- Academic Chief, Division of Cardiology
- Professor, Internal Medicine - (Clinical Scholar Track)
Martha Gulati, MD, MS, FACC, FAHA is a Professor of Medicine and the chief of cardiology at the University of Arizona (Phoenix). She held the Sarah Ross Soter Chair in Women’s Cardiovascular Health and was the Section Director for Women’s Cardiovascular Health and Preventive Cardiology at The Ohio State University until 2015. She is the author of the best-seller, “Saving Women’s Hearts”. She is the Editor-in-Chief of the American College of Cardiology “CardioSmart”, the patient education and empowerment initiative.
Her exceptional commitment to the study of women and cardiac diseases has won her numerous awards and distinctions, including being named by Crain’s Chicago Business as one of Chicago’s “Top 40 under 40,” a list that honors 40 outstanding individuals who have made a major impact in their respective industries before the age of 40. In 2011, she received the first CREDO (Coalition to Reduce Racial and Ethnic Disparities in Cardiovascular Outcomes) Award from the American College of Cardiology that was given to honor her contributions to improve cardiovascular healthcare of women patients. In 2012, she was awarded the National Red Dress Award for her efforts in raising awareness of heart disease in women and advancing research in this field.
Dr. Gulati is passionate about the study of women and heart disease and prevention of heart disease. She is the principal investigator of the St. James Women Take Heart Project, a study examining cardiac risk factors in women, which set new standards for women’s fitness levels and heart rate response to exercise in women. She also is a co-investigator on the Women Ischemic Syndrome Evaluation (WISE) and previously served as a co-investigator on the Women’s Health Initiative (WHI).
She is a member of numerous advisory boards and societies, including the American Heart Association (AHA), the American College of Cardiology and the American Society of Preventive Cardiology (ASPC). She serves on the board of the ASPC, thePhoenix chapter of the American Heart Association and the board of WomenHeart. She has published articles in peer-reviewed publications, including The New England Journal of Medicine, Circulation, and Journal of the American Medical Association (JAMA). Her research has been featured in hundreds of newspapers across the world, including The New York Times and USA Today. She has also been featured on Oprah and been feature on CBS National News, The Today Show, Canada AM, in addition to many others. She recently was listed on the Marquis 2015 Who’s Who in America, Who’s Who in the World, and Who’s Who in American Women.
Dr. Gulati completed medical school at the University of Toronto, Canada. She went on to complete her internship, residency, and cardiology fellowship at the University of Chicago. She received a Master in Science at the University of Chicago and is a fellow of the American College of Cardiology and the American Heart Association. She is board certified in cardiovascular disease.
- M.S. Health Studies
- University of Chicago, Chicago, Illinois, United States
- M.D. Medicine
- University of Toronto, Toronto, Canada
- B.S. General Science
- McMaster University, Canada
- FierceHealthcare's 2019 Women of Influence Awards
- Winter 2019
- American Society of Preventive Cardiology Nanette Wenger Award
- American Society of Preventive Cardiology, Summer 2019
- Arizona Business Magazine’s Most Influential Woman in Arizona Award
- Arizona Business Magazine, Summer 2019
- American College of Cardiology Bernadine Healy Leadership Award in Women's Cardiovascular Disease
- American College of Cardiology, Spring 2019
- AAMC Awards for Excellence Competition 2018 Gold Award
- AAMC, Summer 2018
- 2017 Academic University Cardiologists- Elected Member
- Academic University Cardiologists, Spring 2017
- 2017 Outstanding Women in Business – Phoenix Business Journal
- Phoenix Business Journal, Spring 2017
Licensure & Certification
- Fellow, American College of Cardiology (F.A.C.C.), American College of Cardiology (2005)
- Diplomate, American Board of Internal Medicine (Cardiology), American Board of Internal Medicine (2004)
- Diplomate, American Board of Internal Medicine (Cardiology), American Board of Internal Medicine (2014)
- Licensed Physician: Arizona (2016)
- Diplomate, American Board of Internal Medicine (Internal Medicine), American Board of Internal Medicine (1999)
- License of the Medical Council of Canada, Medical Council of Canada (1997)
- Licensed Physician: Ohio (2010)
Medical Education: Cardiovascular Disease Prevention, Women's Cardiovascular Health, Gender & Sex Differences in Health Outcomes
Sex Differences in CVD, Women's CV Health, CVD Prevention, MINOCA/INOCA, Gender Equity in Academic medicine
No activities entered.
