Malissa Wood, MD: Women and the Heart

Q: My guest this episode is Malissa Wood, who is a member of the Heart Center at Mass General. So can you just start out by telling us a little bit about who you are and what you do at the hospital?

A: Sure. So I am the co-director of the Corrigan Women’s Heart Health Program at Massachusetts General Hospital. And I spend the majority of my time caring for women with cardiovascular disease. And the rest of my time is spent designing research projects related to how we can improve care for women with cardiovascular disease. And I also work in the Echo Lab and read echocardiograms on both women and men who have heart disease.

Q: Some people might be surprised that you work in a women’s heart health program. You know, everyone has a heart. So why it is divided out in that way?

A: So cardiovascular disease is the number one killer of American men and women. However, over the past two decades we’ve recognized that the disparities with regard to treatments have really become more apparent because most of the studies that were done looking at heart disease treatments included about 80 to 90% men. So while women are dying from heart disease, the treatments and the, you know, the solutions for those problems have not been well defined because women were excluded from the trials.That largely occurred because in the 1970s we realized women that we exposed to drugs like diethylstilbestrol and thalidomide caused problems, especially if they were pregnant.

Q: Are those heart medications?

A: Those are not. But those women that were exposed to those treatments had problems with their offspring. And so women were then excluded from trials because they might--

Q: All trials.

A: That’s right.

Q: Got it.

A: And so it took about two decades for us to realize that that exclusion was really hurting us because we didn’t really recognize how much the sex differences would really apply to care of women with heart disease. So, you know, we use a term, every cell has a sex. And that’s true. So a cell of a heart muscle that’s from a women is different from a cell from a man. And the medications, the surgeries, all of the interventions are very, very different. And we need to recognize that more. Now in 1985 the NIH started recognizing, and the Institution of Medicine recognized that we needed to include more women. And so studies started to have mandates. And actually, as of the past decade now most studies that involve a disease that affects both men and women, have to have at least 50% women in the study. And so that’s been a big game changer. So now we have data to change the way we are caring for women.

Q: What makes a female heart different than a male heart? Or how do you treat it differently?

A: So women’s hearts are smaller. The blood vessels are smaller. The chambers are smaller. But interestingly, women’s hearts are more resilient to certain difficult conditions. If you think about, you know, other places where women have shown a difference from men, like look at the English Channel swimmers. So women have a better time crossing the English Channel than men.

Q: Really?

A: And that’s probably because their heart and their body was more adapted to adverse conditions like childbirth, right? So pregnancy is considered a stress test for the heart. And we know that being able to get through a pregnancy without problems is a way that we can see whether or not a heart is adapted. And so we’ve been able to really play into that and see that if women can get through a pregnancy without problems, their heart’s probably going to be healthy. However, women who show up with heart problems during pregnancy or conditions like pre-eclampsia, gestational diabetes, gestational hypertension, they will have more heart disease earlier in life than women who have gotten through pregnancy very healthy. That was really a way for us to kind of focus on identifying risk for heart disease and developing treatments to prevent heart disease earlier on in those women who have had problems during pregnancy.

Q: Wow! So it is sort of an indicator of--

A: It is.

Q: --What your body can handle.

A: It is. Yeah. And so one of the other differences in women’s hearts from men is that if women have a blockage in a valve, like an aortic stenosis, which is a pretty common condition in people over the age of seventy, women actually respond better to the therapy, which is where we put a new valve in the heart, than do men. The heart recovers much quicker. And their heart function is much stronger. So we realized that women are, although less likely to be referred for treatment, they’re much more likely to benefit from treatment. Really my role over the past, you know, two decades has been to deliver better care to women and to help push for research that will allow us to continue identifying ways of improving heart care for men and women based on studies in women.

Q: Are there things you think we still need to know?

A: Yeah. I think there’s a lot we don’t know. So, for instance, we’re kind of moving from the macro, which is the heart, the muscle, the valve, to the micro, to the ultra-micro, which is the genetics. And I think we realize that looking at genetics we can actually identify precision medicine, so looking at individual risks. So even one woman versus the next woman versus a man, their genetics may predict that they will respond to treatments differently. So we actually are now looking at ways of looking at their blood cells, even samples of, you know, tissue, etcetera, to identify personal risk of heart disease and how we can better treat it. And that’s what for me is really exciting is that precision medicine.

