Women as leaders in cardiovascular medicine

Abstract

Cardiology remains a specialty that is dominated by men. Even though half of all medical students and over 40% of internal medicine residents are women, the number of women in the field of cardiology remains low. The reasons for the persistent lack of increase in cardiology trainees are not well understood and are likely multifactorial. Despite this under‐representation, women cardiologists are increasingly visible in leadership roles, including those in research science, health systems administration, professional societies, and clinical practice. This review will highlight the various leadership roles and paths taken on by prominent women in the practice of cardiovascular medicine.

1. INTRODUCTION

Cardiology remains a specialty that is dominated by men. Even though half of all medical students and over 40% of internal medicine residents are women, the American Association of Medical Colleges workforce reports that in 2015, only 13.2% of cardiologists were women.1 Although women represent a greater proportion of those training in cardiovascular disease programs, this number has remained stagnant at just over 20% for several years.2 The reasons for the persistent lack of increase in cardiology trainees are not well understood and are likely multifactorial. A survey of internal medicine residents recently demonstrated that women and those not choosing cardiology fellowships valued work–life balance more, and had more negative perceptions of cardiology than men or future cardiologists, who emphasized inherent professional advantages in cardiology (unpublished data).3

Despite this under‐representation, women cardiologists are increasingly visible in leadership roles, including those in research science, health systems administration, professional societies, and clinical practice. Women are leaders in all the subspecialties of cardiology including interventional cardiology, electrophysiology, advanced heart failure and transplant cardiology, and adult congenital heart disease. Furthermore, women are well represented in pediatric cardiology, where half of all trainees are women.2 This review will highlight the various leadership roles and paths taken on by prominent women in the practice of cardiovascular medicine. No review is long enough to do justice to all the women who have led or continue to lead our field, but the women highlighted here are those whose lives and careers may serve as guiding stars for those in training or in early career practice.

Many of the women featured have had very long and distinguished careers, and several have excelled in more than 1 arena of leadership. These women, who are triple or even quadruple threats, have made contributions in science, editorial boards, professional society leadership, and innovation. I have included them here in the category that best describes their major accomplishments.

2. WOMEN SCIENCE LEADERS

Women have made numerous contributions to the scientific investigation of the causes and treatment of cardiovascular disease. Although not a universal interest, many women have had a scientific focus on how the disease is manifested and treated in women patients. The paths of a few distinguished scientists and clinicians follow.

Helen Brooke Taussig, MD, is considered the founder of the field of pediatric cardiology, and she is best known for her contributions to the development of the first successful treatment of blue baby syndrome. She was educated at Radcliffe College and the University of California– Berkeley. She was denied admission to Harvard Medical School because the university did not then accept women, and instead attended Boston University and graduated from Johns Hopkins University School of Medicine, where she later trained and was named Director of Hopkins' Harriet Lane Clinic, a healthcare center for children, making her 1 of the first women in the country to hold such a prestigious position. Her work with surgeon Alfred Blalock, MD, led to the development of the Blalock‐Taussig shunt, a development that has allowed babies with cyanotic heart disease to survive well into adulthood. In 1947, Taussig wrote Congenital Malformations of the Heart, which was revised in 1960. She was awarded the Medal of Freedom by President Johnson in 1964, and in 1965 Taussig became the first woman President of the American Heart Association.

Celia Mary Oakley, MD was one of the first women cardiologists in the United Kingdom and was part of the team that coined the term hypertrophic cardiomyopathy. She was widely considered one of the most outstanding clinical cardiologists of her time. She studied medicine at the Royal Free Hospital School of Medicine, where she was subsequently a house physician. She was briefly at the National Hospital, Queen Square, and then spent the rest of her career at the Postgraduate Medical School at Hammersmith Hospital. She spent time as a research fellow at the cardiopulmonary laboratory at the University of Rochester, where she wrote her thesis on pulmonary blood volume in humans, and subsequently developed an interest in pulmonary hypertension, and valvular and congenital heart disease. In 1991, Oakley was appointed to a personal chair at the Hammersmith. She was a founding fellow of the European Society of Cardiology and was chair—from 1995 to 1998—of the society's working group on valve disease and of the task force on the management of heart disease in pregnancy.

