Heart Matters: An Interview w/ Dr Gary H Gibbons of NHLBI
“We understand the risk factors of high blood pressure, obesity, high cholesterol, and those are things that women can do something about;( a) by having those conversations with their doctors to be sure they know their numbers, their blood pressure, their cholesterol and (b) that they are being controlled.” Dr. Gary H. Gibbons, Director of the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health (NIH)
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“An estimated 43 million women in the U.S. are affected by heart disease. Ninety percent of women have one or more risk factors for developing heart disease. Since 1984, more women than men have died each year from heart disease. The symptoms of heart disease can be different in women and men, and are often misunderstood. While 1 in 31 American women dies from breast cancer each year, 1 in 3 dies of heart disease. Cardiovascular disease is the leading cause of death for African American women. Of African American women ages 20 and older, 46.9 percent have cardiovascular disease. Hispanic women are likely to develop heart disease 10 years earlier than Caucasian women.” NHLBI/NIH
February was American Heart Health month and there was tremendous focus on Women and Heart disease. On February 5th, many of us joined Go Red for Women, the American Heart Association (AHA), National Institutes for Health (NIH), National Heart, Lung, and Blood Institute (NHLBI), the Office on Women’s Health (OWH), U.S. Department of Health and Human Services (HHS), and many other groups to promote and celebrate National Wear Red Day 2016 in our communities. As we know by now, 1 in 3 women die of heart disease and that is a frightening statistic. Some of us dismiss the signs we get because we are busy tending to the needs of others. By the time some women stop to respond, they are in full cardiac distress and 1 in 3 never recover. Fighting this insidious disease takes a lot of effort through funded research, early intervention and education. When the organizers of #HeartChat!, which took place on Twitter in February, invited me to continue the conversations we shared at that event with the distinguished cardiologist/medical researcher, Dr. Gary H. Gibbons, Director of the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health (NIH), I was stoked.
Dr. Gibbons graduated from Princeton University and Harvard Medical School with high honors. Before joining NHLBI, he completed his residency at Brigham and Women’s Hospital in Boston, taught at Stanford and Harvard University, and served as the founding director of the Cardiovascular Research Institute, chairperson of the Department of Physiology, and professor of physiology and medicine at the Morehouse School of Medicine, in Atlanta, Georgia. Dr Gibbons work at the Cardiovascular Research Institute led the way “to discoveries related to the cardiovascular health of minority populations and he received several patents for innovations derived from his research in the fields of vascular biology and the pathogenesis of vascular diseases.”
Over a lifetime of doing research work dedicated to finding answers to our heart health matters, he has been the recipient of numerous awards. It was with great pleasure that I sat with Dr. Gibbons at the Hilton Hotel Midtown for the interview below. Please take the requisite time to read it and share it with the women and men in your lives. The information could save YOUR life. If each one tells one, we can save many lives.
QUESTION: As a survivor of heart failure, I’ve made it part of my life’s work to be an advocate, to speak up, and to encourage women to take care of their health and make sure that they ask lots of questions and get 2-3rd opinions. This opportunity to speak with you is really a blessing. What led you down this path? Were there any personal life experiences, family experiences that helped you develop this passion for cardiology and for women’s health as well?
ANSWER: Dr Gibbons – Well, I guess there are many layers to that question. It’s a great question. Certainly, from early on, I was drawn to both science and medicine as a way of helping people. And when I went to medical school, I asked my professor, in my first year, this question about high blood pressure; I’d been reading and saw the statistics about African Americans having more high blood pressure than other populations. Long story short, this Harvard professor, renowned for understanding blood pressure and he couldn’t give me an answer and so, as a professor, he turned the question back on me and challenged me to ask and answer that question myself as to why this is more prevalent (among African Americans) and that’s a part of why I do medical research. I want to understand disorders that disproportionately affect people like me, my neighbors, and the family I grew up with.
Indeed, My mother died of a stroke and how it was, common among mothers; they take care of us more than they take care of themselves. So this reinforces our passion as to why it is important to raise awareness, to have the courage as women to take care of themselves first as the best way to helping their family and that once we have that awareness that it’s the number one killer of men and of women as well, to make a call to action because these are preventable in many ways. We understand the risk factors of blood pressure, obesity, high cholesterol, and those are things that women can do something about;( a) by having those conversations with their doctors to be sure they know their numbers, their blood pressure, their cholesterol and (b) that they are being controlled.
We recently did a study called the Sprint Trial – Systolic Blood Pressure Intervention Trial (SPRINT); that looked at how/asked the question: How long should we treat (high blood pressure) and what are the goals of treating high blood pressure? How low should it go? Again, this is a landmark study just published in the last few months that we think will change the practice of medicine in which it appears that the lower, the better. Again, these are conversations that women should be having with their doctors: “Is my blood pressure at the right level? Is it as low as it should be?” Because, again, the lower the blood pressure, and the lower cholesterol; as increasing evidence suggests, that helps prevent heart attacks, strokes and helps you live longer. So that’s why we keep pushing for awareness.
QUESTION: Are there genetic markers that make this prevalent in our group vis a vis people of color. I’m just curious about that. Why is it so much higher for us than it is for Caucasians?
