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“Alarming” Number Of Deaths From Heart Disease In Women

“When you look specifically at women and cardiovascular disease risk, we need to better understand links with stress and mental health."

THE LANCET – Roxana Mehran’s remarkable career as an interventional cardiologist and clinical trialist has been wide-ranging.

She is Professor of Medicine, Cardiology, and Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai (ISMMS) in New York and is the lead Commissioner of the Lancet women and cardiovascular disease Commission.

“There has been an alarming stagnation in death rates due to cardiovascular disease among women in the past decade. This Commission will set out what needs to be done, with clear actions and metrics that we can track and report back on in 2030”, she says.

Born in Iran, Mehran’s family moved to New York City, USA, when she was aged 13 years. After a degree in chemistry at New York University, Mehran studied medicine at St George’s University School of Medicine in Grenada, completing medical training at the University of Connecticut, where, later as an intern at a district hospital in Hartford, CT, she knew her destiny lay in cardiology.

“I was blown away by the possibilities of what the specialty could do, especially as many of the new interventional technologies were becoming established”, she recalls. Joining Mount Sinai Medical Center as a fellow in cardiology in 1991, she found herself in esteemed company.

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“I was recruited by Milton Packer and worked alongside other legendary figures including Valentín Fuster and Richard Gorlin. It seemed like every week there was a new cardiology trial being published in a high-impact journal, helping to build evidence in the relatively new subspecialty of interventional cardiology. It was incredibly exciting, not just in being trained in the technical skills, but to see the potential of clinical trials and how I could be part of a revolution that was transforming health”, Mehran says.

Mehran’s research career developed in the late 1990s through her collaboration with Martin Leon at the Cardiovascular Research Foundation in Washington, DC. “We understood that with intervention came risk, so a lot of evidence was needed for our work”, Mehran says. She was an early advocate of the power of electronic data, prospectively creating a database of patients from her clinical work at the Washington Hospital Center in DC.

KEY BACKGROUND: Despite being responsible for causing 35% of deaths in women each year, cardiovascular disease (CVD) in women remains under-studied, under-recognised, under-diagnosed, and under-treated, with women under-represented in clinical trials.

To tackle these inequities, 17 experts from 11 countries have authored the first-ever global report on CVD in women. The all-female-led Commission outlines 10 ambitious new recommendations to tackle inequities in targeting diagnosis, treatment, and prevention to reduce CVD in women, including:

  • educating health care providers and patients on early detection to prevent heart disease in women;
  • scaling up heart health programs in highly populated and underdeveloped regions;
  • and prioritising sex-specific research on heart disease in women and intervention strategies for women.

“This not only gave us a clearer insight into the demographics and epidemiology of our patients, but, from hours of work studying angiograms and intravascular images, helped us to illuminate new clinical issues, such as restenosis, and a link between contrast agents used in percutaneous coronary intervention and kidney disease”, she explains.

“Why not coordinate cardiac risk profiles at the same time as a breast care clinic evaluation?”

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Returning to New York in 1999, she continued clinical work in interventional cardiology at Lenox Hill Hospital, before joining Columbia University from 2004 to 2010 as Associate Professor of Medicine and Cardiovascular Disease. Working again with Leon, Mehran became Director of Outcomes Research at the Columbia University Center for Interventional Vascular Therapy.

Since rejoining Mount Sinai in 2010, Mehran has been Director of the Center for Interventional Cardiovascular Research and Clinical Trials at the Zena and Michael A Wiener Cardiovascular Institute within ISMMS. A prolific clinical researcher, Mehran has accumulated more than 1200 publications over the past quarter of a century.

While acknowledging the teamwork required in her work, she cites the identification of patterns of in-stent restenosis, the development of risk models around acute kidney injury, ischaemia, and bleeding, and adherence to antiplatelet dual therapy as having had most clinical impact.

Central to Mehran’s approach is the inclusivity of clinical research and practice, especially concerning minorities and women. She is part of a team at ISMMS involved in creating a comprehensive multidisciplinary health-care centre for women.

“Why not coordinate cardiac risk profiles at the same time as a breast care clinic evaluation? These are the ideas that we are exploring as part of a broader approach to women’s health”, she says. Leon, the Mallah Family Professor of Cardiology and Director at the Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, comments on Mehran’s impact: “One of Roxana’s most powerful attributes is her unabashed, fearless approach to academic problem-solving and clinical research.

Where others would step cautiously, she forges boldly with progressive ideas designed to promote disruptive changes in patient outcomes. Over many decades she has become the voice in gender balance and gender equality in our field. As such, she is an extraordinary role model for young physicians.”

Mehran sees a transformation in her specialty as she looks ahead. “Cardiology is changing, and as global citizens, the number one cause of death worldwide has to be addressed in an ethical and epidemiological fashion”, she says.

With regard to the new Lancet Commission, her vision is clear: “When you look specifically at women and cardiovascular disease risk, we need to better understand links with stress and mental health, and also the reality that for many young women, their chest pain relates to ischaemia, even if it does not show up on an angiogram; we need to better understand the pathophysiology of the female heart.

At a broader level, we need to help women appreciate that there are many points along the lifespan where interventions can improve cardiovascular health. But only when we recruit more women into clinical trials can we establish clear, women-focused clinical guidelines. It’s time we stopped talking about it, and took urgent action”, she says. Source. 

Roxana Mehran, MD, FACC, FACP, FCCP, FESC, FAHA, FSCAI is Professor of Medicine and Director of Interventional Cardiovascular Research and Clinical Trials at the Zena and Michael A. Wiener Cardiovascular Institute at Mount Sinai School of Medicine (icahn.mssm.edu/research/center-interventional-cardiology).

Dr. Mehran completed her training in internal medicine at the University of Connecticut, where she was also a Chief Medical Resident, before continuing with Fellowships in Cardiovascular Disease and Interventional Cardiology at Mount Sinai Medical Center. Dr. Mehran is internationally recognized for her work as a clinical trial specialist with complex data analyses and outcomes research within the field of interventional cardiology and for her experience and expertise in working with regulatory agencies to conduct clinical trials.

 

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