Nanette Kass Wenger, MD, was among the first cardiologists to focus on heart disease in women, and to evaluate the different risk factors and manifestations of the condition on women and men. She graduated summa cum laude from Hunter College in 1951, and was one of the first women to attend Harvard Medical School, graduating in 1954. She began her residency training at Mount Sinai Hospital in New York, later finishing her residency and cardiology training at Emory University. Wenger was named Director of the Grady Hospital Ambulatory Electrocardiography Laboratory in the 1960s and Chief of Cardiology in 1998. She is Professor of Medicine in the Division of Cardiology at the Emory University School of Medicine. She is a past President of the Society of Geriatric Cardiology and was editor‐in‐chief of the American Journal of Geriatric Cardiology for more than 15 years. Among her numerous awards, she has received the Gold Heart Award from the American Heart Association in 2004 and the inaugural Bernadine Healy Leadership in Women's CV Disease Distinguished Award from the American College of Cardiology in 2015. Wenger was a Time magazine Woman of the Year in 1976.

Christine (Kricket) Seidman, MD, is a researcher whose work aims to define the genetic mechanisms for heart disease and to use these insights to improve diagnostic precision and effective therapies. She was an undergraduate at Harvard College and received an doctor of medicine degree from George Washington University School of Medicine in 1978. Seidman served as an intern and resident in internal medicine at John Hopkins Hospital and received subspecialty training in cardiology at the Massachusetts General Hospital. She joined the staff at Brigham and Women's Hospital in 1987, and is the Director of the Cardiovascular Genetics Center and the Thomas W. Smith Professor of Medicine. She is also an investigator of the Howard Hughes Medical Institute. Seidman is a member of the American Academy of Arts and Sciences (1999), the Institutes of Medicine (1999), and the National Academy of Sciences (2005.) She has received the Distinguished Scientist Award from the American Heart Association (2003), the Distinguished Alumni Achievement Award from George Washington University (2005); and the Grand Prix Lefoulon‐Delalande Institut de France 2007 jointly with Jonathan Seidman, PhD. In 2012, she cofounded MyoKardia, Inc., a company with a focus on precision medicine.

Alice K. Jacobs, MD, is an interventional cardiologist whose major research interest is in coronary revascularization strategies. She is also interested in cardiovascular disease in women and the gender differences in the epidemiology, diagnosis, treatment, and prognosis of ischemic heart disease. Jacobs has made major contributions to improving systems of care for patients with ST‐elevation myocardial infarction and understanding the acute and long‐term outcomes of percutaneous coronary intervention in women compared to men. She received her medical degree and residency training from St. Louis University and her fellowship in metabolism and endocrinology at the University of California–San Diego. Her fellowship in cardiology was at Boston City Hospital. Jacobs is Professor of Medicine at Boston University School of Medicine and Director of the Cardiac Catheterization Laboratory and Interventional Cardiology at Boston Medical Center. She is a past President of the American Heart Association and received the organization's Gold Heart Award in 2009.

Sharon A. Hunt, MD, is a pioneer in the field of heart failure and cardiac transplantation. She started her career at Stanford as a medical student in 1967, as 1 of just 7 women in her class. The following year, the first adult cardiac transplantation was performed at Stanford. By the time she finished her training in internal medicine and then cardiology at Stanford, Hunt had a focus on improving the survival of transplant patients by identifying and treating rejection and determining how to reduce the side effects of immunosuppression medications. Hunt's early work set the stage for the development of the field of advanced heart failure and transplantation as a subspecialty of cardiology. Her career advanced at Stanford, where she is Professor in the Division of Cardiovascular Medicine. In 2001, Hunt served as Chair of the inaugural American College of Cardiology/American Heart Association (ACC/AHA) Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult. She is past President of the International Society for Heart and Lung Transplantation and has received that organization's Lifetime Achievement Award. She is a Master of the American College of Cardiology.

3. WOMEN EDITORIAL LEADERS

The role of the editor of a scientific journal is a role of significant influence. Final decisions regarding scope of the publication, selection of reviewers, and ultimate disposition of submitted scientific manuscripts are the responsibility of the editor. Women are and have been woefully under‐represented on most of the editorial boards of major cardiovascular medicine journals. Moreover, the number of women who are editors‐in‐chief of high impact journals remains very low. Nancy K. Sweitzer, MD, PhD, Director of the University of Arizona Sarver Heart Center, and Professor of Medicine and Chief of the Division of Cardiology in the University of Arizona College of Medicine, is a recognized leader in the fields of heart failure and cardiac transplantation, with a special interest in heart failure with preserved ejection fraction. Sweitzer became the editor of Circulation: Heart Failure on July 1, 2017.