Q: What does that mean? To me it seems like shouldn’t all medicine be precise?

A: It should be precise. But I think we’ve had very imprecise indicators of individual risk. So I think now that we have DNA, DNA allows us to look at different responses. It’s been very well played out in the cancer world. So in cancer you can look at a tissue sample and say this person has a mutation and they will respond to X-drug. And the drug companies have responded by developing drugs that will respond to that mutation. However, in cardiovascular disease we’ve kind of been behind because we haven’t yet identified all of those mutations and then ways of treating them. So I think there’s a lot of work to be done. But we’re really beginning to scratch the surface. And I’m so excited to be part of the Heart Center here where that work is being done.

Q: Yeah. That’s really exciting. So you’ve been caring for patients and particularly female patients with heart problems for a long time. Are there any particular patients that stand out that you’ve cared for?

A: Absolutely. So I think I have a couple of patients that really bring home the message of what I do. The first patient that I remember is a young woman who I cared for in my residency. She was in her twenties and she had palpitations. And she came to see me. I was a medicine resident. And she said, “My heart is beating very strongly. I don’t understand why.” And I said, “Well, I think you need to see a cardiologist.” So I sent her to one of my colleagues. And they said, “Well, her valve is leaky. We don’t really know what’s going on.” And at the end of the day she have very, very bad rhythms coming from the valve issue. But because she was a young woman she kept getting pushed to the back. It’s like, she’s healthy. She’s just having a panic attack. And, you know, in the end she had a very significant rhythm problem that had to be managed very aggressively. And I think because she was a healthy young woman, it really delayed her access to care. Additionally, I take care of many young women, and especially one that I think of most significantly who’s a young mother of two children who had a heart attack six weeks after delivering her second child.

Q: Wow!

A: Again, another fit, healthy woman who had a spontaneous dissection, which is a condition that affects primarily healthy people, and that’s my area of specialty. And she went to the Emergency Room and she’s like, “I’m having chest pain.” And they are like, “You’re just nervous. You’re not getting enough sleep. You have a young baby.” But she advocated for herself, which is the message. She said, “I think there is something wrong.” This wasn’t at our center but they did check her blood work and then found that she was actually having a heart attack. She got a procedure and was well taken care of. But I think those cases show me that even though you’re young and healthy and athletic, it doesn’t mean that you couldn’t—I mean you could still have heart disease.

Q: Especially with the heart, you know, we all have one and you feel it.

A: Right. Well, I think that’s an important point. So I think there’s a huge link between how we think and who we feel. And I think the link between stress, depression, anxiety and the heart is now being very well developed in our center. And that’s the area that I’m really interested in doing further research in, which is that mind-body connection and how we can actually use that to our advantage by treating patients and managing their stress, depression, anxiety to reduce the risk of cardiovascular disease.

Q: I’m curious to ask you a little more about this idea of advocacy. I’ve been reading a lot lately about, you know, women,saying they have symptoms and not getting the care that they need because people say--

A: Right.

Q: --You know, you’ve having a panic attack. You’re tired. How do you think—I guess two sides to the question. How do we help encourage and empower women to stand up and advocate and how do we, on the other side encourage doctors to listen and to pay attention?

A: Right. I think education is critical. So we have done a lot to educate the public, both through the American Heart Association’s campaigns as well as, you know, Massachusetts General Hospital getting out there and having us speak to communities. We’ve tried to raise awareness that even young women can have cardiac disease. So women and men need to be aware of the symptoms of heart disease and recognize what they are. And also recognize that heart disease isn’t always like, a heart attack isn’t an elephant on your chest. It can be arm pain, neck pain and jaw pain. So when something happens that you haven’t felt before, get it examined. Go see a doctor and make sure that everything’s okay. So that’s the first piece. The second piece, really, is educating my peers and getting out there and helping them understand that although when I was training 30 years ago we thought of heart patients as a 70-year old man. We now recognize it could be anybody.

Q: Yeah.

A: And so you really need to look at every patient and take them seriously. You know, and now we have very precise tests, like troponin, like EKGs, like CT scans that will help us quickly identify who doesn’t have a high-risk problem—but then will help us identify who does. And using those tests better and in an efficient way to identify the patients that really need the care immediately.