ANSWER: It’s a great question. Some of it relates to the factors that predispose us, for example, to high blood pressure. So we know that the bigger the body weight, or overweight and obese people are more likely to develop high blood pressure. And so it’s not always 100% correlation but it increases your risk and, of course, as you’re aware of more than 75% of African American women are either overweight or obese and so when you see more obesity and then more high blood pressure, some of it relates to those ricks factors. Certainly, we know that your diet is a determinant of your blood pressure and so a high salt diet is more likely to predispose, and then again, often either via culture or by social economic status, tend to eat higher salt, higher fat diet and both those things will tend to predispose…
One of the areas that we are studying is to see if there are genetic factors, things related to our African ancestry that also contribute because we know that, particularly African Americans had their origins in predominantly Western African; Sub-Saharan Africa. At least, one of the hypothesis is that in a salt poor and hot environment, there may have been a predisposition to retain more salt as a way of (having) a survival advantage. Unfortunately, now in this situation where we have all these processed foods with high salt in them, that same ability to hold unto salt is not as good an advantage. So that’s being studied actively and we’re funding research in that regard.
“As a result, of studying populations over time, we’ve understood what the risk factors are for heart disease or what predisposes people to have a heart attack … There are things that women can empower themselves to do just by more knowledge and information. “ Dr. Gary H Gibbons
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QUESTION: How has research led to the improvement and management of heart disease; perhaps, research that you have participated in or you are aware of?
ANSWER: We give a lot of credit to our population studies like the Framingham Heart Study that you might be aware of which started in 1948 when heart disease was first emerging as the #1 killer of Americans. As a result, of studying populations over time, we’ve understood what the risk factors are for heart disease or what predisposes people to have a heart attack. Once we understood that high cholesterol, high blood pressure, cigarette smoking, all of those contribute to high blood pressure, that provided the evidence base to say; “Okay, if we can control blood pressure, if we can control cholesterol, can we reduce the amount of heart attacks?” That’s where the National Institutes of Health (NIH) and NHLBI Funded studies to actually test that. We do know now from those studies that if you lower cholesterol, you can prevent heart attacks; if you lower high blood pressure, you can prevent that.
We know from a study we did called the Dietary Approaches to Stop Hypertension – The Dash Diet, that a diet that is rich in fruits and vegetables, unprocessed whole grains, low fat dairy, low salt, low sugar, and fat actually, is able to reduce blood pressure. That diet can reduce blood pressure as much as the pills you can get.
QUESTION: People can go off the pills?
ANSWER: Some people can come off the pills, if they have mild high blood pressure and if they can respond to lifestyle modification alone, such as taking that diet. So, by restoring that dietary balance, it can control blood pressure. So those are studies that have been done to show that if you can control those things, you can have a healthier heart.
QUESTION: How much of this information is available to a general practitioner out there or average cardiologist out there? Some folks on high blood pressure medications visit their GP and the doctors don’t talk to them about the dash diet. They might suggest a new drug… I’m curious.
ANSWER: It’s part of the reason we do this. We want to increase awareness and empower women to have those conversations and that’s why, hopefully, in your blog and other messages coming through our website, they can have those conversations to ask their doctors that certainly medications are important to take and adhere to, but to have a conversation about – “What can I do doctor, that could help control my blood pressure?” We have a lot of information in what’s called Clinical Guidelines where we try to inform care providers about some of this information and in which we review the evidence I just recounted to you. So that is providing guidance that, indeed, by potentially losing weight or adopting a dash diet, your blood pressure can go down. It may not mean that you come off medicine but, it could reduce the number of medications you need or optimize your ability to control your blood pressure more effectively in concert with the medications. There are things that women can empower themselves to do just by more knowledge and information.
“So that’s very important; an important thing for your listeners/audience to be aware of is that a part of empowerment is participation in the understanding of diseases and what can benefit our community.” Dr. Gary Gibbons
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QUESTION: They say knowledge is power. Another question is about the clinical studies/trials giving women access, I’m thinking of women of color/minority women, about giving them access to these clinical trials and studies. What are some of the progresses and challenges to it becoming more available to us?
ANSWER: It’s a great question. So, one platform is clinical trials that they can go to/find on our website that describes many kinds of trials that are out there both those funded by the NIH as well as those that are pharmaceutical sponsored trials. Similarly, you raise a very good point that in order for us to understand how best to treat you, to appreciate the differences based on your own family history, population history, where your coming from and your own culture, it’s important to study YOU. And so that will enable us to treat you better. It goes hand in hand that if we want to take the best care of you, it’s important that we also study how you respond to these drugs and how you respond to different interventions; and what works best for you. So, the participation in the clinical research is critically important for all individuals; particularly for women, and particularly for African American women and also lower income women.
The NIH, particularly NHLBI, has a pretty good track record of inclusion of women; in an analysis of our clinical trials we do hit about 50/50 in that regard and we often are very good at including both African American and Hispanic populations. In fact, the study I described to you, the Sprint Trial, our most recent high blood pressure trial, included a very larger proportion of African Americans and women in that study because we know this is a problem that affects those communities and we want to be sure that we over-sample, there’s more prevalence in that sample than in the population because we want to be sure that the results were applicable to those other groups. So that’s very important; an important thing for your listeners/audience to be aware of is that a part of empowerment is participation in the understanding of diseases and what can benefit our community.
