Martha Gulati: all-round champion of women’s heart health

All correspondence relating to this paper should be sent to: [email protected] The US-based cardiologist Martha Gulati, MD, has dedicated her career to understanding and improving women’s cardiovascular health—a commitment that has earned her widespread recognition. She has been associated with high-profile institutions initially in Canada and later in the USA, and she is currently based in Los Angeles at Cedars Sinai Heart Institute where she is the Director of Prevention and Associate Director of the Barbra Streisand Women’s Heart Center (Figure 1). Prof. Martha Gulati, MD Raised in Canada, the daughter of a physicist mother and mathematician father, Prof. Gulati’s early years were shaped by personal experiences and influential figures, notably her grandfather, a physician, who ignited a passion for medicine. Losing her mother at a young age had a profound influence on Prof. Gulati’s outlook. ‘That shaped a big part of the person I was, and would become and from then on, I knew I wanted to be a doctor. The experience of repeated misdiagnoses in my mother’s case meant she didn’t have a fighting chance and it made me realise both the power of medicine and the trust we put in the hands of our physicians.’ Prof. Gulati studied medicine at the University of Toronto and drew on her personal experience of women in her family, none of whom had lived beyond the age of 50, due to cardiovascular events and strokes. This presented the medical student with a series of questions that would go on to influence her choice of speciality. She says: ‘Men who had heart disease were still alive, but there was something different with the women. They didn’t seem to survive, and the end was very sudden.’ This personal observation was amplified following an encounter with renowned American physician Dr Nanette Wenger who was a visiting lecturer at Toronto. Dr Wenger’s stark revelations about the lack of research on women’s heart health galvanized Prof. Gulati’s determination to address the critical gap in medical knowledge as a result of not including them in trials. Dr Wenger—who is professor emerita at Emory University School of Medicine in Atlanta Georgia—remains a valued mentor and friend. Alongside Dr Wenger, she credits cardiologists Leonard Sternberg and Rory Childers from her time in Toronto and Chicago, respectively, for nurturing her interests in cardiology. Prof. Gulati’s determination to explore cardiovascular disease in women brought her to the USA in the late 1990s where she pursued an internship and residency at the University of Chicago. There, Prof. Gulati’s focus on finding solutions to inequities in women’s cardiac health was fortified by the mentor Prof. Morton Arnsdorf, who provided guidance and support. She says: ‘Prof. Arnsdorf spent a lot of his time opening doors for us.’ He would eventually steer his mentee towards accessing and analysing the data of 6000 asymptomatic women which would result in a landmark paper in Circulation addressing the prognostic value of fitness in women. This was followed by a paper in the New England Journal of Medicine that defined fitness by age in women and validated this formula in symptomatic women and called for a rethink of the status quo. Prof. Gulati moved forward with her focus on disparities in women’s heart health throughout her professional development encompassing roles in Chicago, IL, and Columbus, OH. This focus continued when she was appointed inaugural Chief of Cardiology at the University of Arizona, Phoenix, in 2016. A pivotal introduction that Prof. Arnsdorf effected was to pioneering female cardiologist C. Noel Bairey Mertz, who turned out to be a researcher after Prof. Gulati’s own heart. The two women would go on to fruitful collaborations, and in 2022, Prof. Gulati took up her current role at the renowned Cedars Sinai Medical Centre in Los Angeles, CA, alongside her mentor. Prevention has always been a major passion and Prof. Gulati co-authored a bestselling book aimed at a lay audience. ‘Saving Women’s Hearts’ explains the complexities of women’s cardiovascular health in an accessible way and offers strategies and hints for a long and healthier life. Whilst the book has helped many women understand some fundamental facts about their heart health, there is still much work to be done. Prof. Gulati notes that the conversation about disparities in women’s heart health has been going on for decades and remains a global issue. She says: ‘We are at the infancy of understanding how women’s hearts work. We need to investigate whether we apply guidelines as equally in women compared to men, whether we use devices at the same rate, how we use interventions and whether we try to prevent stroke in women in the same way that we do in men. We need to find how to overcome biases, either through training or new technology and to ensure that we've done the right things for all our patients.’ Similarly, the information gap that exists in scientific literature needs to be addressed particularly in pharmacology and in women’s experience of pregnancy and medication. ‘Women form 51 per cent of the population and it’s essential to study them to see disease patterns and understand how heart failure affects women differently. We know that women don't always have heart failure with reduced ejection fraction and fundamentals such as blood pressure thresholds may also be different for women.’ Prof. Gulati is optimistic that prevention of heart disease is the way forward despite cardiologists/physicians being ‘disease focused’ and often appearing on the scene after serious problems have developed. ‘Most of us don't have the opportunity to preserve health as we are actually dealing with the consequences of adverse health. It's exciting that there's an emerging group of cardiologists throughout Europe, Canada and the US who are changing what we can do from a primary, secondary, and primordial prevention perspective to discover how to keep our society healthier and advocate for policy.’ The European Association of Preventive Cardiology and the American Society for Preventive Cardiology—of which Prof. Gulati is president-elect—have recently joined forces at a clinical, academic, and policy level in a promising collaboration which will see the profile of preventive medicine raised higher in the cardiology community. Prof. Gulati also believes there is a new generation of trainees who are excited about and focused on the possibilities of prevention. In her current role at Cedars Sinai Heart Institute, Prof. Gulati continues to champion the cause of women’s cardiovascular health. She emphasizes the pressing need to bridge the gap in healthcare, highlighting the significance of implementing science in overcoming deep-rooted biases and enhancing patient care. With her ongoing involvement in the WARRIOR study, focusing on understanding and treating ischaemia with no obstructive coronary artery, Prof. Gulati remains at the forefront of groundbreaking research, bringing hope to patients and therapeutic options to physicians. Prof. Gulati’s leadership extends beyond her clinical/academic roles. She served as the US Chair of the National Chest Pain Guidelines and was the former Editor-in-Chief for the American College of Cardiology programme CardioSmart. Her exceptional commitment to the study of women and cardiac diseases has won her numerous awards and distinctions. She received the first CREDO (Coalition to Reduce Racial and Ethnic Disparities in Cardiovascular Outcomes) award from the American College of Cardiology in 2011, the National Red Dress Award for her efforts in raising awareness of heart disease in women and advancing research in 2012, and the 2019 American College of Cardiology’s Bernadine Healy Award for her leadership and accomplishment in the field of cardiovascular disease in women. She continues to advocate for equitable treatment to aspiring cardiologists and advises the next generation to find their passion and seek mentors to help them challenge assumptions in medicine. No one should be afraid to take time out to master new skills, she believes, and trainees should understand there are many gaps in medical knowledge that require answers. All authors declare no disclosure of interest for this contribution.

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