Q: Yeah. I don't know if you watch Grey’s Anatomy.

A: I do.

Q: Did you see the episode a few weeks ago--

A: I did.

Q: --With Miranda Bailey. I thought it was so interesting that they were--

A: It’s a big deal. Yeah.

Q: --Bringing that to the forefront that women present differently with heart symptoms.

A: Right. And she’s a perfect example of how a young woman, you know, with a lot of things on her plate can have a problem. And I think, you know, we’re sort of quickly changing the landscape. And I’m really excited that I’ve been a very small part of changing the landscape.

Q: I know that you started something called the Happy Heart Trial, which is really aimed at improving cardiovascular health for women at high risk. Can you talk a little bit about that?

A: Sure. So the Happy Heart, means “Heart Awareness and Primary Prevention in Your Neighborhood.” And it was a very, it’s a very holistic study that looks at all aspects of a person’s health so that everything that you do, everything that you eat, how you feel, really affects your health. So what we did was we brought a holistic health program to women in the community of Revere, which is a low income neighborhood associated, you know, a part of Boston. But the women that live there didn’t want to come into Boston to be part of a study. So we brought it to them. And what we did was, we did guided nutritional counseling, exercise counseling. We worked with their PCPs to make sure their medical conditions were addressed appropriately. And then we gave them a social network. So many of the women that lived in Revere actually were quite isolated. I mean their managing a low income family with a lot of stressors a lot of issues socially.

And we gave them friendship and kinship with other women that had similar problems. So they were able to build a social fabric that allowed them to kind of feel more comfortable talking about their problems. And then we pulled them together twice a month and gave them a guided education. And we also taught them how to do Tai Chi. We gave them access to Zumba and to yoga classes. And at the end of the two year study the women’s heart health markers had improved drastically. And we think it was largely related to the fact that they were able to access these different therapies because they had other people that would do it with them. And we know from data from the Framingham Heart Study that being surrounded by people that are like you will help you but it can also hurt you. So in the Framingham Study they showed, if you’re obese and diabetic you’ll spend time with other people that are obese and diabetic. However, if you’ve decided to start exercising and take on a healthier lifestyle, if you surround yourself with people like you, you’ll be more likely to succeed. So we kind of tapped into that. And interestingly, you know, we’ve looked at some of these books that have been written, like The Blue Zones, The Longevity Cure that look at people around the world who have the best health. And some of the key components are regular exercise, healthy nutrition and a social network of people that support your good behaviors. And I think, you know, we kind of did it a decade before those books were written. But we’re so excited that our patients benefited and we hope to continue to see that kind of progress permeate the healthcare environment in the United States.

Q: That’s so cool because I wouldn’t think of like your social situation being a part of sort of your health regimen.

A: It is. It’s a huge part of it. You know, if you’re given directions by your doctor to start walking, but you go home and your family is like, “Let’s sit in front of the TV and eat,” that’s probably not going to really work. But if you actually go home and you have kids or a partner who says, “Let’s get outside and go for a walk before we eat, or after we eat, and let’s all do this as a family,” it will help. And we saw that in Happy Heart. Like one of the patients who was very, you know, remarkable, her husband, her kids, her husband’s coworker all benefited from the lessons we taught them because they were able to share it and they all really wanted to lose weight and eat a better diet and it worked for them.

Q: So it’s sort of a ripple effect.

A: It’s a ripple effect. That’s right.

Q: So another thing about cardiology, it’s a very male dominated field. Only 20% of fellows are women. Only 12% of board certified cardiologists are women. So can you tell me what it’s like to be a woman in the field?