Catherine M. Otto, MD, who is the J. Ward Kennedy‐Hamilton Endowed Chair in Cardiology, and Professor of Medicine and Director of the Heart Valve Clinic at the University of Washington School of Medicine in Seattle, Washington. She is recognized internationally as an expert in the diagnosis and management of heart valve disease, Marfan syndrome, and other inherited structural heart conditions. She is the author of several cardiology textbooks and cardiology editor‐in‐chief for the online medical textbook Up‐to‐Date. She currently serves as editor‐in‐chief of the journal Heart, the official journal of British Cardiovascular Society, published by BMJ Publishing.

4. WOMEN PROFESSIONAL SOCIETY LEADERS

Cardiology professional society leadership worldwide has recently seen an increase in women leaders. This year, in particular, has been a banner year for women. Women have been, are now, or soon will be at the helm of many of the major cardiology societies in the world. Some of them are serving their societies as the first woman President. I have the pleasure of serving the American College of Cardiology as its third woman President. Suzanne B. Knoebel, MD, was President in 1982 to 1983 and Pamela S. Douglas, MD, in 2005 to 2006.

Catherine Kells, MD, is the current President of the Canadian Cardiovascular Society, and she succeeded Heather J. Ross, MD, the organization's immediate past President. Han Yaling, MD, is President‐Elect, Chinese Society of Cardiology, and Barbara Casadei, MD, DPhil, will become the next President of the European Society of Cardiology. Professor Khalida Soomro, MBBS(SU), D.CARD(KU), MD(Cardiology) serves as the President of the Pakistan Cardiac Society, and Sarah Clarke, MA, MD, is the first woman to serve as President of the British Cardiac Society.

The American Heart Association has had 10 women presidents, with several women mentioned elsewhere in this review serving in that capacity. Furthermore, the cardiology subspecialty societies have had several women serve as president. Along with those who have been previously noted, Maryl R. Johnson, MD, has served as President of both the International Society for Heart and Lung Transplantation as well as the American Society of Transplantation. Vera H. Rigolin, MD, is the President of the American Society of Echocardiography, following in the footsteps of the 4 women who preceded her. Jennifer Mieres, MD, and Leslee Shaw, PhD, have been President of the American Society of Nuclear Cardiology, and Airlie A. C. Cameron, MD, and Bonnie H. Weiner, MD, MBA, have served as President of the Society for Angiography and Interventions. The Heart Rhythm Society has had 4 past presidents who were women, the most recent being Anne M. Gillis, MD. JoAnn Lindenfeld, MD, was named as the inaugural woman President of the Heart Failure Society of America in 2014.

5. WOMEN LEADERS AS DEANS AND SYSTEM ADMINISTRATORS

Cardiology divisions in academic medical centers have seen an increasing number of women leading the cardiovascular service line and serving as clinical chiefs and program directors. Less commonly, women lead as deans, chairs of departments, and university presidents. Only 15% of medical school deans and interim deans are women, and the prevalence of women in decanal positions decreases with ascending professional rank.4 The women included here have had pioneering roles.

Anne B. Curtis, MD, is the Charles and Mary Bauer Professor of Medicine and Chair of the Department of Medicine at the State University of New York, Buffalo. Previously, Curtis was a Professor of Medicine, Chief of the Division of Cardiology, and Director of Cardiovascular Services at the University of South Florida, Tampa. Curtis received her medical training at Columbia University College of Physicians and Surgeons Medical School, her residency at New York Presbyterian Hospital–Columbia Campus, and fellowship at Duke University. She served as President of the Heart Rhythm Society in 2005 to 2006.

