disease in women?

As you know, one in every third woman has heart disease and one woman dies of heart disease almost every 80 seconds. So, that's a pretty significant amount of deaths due to heart disease. As a matter of fact, when you compare it to breast cancer, the death from breast cancer is only one in every 31 women versus cardiac disease at one in every three. Also, heart disease can be prevented if patients know what they need to look out for, and if they appropriately manage it. More than 90% of women have at least one cardiac risk factor that they don't know about.

According to the American guidelines, every single patient needs to be screened. Every single woman needs to be screened for cardiovascular disease, it doesn't matter about their age. That's because data has shown that if these cardiac risk factors are identified, and they're managed, the actual event of a heart attack, stroke, congestive heart failure, are markedly reduced.

Go Red Day and really Red month is about bringing awareness to this for women. We are a little bit of a different species in terms of the way it presents itself. It's different in the type of disease that causes in our body when it comes to heart attacks and heart failure and stroke. Also, the care currently that is provided, there is also a little bit of a gender bias present. I think the awareness is not only to patients so that they're educated, it's also to the medical community so that we do a better job.

Is there a better way to spread the message to make sure that there's representation, for gender and for race and ethnicity? Additionally, do you have any opinions regarding the stressors of women who don’t get screened, despite potential risk factors?

I think in women, generally speaking, there's a lot of common aches and pains that we just tend to kind of ignore, and we say it's not a big deal, it'll go away. We don't pay attention to it. There’s a lot of reasons why there's gender bias, but the most common reason is that women don't go to doctors to get screened, or to get diagnosed. Two out of three women don't even have one symptom at the time of a heart attack.

So, they don't even show up because they don't know what the symptoms are, or their symptoms seem a little bit atypical, and they just kind of ignore it. If we don't show up to get evaluated, because we feel something is wrong, and we just kind of keep ignoring that, that's really what leads to increased numbers.

I think when it comes to stress, it's just a matter of constantly checking in and seeing where you are. Stress actually causes an increase in heart rate, it causes an increase in blood pressure, it causes endothelial dysfunction, changes in the lining of your arteries so that all of these risk factors increase.

It’s been shown that women are more likely to get a stress induced heart attack, when compared to men. We are double the risk compared to man to develop a stress induced heart attack. There’s not only a heart attack, there is also called a stress induced heart failure, that's when the heart muscle gets so weak.

Now, these may seem like they're benign, but you have to understand that if that underlying risk doesn't go away, that event could be considered repetitive and very damaging to the heart. So I think a big part of our care is stress management.

Another thing in terms of social determinants of health, at least at Allegheny Health Network, we’re really trying to do a great job in trying to understand social determinants of health for every single patient coming in. Trying to understand where their education is, understanding if they understand their cardiac condition, and giving them appropriate resources, so they do, and understand what their financial income is, and see if there's any kind of pharmacy options to help with medications, and understand where they live and see this transportation.

There are some resources that we offer at AHN that we give to our patients that we feel really do screen positive, when it comes to stress and social determinants of health. It has become a big part of heart disease, and so we are now actively screening so that we can help manage this side of it.

Any final thoughts regarding Wear Red Day or women’s cardiovascular health?

I think medicine when it comes to women, there's a lot of improvement that needs to take place.  Because as a doctor, when it comes to a patient, studies have shown that patients are not getting the same care that men are getting, they're not getting life saving procedures, they're not getting defibrillators, they're not getting the same thing men are getting. Because of that the outcomes are different.

American Heart with Go Red is definitely putting in a big initiative to try to spread the word. I think the only thing I would say is that it's constantly changing, like what we're learning about women is constantly changing. There’s new data coming out every day. I would say that what your doctor told you maybe 10 years ago, it does not pertain anymore.

Some women come to me in the clinic with a cholesterol level that looks great to them and they say my cholesterol looks good and I don't need medications. But, cholesterol is no longer treated by numbers. It is treated by an overall cardiac risk and their overall risk of developing heart disease in 10 years.

Those are changes that evolved over the last 5 to 10 years and and some even over the last 1 to 2 years. I think just understanding that there's a lot out there that perhaps patients don't know and remembering that every single patient needs to be screened, not necessarily by a cardiologist, but by at least their primary care and the right ones being referred to us if necessary.