A: It’s actually a great privilege. I think at the time that I started cardiology I looked at it as a challenge because I realized I didn’t have a lot of role models for mentors. But then I realized that it was also a great opportunity to make a difference. And so we weren’t seeing patients that were women because they weren’t being identified. But we also weren’t seeing women coming into the field. And as we began to bring more women into the field we saw more women that were patients. So I think it worked on both ends. I do think that some of the best mentors that I’ve had have been men who saw that women bring something unique to the field. I think the attention to detail, the sort of nurturing approach that a lot of women and men have is very important in cardiology because we have to get our patients to change behavior. And if you can’t communicate with your patient you cannot get them to change their behavior. So I think that aspect was really exciting. It was very challenging to not have many friends that were cardiologists and sort of have to—you know, I was planning my wedding. I was planning the birth of my first child and nobody understood it. It’s like, “Well, she’s just off doing that.” However, you know, I think as more of us enter the field it becomes much more commonplace to see a woman planning their wedding and planning the birth of first child. I’ve been so fortunate to be able now, 30 years later, to look back and write a few papers about that experience that will help enable the next generation of men and women bring more balance into their career of cardiology.

Q: Do you think early in your career, did you find balance pretty naturally or did you have to learn some tough lessons along the way?

A: You know, so I was kind of one of those first people that went into it, like I’m just going to be an interventional cardiologist. I’m going to have a huge career. I then had a little hiccup, which was called life. And I wanted to have a family. And so I kind of scaled back and I said, I’m going to take some time. I’m going to work part time and then reenter full time. And that worked for me. Now every person has different, you know, plans and a different way of entering it. But for me that actually worked because it allowed me to maintain my clinical skills but also make sure things were taken care of at home, which I think is important. And I think in the traditional sense more women have that responsibility of managing the work-life balance. However now, I think because so many more men are taking on that responsibility, it’s the landscape is changing.

Q: Yeah, so everybody kind of has to find that balance in a way that maybe they didn’t before.

A: Right. But I’m really happy that it actually worked really well for me.

Q: Sometimes people talk about having a tool kit. Are there pieces in your took kit that helped you get through those years when it was really hard or when the kids wouldn’t sleep, the baby is crying, you’re tired--

A: Absolutely. So there were major pieces in the tool kit. Number one, support. So, you know, having people to support you when you go to work, be good to them and appreciate that they are such an important part of your personal success and they are part of the team. Number two, make sure that you have a focus on what you’re doing in your career. Identify very early on what it is that you want to accomplish. And that could be private practice, academics, basic science. But have your eye on the ball so that everything you do in your career kind of plays to that strength or passion. Number three, have appropriate mentorship and guidance from people around you. And that can sometimes be from people that aren’t even in your own area of expertise and sometimes not even in medicine. Someone that I have taken on as a fabulous mentor is in the world of economics. But she’s been a leader in her field and has really demonstrated to me that you can lead while being graceful, enjoying your life and yet really rise to the top of your field because you’re so committed to what you do. And then I think number four, finally, is just take care of yourself.

Q: I love that idea of women. I think it can be easy especially if you’re in a field that is very competitive to kind of head down and only be there for yourself.

A: I think the first generation of women in cardiology were a bit more, you know, we have to—they’re survivalists.

Q: Yeah.

A: And I think now we’re like thrivists. Let’s thrive together and make it better. And I think we’ve been so lucky because, you know, the advent of social media, a lot of us are connected now that wouldn’t have even known each other before because we are in different countries, different parts of the United States. And now we’re all super connected and lift each other up. Every time one of us has a publication the other people share it. And I think that’s been a really nice gift as well.

Q: Wow! Are there like Facebook groups for-

A: Or Twitter, you know. We have something called the Carrot Squad, which is people that are largely plant-based eaters who are cardiologists. So it’s #carrotsquad. And we really try to get the message out there that healthy nutrition is important. You know, but every time one of us writes something or does something we really lift each other up. Also, our American College of Cardiology, Women in Cardiology group, again, also lift each other up. We have colleagues in Australia, Serbia, in the Ukraine, you know, all over the United States. And we follow each other and make sure that our messages get out there.

Q: You mentioned younger women coming up in the field. Are there lessons or skills that you’re trying to impart to them to kind of, I think sort of like a parent. You want your kid to have a better life than you. Are you thinking about it in that way?