QUESTION: I (still) participate in a study done out of Boston University; The Black Women’s Health Study. I’m one of the original participants (it’s been going on for many years and they really follow everyone to make sure the surveys are completed and returned), and I got involved when I was teaching at Hunter College. They are very focused on following up. There’s one at Harvard too; The Women’s Health Study. I remember talking to a few female friends who said, “I would have loved to participate in those studies. How did you get into it?” and I tell them that I was in an academic setting and I guess it became easy for me to join … I had access. But, how (can) other women who are not in that kind of environment get access to research studies and the clinical trials? Because I want to promote that part of it … Do I tell women to go to the NHLBI website and search to see what’s available? If I recall, some of them offer pay to do it?
ANSWER: Often, it’s more that it’s recognized that there is an inconvenience in terms of logistics, travel, so there is a compensation that considers the inconvenience, if you will, of participating. I wouldn’t necessarily characterize it as being paid for the study but, certainly, making it such that you are compensated for your participation. Again, I think its terrific that you do that (The Black Women’s Health Study) and what I appreciate with your story is that, potentially, some of the treatments that you may be on, are reflected with other people who came before who just because they were are social beneficiaries wanting to be a blessing, and pay it forward and were able to participate in the studies so we had therapies. When your doctor writes a prescription, someone undoubtedly participated in a clinical trial that showed that prescription would work for someone like you. In that sense, if we’re all contributing through this route, we are helping each other.
QUESTION: How would you recommend we disseminate this information in language that women can understand? A lot of it is medical lingo and sometimes people’s eyes glaze over and they are not even sure, some people don’t even know where their heart is. How do we we disseminate this in language that people across the board will understand? Are there any sources you’ve come across that you thought will help people successfully?
ANSWER: Well I guess, someone who blogs probably has a good way of translating my medicalese. 🙂 I agree with you it can be a challenge. I think, one of the things that sounds like you have experience with, is how important really the heart is and how you feel. Because its ability to squeeze and pump blood throughout your body is so vital. I think most people experience what it means to say, walk or run briskly after a bus and feeling short of breath and fatigued. They may experience that for a fleeting moment but, when you have heart failure, you feel that way all the time. I think most people have a sense of how stress affects their heart because when they are excited, it also will beat fast. The heart is so responsive to how we feel and what our body needs to do that it’s important to keep it healthy. So I guess, just giving them that awareness of that beat which, in essence, is probably one of the organs of the body you can be most aware of, and recognize how critical it is to how you feel and how important it is to take care of it…
QUESTION: I like that you said that how you feel is important because that is where it all starts. Are there any other heart health or women’s health trends or new research that’s coming up or things that you’ve come across that I need to include?
ANSWER: I guess, maybe one other thing to be aware of is the growing appreciation of the difference between men and women; some of it is recognizing that women are affected by heart disease. It can manifest itself a bit differently in men and women. One of the areas that NHLBI has funded research on is to determine: Are heart attacks caused by blockages in the blood vessels that feed the heart? Cholesterol accumulates by clogging the pipes, if you will, so blood doesn’t flow to the heart. The heart needs that blood flow to work as a pump. In men, those blockages happen in the large arteries but, it appears like in women, it’s the smaller blood vessels. It’s almost like a tree with a trunk is the big vessel but, the limbs and the small branches those are the vessels that are most affected in women. So, it looks like even the pattern of heart disease among women might be somewhat different than in men in many cases. Understanding those differences between the sexes and how it manifests is also one of the areas that we are actively pursuing.
QUESTION: Do they show up on MRIs?
ANSWER: That’s a great question. As you astutely noted, a lot of the tests are very good at picking up disease in the large vessels but, they are not as good in picking it up in these smaller, tiny vessels. So indeed, it could look like you came in, you had classical chest pain, consistent with having a heart issue and then, the typical test was done and it looked pretty good. So, the heart doctor might say “It looks like this is not a problem.” We are still learning to appreciate how can we detect more effectively those kind of problems that appear to be more problematic and prevalent in women?
QUESTION: Is there something more?
ANSWER: We are working on better diagnostic tests for women because there are ways to understand those small vessels; how blood flows through them to the heart. That’s where research is going. Thank you so much, Dr. Gibbons!
END OF INTERVIEW
What more can we do about it? We must make sure to reduce stress in our lives and get check ups regularly. We can donate or volunteer our time, participate in local events that raise awareness about heart disease and share the invaluable toolkit/resources that NHLBI provides. We can participate in the #HeartChat initiative and spread the word. We can be proactive by reaching out to our elected officials to demand support for equitable resources for us all. The Go Red for Women Campaign, wants us all to remember the following lifesaving tips:
What are you waiting for? Get your heart health in order and share your thoughts with the world.
For More: Women’s Lives & Issues
Positive Motivation Tip: Your heart is a precious life force. Take care of your heart and make sure your family does too.