Laura F. Wexler, MD, received her medical degree from Washington University School of Medicine in St. Louis, Missouri. After an internal medicine internship and residency at Boston City Hospital, she completed a clinical and research fellowship in cardiology at Massachusetts General Hospital in Boston. She joined the faculty of Boston University School of Medicine until she moved to the University of Cincinnati College of Medicine, and served as Section Chief of Cardiology at the Cincinnati Department of Veterans Affairs Medical Center. After serving as Interim Chair of the Division of Cardiology, Wexler was appointed Senior Associate Dean of Student Affairs and Admissions and served in this position for 10 years. She also chaired the American Board of Internal Medicine Cardiovascular Board as well as serving on the American Board of Internal Medicine Board of Directors and Executive Committee.

Anne L. Taylor, MD, is the John Lindenbaum Professor of Medicine at Columbia University Medical Center, SVP for Faculty Affairs and Career Development at CUMC, and Vice Dean for Academic Affairs. Taylor received her bachelor's degree from Hofstra University and then completed medical school, internal medicine residency, and clinical cardiology fellowship at the University of Chicago, with cardiovascular research training at Johns Hopkins University and the University of Iowa. Taylor began her academic career at the University of Texas Southwestern Medical Center in 1984 as Assistant Professor of Medicine and Director of the Echocardiography Lab at Parkland Memorial Hospital. She had previously been Associate Professor of Internal Medicine/Cardiology at Case Western Reserve University and Professor of Medicine and Associate Dean for faculty affairs at the University of Minnesota. From 2001 to 2005, Taylor chaired the Steering Committee for the African‐American Heart Failure Trial, the first major clinical trial to test the effectiveness of a heart failure medication in self‐identified African Americans.

Elizabeth G. Nabel, MD, has served as President of Harvard‐affiliated Brigham Health since 2010. A cardiologist and distinguished biomedical researcher, Nabel is Professor of Medicine at Harvard Medical School. She was previously Director of the National Heart, Lung, and Blood Institute from 2005 to 2009. One of her signature advocacy efforts was the Red Dress Heart Truth campaign, which raised awareness of heart disease in women. In 2015, Nabel was appointed Chief Health and Medical Advisor to the National Football League. She attended Weill Cornell Medical College and completed her internal medicine and cardiology training at Brigham and Women's Hospital. She has been elected to the American Academy of the Arts and Sciences, the National Academy of Medicine, the Association of American Physicians, the American Society of Clinical Investigation, and she is a Fellow of the American Association for the Advancement of Science.

Paula A. Johnson, MD, became the 14th President of Wellesley College in 2016. Prior to her position she was a professor and faculty member at Harvard Medical School and the Harvard T. H. Chan School of Public Health. Johnson also served as Chief of the Division of Women's Health at Harvard Medical School and Boston's Brigham and Women's Hospital, where she founded and is Executive Director of the Connors Center for Women's Health and Gender Biology. After attending Harvard and Radcliffe Colleges, Johnson received her MD and MPH degrees from Harvard. Her residency training and cardiology fellowship were completed at Brigham and Women's Hospital. Johnson was the lead author on “Sex‐Specific Medical Research: Why Women's Health Can't Wait” (2014), from the Mary Horrigan Connors Center for Women's Health & Gender Biology at Brigham and Women's Hospital.

6. WOMEN AS LEADERS AND INNOVATORS

Many women leaders in cardiovascular medicine have excelled in 1 or more areas, be it science, academic leadership, or professional societal positions. Sometimes these accomplished women change paths and pursue a new venture after a very successful career. Several of these innovators are highlighted.

Bernadine P. Healy, MD, graduated from Vassar College in 3 years and from Harvard Medical School in 1970. After postdoctoral work, she became a full professor at Johns Hopkins in 1982 and directed its cardiac care unit from 1976 to 1984. She practiced cardiology and directed research at the Cleveland Clinic Foundation from 1985 to 1991, and was the first woman Director of the National Institutes of Health (1991–1993), where she initiated the Women's Health Initiative, a $625 million study of the causes, prevention, and treatment of cardiovascular diseases, osteoporosis, and cancer in women. She was subsequently Dean of Ohio State University College of Medicine (1995–1999), President of the American Heart Association (1998–1999), Deputy Director of the President's Council of Advisors on Science and Technology, and President and Chief Executive Officer of the American Red Cross (1999–2001). She ran unsuccessfully in a Senate primary in Ohio in 1994, and served as an advisor of bioterrorism to President George W. Bush. She served as a medical commentator and consultant to CBS, PBS, and MSNBC, then as Health Editor for US News & World Report.