A: Absolutely. And you know, we are so fortunate to have so many talented young men and women in our field today. And one of the things that I have taken as a personal responsibility is helping them navigate a successful career. And I think one of the first things that I share with them, as I’ve mentioned earlier, is really identify where your interests lie and follow those interests. I think there are so many things that we’re asked to do on a regular basis. And it’s easy to say yes, especially if you’re a person who feels like you need to help other people out. But I think you need to be a little selfish and focus on the things that will support your goals as an individual, as a scientist, as a cardiologist—and say if I take on this responsibility will that time I’m spending support my goal. I think that’s very important. I also think it’s important to get the best training you can. And we’re so fortunate to be at MGH where we have so many excellent clinicians and scientists we can train with. But getting that training will allow you to go out into the world and have expertise and be an authority on a topic. And I think that’s also really important. Because if you want to have an impact you have to have a platform to stand on.

Q: I want to go back to something you talked about earlier, kind of transitioning from training to part-time work back to full-time work. Was it challenging to do that and to be a doctor but not here all the time?

A: You know what, there was no guidebook for doing that in the 1980’s. And I read a few books that helped me along the way. And I realized that that need to have some control over your personal life while being a professional wasn’t unique to medicine. So I was able to really take advantage of some of the other work that had been done in the business world. And for me, I had to negotiate and I had to give up a lot of things that maybe I shouldn’t have early on because it was unusual to work part-time then. But because I did it, it allowed me to sort of achieve personal goals while continuing to work professionally and not giving up my career. I think that being able to have that breathing room, for me allowed me to still engage in the process of being a cardiologist and be really enthusiastic about it. And then when I had more time I had a lot more energy to devote, versus feeling like, you know, people that just work full-time throughout and are trying to manage both things, I think get a little burned out. And especially today where burnout affects men and women equally, I think women perhaps even have a little bit more of a challenge. But it’s something that having done that throughout my career, I can handle today’s burdens a little bit easier I think.

Q: Yeah. You have plenty of children, correct?

A: Four kids. Yeah. Yeah.

Q: I think a lot of people would be astonished that you’ve been able to balance this career and what’s clearly a very full life outside of work.

A: Well, I’ve been very fortunate because their father, who’s also a physician has been very involved and helped me out a lot. You know, if I couldn’t get to the track meet he went. And we both realized that, you know, somebody needed to be there for certain things. Then there were a lot of things what we didn’t have to be there for. But the things that counted one of us was there. And that was very important.

Q: And that partnership.

A: That’s right. That’s right.

Q: I know you are taking over leadership soon of the Massachusetts Chapter of the American College of Cardiology. What is that role going to be like? What do you hope to accomplish?

A: I’m so honored to have been elected as the Governor of the American College of Cardiology. And it is an opportunity to be part of the leadership of an organization that really is directing the field of cardiology. So we have our finger not only on the further development or research and helping develop careers of junior people, but really importantly we are in D.C. a lot. And so we have an impact on advocacy, policy, and the direction of healthcare. I think that the politicians in D.C. recognize that the largest percentage of the healthcare budget is spent on cardiovascular disease. So they listen to us. And when we bring them ideas for things that will help our patients while saving money, they listen. And I really want to be able to bring better care to people around the United States. And Massachusetts, as you know has a very, a large number of cardiologists, a large number of cardiovascular training programs, given the size of our state. And many of the important studies that have been done in healthcare, especially in cardiology have come from Massachusetts. And much of the healthcare budget for research comes here. So I think we really get attention when we say something. And so it’s an important position and I really want to use it in the right way.

Q: So people here know hearts.

A: They do. They know hearts. The Framingham Heart Study, you know—Paul Dudley White who was, you know, the really father of American cardiology was here at Massachusetts General Hospital and he really created the space of cardiology. He rode his bike to work. He showed us that being healthy translates into better healthcare. He developed the concept of cardiac rehab so that after people had a heart attacks they needed to get up and move. Back in the 1950s they were basically left in the hospital to sit for three weeks to recover from the heart attack.

Q: Three weeks?

A: He came along and he said, “You need to get up. You need to walk. You need to move and then you need to start exercising so you don’t have another heart attack. And so, you know, we’re so lucky because his leadership has really transcended the decades and we all are continuing to follow his advice.

Q: So we talked a little bit about, you know, the next generation of doctors and thinking about training. What do you think the responsibility of the women who have come up already, like you, how are you leading maybe by example, how are you working together?