- Gulati, M. (2019). Cardiovascular Disease in Women: Ischemic Heart Disease. In The ESC Textbook of Cardiovascular Medicine (3rd Edition).. Oxford, UK: Oxford University Press.More infoGulati M. Cardiovascular Disease in Women: Ischemic Heart Disease. The ESC Textbook of Cardiovascular Medicine (3rd Edition). Lusher TF, Camm AJ, Maurer G, Serruys PW. Eds. Oxford University Press, Oxford UK. 2019. ISBN: 9780198784906
- Gulati, M., & Bairey Merz, N. (2018). Cardiovascular disease in women. In Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine (11th Edition).. Elsevier.More infoGulati M, Bairey-Merz CN. Cardiovascular disease in women. In: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine (11th Edition). Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF. February 20, 2018. Elsevier. ISBN 9780323463423
- Mehta, A., Mahtta, D., Gulati, M., Sperling, L. S., Blumenthal, R. S., & Virani, S. S. (2020). Cardiovascular Disease Prevention in Focus: Highlights from the 2019 American Heart Association Scientific Sessions. Current atherosclerosis reports, 22(1), 3.More infoThis review highlights selected cardiovascular disease (CVD) prevention studies presented at the 2019 American Heart Association (AHA) Scientific Sessions.
- Mohamed, M. O., Lopez-Mattei, J. C., Parwani, P., Iliescu, C. A., Bharadwaj, A., Kim, P. Y., Palaskas, N. L., Rashid, M., Potts, J., Kwok, C. S., Gulati, M., Al Zubaidi, A. M., & Mamas, M. A. (2020). Management Strategies and Clinical Outcomes of Acute Myocardial Infarction in Leukemia Patients: Insights from Nationwide United States Hospitalizations. International journal of clinical practice, e13476.More infoPatients with leukemia are at increased risk of cardiovascular events. There are limited outcomes data for patients with a history of leukemia who present with an acute myocardial infarction (AMI).
- Bagai, A., Chen, A. Y., Udell, J. A., Dodson, J. A., McManus, D. D., Maurer, M. S., Enriquez, J. R., Hochman, J., Goyal, A., Henry, T. D., Gulati, M., Garratt, K. N., Roe, M. T., & Alexander, K. P. (2019). Association of Cognitive Impairment With Treatment and Outcomes in Older Myocardial Infarction Patients: A Report From the NCDR Chest Pain-MI Registry. Journal of the American Heart Association, 8(17), e012929.More infoBackground Little is known regarding use of cardiac therapies and clinical outcomes among older myocardial infarction (MI) patients with cognitive impairment. Methods and Results Patients ≥65 years old with MI in the NCDR (National Cardiovascular Data Registry) Chest Pain-MI Registry between January 2015 and December 2016 were categorized by presence and degree of chart-documented cognitive impairment. We evaluated whether cognitive impairment was associated with all-cause in-hospital mortality after adjusting for known prognosticators. Among 43 812 ST-segment-elevation myocardial infarction (STEMI) patients, 3.9% had mild and 2.0% had moderate/severe cognitive impairment; among 90 904 non-ST-segment-elevation myocardial infarction (NSTEMI patients, 5.7% had mild and 2.6% had moderate/severe cognitive impairment. A statistically significant but numerically small difference in the use of primary percutaneous coronary intervention was observed between patients with STEMI with and without cognitive impairment (none, 92.1% versus mild, 92.8% versus moderate/severe, 90.4%; P=0.03); use of fibrinolysis was lower among patients with cognitive impairment (none, 40.9% versus mild, 27.4% versus moderate/severe, 24.2%; P
- Bigeh, A., Sanchez, A., Maestas, C., & Gulati, M. (2019). Inflammatory bowel disease and the risk for cardiovascular disease: Does all inflammation lead to heart disease?. Trends in cardiovascular medicine.More infoInflammation has a strong role in the development of atherosclerotic cardiovascular disease (ASCVD). Several systemic inflammatory conditions have been linked to an increased risk of ASCVD; however, this has not been well established in Inflammatory Bowel Disease (IBD). IBD is comprised of Ulcerative Colitis and Crohn's disease, both of which involve chronic inflammation of the intestinal tract, often with evidence of systemic involvement. Several ASCVD risk factors such as smoking, diabetes, poor diet and the presence of obesity may increase the risk of ASCVD in patients suffering from IBD, despite a lower prevalence of hypertension and hypercholesterolemia. Medications used to treat IBD and target inflammation, such as steroids, may also accelerate the risk of the risk for ASCVD heart failure while exacerbating ASCVD risk factors. Several studies have demonstrated an elevated risk of acute myocardial infarction and stroke in these patients, most notably in women and in younger patients. Some cohort studies have also suggested a link between IBD and both atrial fibrillation and heart failure, particularly during periods of active flares. All IBD patients, particularly younger individuals, should be screened for ASCVD risk factors with aggressive risk factor modification to reduce the risk of cardiovascular events. Further research is needed to identify how to prevent and treat cardiovascular events that occur in patients with IBD, particularly during active flares.