Janet S. Wright, MD, is the Executive Director of Million Hearts, an Health and Human Services national initiative, co‐led by the Centers for Disease Control and Prevention and Centers for Medicare and Medicaid Services, with the explicit goal to prevent 1 million heart attacks and strokes in the United States. From 2008 to 2011, Wright served as Senior Vice President for Science and Quality at the American College of Cardiology. In that role she provided medical and scientific oversight of clinical guidelines, performance measures, health policy statements and appropriate use criteria; quality improvement projects; and the National Cardiovascular Data Registry. She practiced cardiology for many years in Chico, California, and during those years she served on the American College of Cardiology's board of trustees, NCQA's Physician Program Committee, and the Center for Information Therapy, a nonprofit organization committed to the provision of personalized health information during each health encounter. From 2003 until moving to Washington, Wright served as a founding member of the Independent Citizens' Oversight Committee, the 29‐person board charged with administering the California Institute for Regenerative Medicine.

Mariell Jessup, MD, was until recently Associate Chief of Clinical Affairs of the Division of Cardiovascular Medicine and Medical Director of the Penn Heart and Vascular Center at Penn Medicine. Jessup also served as Professor of Medicine at the University of Pennsylvania School of Medicine. She attended medical school at Drexel University School of Medicine followed by an internship and residency at Hahnemann University Hospital and a fellowship at the Hospital of the University of Pennsylvania. Jessup has served as the Chair of the Committee for Scientific Sessions Program of the American Heart Association, and as a member of the Board of Directors of the national American Heart Association, before becoming President of the American Heart Association in 2013. She recently became the inaugural Chief Scientific Officer at the Leducq organization. As such, she advises Broadview on its investments and portfolio activities. Since making its first award in 1999, the foundation has committed over $350 million to cardiovascular and neurovascular research, supporting 47 research networks at 130 institutions in 19 countries.

Beverly H. Lorell, MD, is the Senior Medical and Policy Advisor with the Food and Drug Administration Lifesciences Practice Group of King & Spalding LLP in Washington, DC. Lorell specializes in the areas of clinical trial design for drugs and devices and postmarket safety. She also addresses physician and industry relations and the development of independent scientific panels. She was previously Professor of Medicine at Harvard University and Beth Israel Deaconess Medical Center. Prior to joining King & Spalding in 2006, Lorell joined Guidant Corporation in 2003 as Vice President and global Chief Medical and Technology Officer. She graduated from Stanford University School of Medicine in 1975 and completed a residency at Massachusetts General Hospital. She has served on the Food and Drug Administration Cardiovascular and Renal Drugs Advisory Committee and National Institutes of Health Cardiovascular Study Section as well as other federal panels.

7. SUMMARY

These women, and many like them not included in this tally, have helped to change the field of cardiology by their intellect, leadership, scholarship, and mentorship of other women. Though not specifically mentioned, many of these women have had a specific focus on the mentoring of women trainees and have received awards for doing so. Through their scientific and research pursuits, many have also helped shape the research agenda of the country to allow for a greater emphasis on the sex‐specific aspects of cardiovascular risk factors, manifestation of cardiovascular disease states, and response to therapies. The under‐representation of women in the field of cardiology is an ongoing concern, because lack of diversity in the medical workforce can influence patient care and outcomes. In the business environment, diversity and inclusion are increasingly recognized as requirements for optimal organizational performance. In medicine, diversity is crucial to better serve diverse patients, to promote health equity, to provide diverse mentors at all levels, and to include investigators with a broad range of perspectives in their scholarly activities. Efforts at getting at the root causes of the under‐representation of women in our field are ongoing. Specifically, the American College of Cardiology has engaged a Task Force on Diversity to explore these root causes and to propose solutions that can lead to an increase in the numbers of women and other under‐represented groups in our ranks.5 With such efforts, we will be adding the names of many more women leaders in cardiology to future discussions of their contributions and legacy in the science and practice of cardiovascular medicine.

Conflicts of interest

The author declares no potential conflicts of interest.

Walsh MN. Women as leaders in cardiovascular medicine. Clin Cardiol. 2018;41:270–274. 10.1002/clc.22920