A: So I think one of the first things that I try to share with women that are interested in leading and that want to be working in that area is really to develop and area of expertise. And to be very authentic in the work that you do in that area. I think that most leaders have gotten to a position of leadership not only because they are skilled at that they do but because others recognize their talent. And so I think using your talent in the best way that you can—so following your passion and your research and looking around to see how you can help others achieve the same type of success. I think that’s very important. And there’s a quote that I heard a long time ago and I totally, firmly believe it, which is “Lead until they follow.” I think people are really mostly I think born leaders. I think people don’t always recognize those qualities because you may sort of disguise them with other aspects of yourself. But I think, you know, remaining very true to the tenants of being a leader and looking around and seeing that you’re taking care of the people around you while being an excellent example of what you’re trying to achieve is very important. I also think developing that network of people that you can go to, to give you advice when you face challenges as a leader is very important. You know, one of my best and most supportive colleagues has been a chief of cardiology in two divisions and leads a huge research group now. And whenever I have a question about a decision that’s important, I reach out to that person and say, “What would you do?” And most of the time they agree entirely with what I was planning to do. But having the ability to ask others to give you advice I think is really important.

Q: You mentioned creating a network. And I think sometimes it can be hard to figure out how to do that.

A: So I think one of the things that’s really been helpful is to reach out beyond your own discipline and find colleagues in other disciplines who will help support your leadership role. For instance, at MGH we have been able to connect with leaders, women that are leaders in areas like radiology, obstetrics and gynecology, neurology—and develop a network of individuals who work together to help achieve a common goal. And to really support one another as we try to push ourselves forward, both in the research world, the clinical world and certainly in the academic world.

Q: You’ve mentioned a couple of times finding your passion. What would you advise a young person who’s trying to figure out their direction and their passion?

A: So I think part of it, just is being in the experience of your world. So being a cardiologist, being a clinician, when patients come into your daily life and you see them and you see a problem, and then you recognize that problem needs to be solved in a better way, that will spark your interest and lead to you developing passion. So for me, as a young woman in the field of cardiology, I was seeing many young women who were dying of heart disease or they weren’t identified as having heart disease initially. And I said this is an area that I need to do more work. I also recognized that women of color, women that were in low income communities were not getting the same healthcare that white women were getting. And that was a real problem for me. That's why I created the Happy Heart study because I wanted to be able to work in the community, embedded in the fabric of the community, with their primary, trusted care providers and provide them world class care that would help reduce their risk of having heart disease.

Q: Well, this has been such a pleasure talking with you. Before we wrap up, I have my final five questions.

A: Okay.

Q: So the first one, what is the best advice you think you’ve received?

A: The best advice I have ever received was to follow your dream and make sure that everything that you do is kind of aligned in that pathway.

Q: The name of this podcast is “Charged.” So in the context of the work that you do, what does that word mean to you?

A: Charged is really reflective of the great privilege I have been given to follow the path of being a cardiologist, especially a female cardiologist in a man’s field and using everything around me to help me achieve success in that field.

Q: How do you recharge?

A: I like to run. I like to meditate. And I like to ride my bike. And that—I live in a beautiful community and I can get out on my bike on weekends and just ride for hours and enjoy the beauty around me. And that helps me kind of recharge.

Q: I’m curious. Are there little moments that you have found for meditation? Do you carve that out especially?

A: I do. The Benson Henry Center at MGH has taught me how to do the relaxation response in as little as three minutes. So I can go in my office, shut the door, turn off the light and micro-recharge. [Laughter]

Q: I love that. When and where are you happiest?

A: I’m happiest at work when I’m sitting with my patients and we’re having a dialogue and I feel like they’re actually listening to that I’m saying. I’m happiest at home when I’m surrounded by my children, my partner, my dogs, and I feel the love that is in our family.

Q: And finally, you are a busy doctor. You have, I’m sure, very busy days. Are there particular rituals that help you have a successful day.

A: Starting the morning with exercise is 100% a key to success. I have to get up in the morning and workout because I realize that’s my time. And if I get that time and I use it appropriately, it doesn’t really matter what happens in the rest of the day because I’ve taken care of myself first, which I think is really important. Oxygen mask. Remember that rule.

Q: That is a good one. Take care of yourself first, before other people. Thank you so much for being here Malissa. It’s been such a pleasure speaking with you. And just really enjoyed learning more about the work that you do.

A: Thank you very much for this opportunity.