- Bullock-Palmer, R. P., Shaw, L. J., & Gulati, M. (2019). Emerging misunderstood presentations of cardiovascular disease in young women. Clinical cardiology, 42(4), 476-483.More infoCardiovascular disease (CVD) remains the leading cause of death for females in the United States accounting for over 412 000 female deaths in 2016. CVD mortality in young women
- Chirumamilla, S., & Gulati, M. (2019). Patient Education and Engagement through Social Media. Current cardiology reviews.More infoThis review addresses the demographics of social media users and their relative health literacy. Means of overcoming health inequities via social media and the role of social media in patient education and engagement are explored. This review discusses forms of appropriate engagement, including pitfalls of social media use.
- Choi, A. D., Parwani, P., Michos, E. D., Lee, J., Singh, V., Fentanes, E., Lopez-Mattei, J., Gulati, M., Nasir, K., Nieman, K., Shaw, L. J., & Blankstein, R. (2019). The global social media response to the 14th annual Society of Cardiovascular Computed Tomography scientific sessions. Journal of cardiovascular computed tomography.More infoThe 2019 Society of Cardiovascular Computed Tomography (SCCT) Annual Scientific Meeting (ASM) was perhaps the most impactful meeting in recent memory for the field of cardiovascular CT. Beyond just being the highest attended ASM meeting in the society's history, the virtual impact of the meeting extended farther than ever before due to coordinated social media coverage and participation. As a result, the ASM reinforced the fact that the educational paradigm and audience of scientific meetings has changed. Bound through the hashtag #SCCT2019, social media allowed the research, education, networking and trends from this year's ASM to extend beyond the walls of the meeting with a record setting level of digital global reach. Using posts from Twitter as a prism of interests and response of the global cardiovascular CT community, this article presents the topics with the highest social media engagement from the 14th ASM.
- Gulati, M. (2019). Yentl's Bikini: Sex Differences in STEMI. Journal of the American Heart Association, 8(10), e012873.More infoSee Article Stehli et al.
- Kwok, C. S., Gulati, M., Michos, E. D., Potts, J., Wu, P., Watson, L., Loke, Y. K., Mallen, C., & Mamas, M. A. (2019). Dietary components and risk of cardiovascular disease and all-cause mortality: a review of evidence from meta-analyses. European journal of preventive cardiology, 26(13), 1415-1429.More infoThe optimal diet for cardiovascular health is controversial. The aim of this review is to summarize the highest level of evidence and rank the risk associated with each individual component of diet within its food group.
- Mahajan, A. M., Gandhi, H., Smilowitz, N. R., Roe, M. T., Hellkamp, A. S., Chiswell, K., Gulati, M., & Reynolds, H. R. (2019). Seasonal and circadian patterns of myocardial infarction by coronary artery disease status and sex in the ACTION Registry-GWTG. International journal of cardiology, 274, 16-20.More infoMyocardial infarction (MI) presentations are more common during winter months and morning hours. However, it is unknown whether MI with obstructive coronary artery disease (MI-CAD) and non-obstructive CAD (MINOCA) display similar patterns.
- Mohamed, M. O., Rashid, M., Farooq, S., Siddiqui, N., Parwani, P., Shiers, D., Thamman, R., Gulati, M., Shoaib, A., Chew-Graham, C., & Mamas, M. A. (2019). Acute Myocardial Infarction in Severe Mental Illness: Prevalence, Clinical Outcomes, and Process of Care in U.S. Hospitalizations. The Canadian journal of cardiology, 35(7), 821-830.More infoSevere mental illness (SMI) is associated with increased cardiovascular mortality. We sought to examine the prevalence, clinical outcomes, and management strategy of patients with SMI presenting with acute myocardial infarction (AMI).
- Okunrintemi, V., Benson, E. A., Tibuakuu, M., Zhao, D., Ogunmoroti, O., Valero-Elizondo, J., Gulati, M., Nasir, K., & Michos, E. D. (2019). Trends and Costs Associated With Suboptimal Physical Activity Among US Women With Cardiovascular Disease. JAMA network open, 2(4), e191977.More infoCardiovascular disease (CVD) is the leading cause of death and disability among women. Achievement of recommended physical activity (PA) levels is an essential component of CVD management.
- Parwani, P., Choi, A. D., Lopez-Mattei, J., Raza, S., Chen, T., Narang, A., Michos, E. D., Erwin, J. P., Mamas, M. A., & Gulati, M. (2019). Understanding Social Media: Opportunities for Cardiovascular Medicine. Journal of the American College of Cardiology, 73(9), 1089-1093.More infoCardiology professionals have used social media platforms such as Twitter to gain exposure to new research, network with experts, share opinions, and engage in scientific debates. The power of social media to communicate openly, with wide-reaching access worldwide, and at a rate faster than ever before makes it a formidable force and voice. However, evolving individual and institutional use has resulted in uncertainty for all parties on how to optimally advance this newer digital frontier. Thus, the purpose of this paper is to: 1) introduce the basics of social media usage (with the focus on Twitter); 2) provide perspective on best social media practices in academic and clinical cardiovascular medicine; and 3) present a vision for social media and the future of cardiovascular medicine.
- Rashid, M., Fischman, D. L., Gulati, M., Tamman, K., Potts, J., Kwok, C. S., Ensor, J., Shoaib, A., Mansour, H., Zaman, A., Savage, M. P., & Mamas, M. A. (2019). Temporal trends and inequalities in coronary angiography utilization in the management of non-ST-Elevation acute coronary syndromes in the U.S. Scientific reports, 9(1), 240.More infoCoronary angiography (CA) is the basis of an invasive management strategy in non-ST elevation acute coronary syndromes (NSTEACS). There are limited contemporary data on national temporal trends in utilization of CA in different patient subgroups. We sought to investigate temporal trends, predictors and clinical outcomes associated with the use of CA in the US. Using the Nationwide Inpatient Sample (NIS) from 2004-2014, we identified all inpatient admissions, age ≥18, with a primary diagnosis of NSTEACS. Descriptive statistics and multivariable logistic regression models were used to investigate temporal trends, predictors and clinical outcomes associated with CA. From a total of 4,380,827 patients, 57.5% received CA during the study period and were more likely to be male, younger and less comorbid as defined per Charlson comorbidity index. The proportion of patients receiving CA increased from 48.5% to 68.5%, however, higher proportional increase was observed in males (53.9% to 69.4% P
- Wu, P., Mamas, M. A., & Gulati, M. (2019). Pregnancy As a Predictor of Maternal Cardiovascular Disease: The Era of CardioObstetrics. Journal of women's health (2002), 28(8), 1037-1050.More infoGlobally, cardiovascular disease (CVD) is the most common cause of mortality in women accounting for one in three deaths. There remains an under recognition of CVD as well as a lack of awareness of risk in women. Promotion of CVD prevention is essential, but the current risk assessment tools do not incorporate any sex-specific cardiovascular risk factors. There is increasing recognition of sex-specific risk factors that appear during pregnancy that are associated with CVD. These adverse pregnancy outcomes (APOs) include preeclampsia, gestational hypertension, preterm birth, gestational diabetes, delivery of a small-for-gestational-age infant, miscarriage, and high parity number. Although the underlying biological mechanism for these association remains to be elucidated, current international guidelines are beginning to recommend the inclusion of APOs in the assessment of CVD risk in women. This review summarizes the evidence for the association between APOs and future CVD. It also highlights the importance of considering APOs in the cardiovascular risk assessment, specifically in young women, allowing for targeted lifestyle-modifying interventions with the potential to alter their risk trajectory and improve their long-term cardiovascular health.
- Bates, C. K., Jagsi, R., Gordon, L. K., Travis, E., Chatterjee, A., Gillis, M., Means, O., Chaudron, L., Ganetzky, R., Gulati, M., Fivush, B., Sharma, P., Grover, A., Lautenberger, D., & Flotte, T. R. (2018). It Is Time for Zero Tolerance for Sexual Harassment in Academic Medicine. Academic medicine : journal of the Association of American Medical Colleges, 93(2), 163-165.More infoWhile more women are in leadership positions in academic medicine now than ever before in U.S. history, evidence from recent surveys of women and graduating medical students demonstrates that sexual harassment continues in academic health centers. Academic medicine's ability to change its culture is hampered by victims' fear of reporting episodes of harassment, which is largely due to fear of retaliation. In this Perspective, the authors describe efforts in scientific societies to address the issue of sexual harassment and to begin to establish safe environments at national meetings. The authors contend that each institution must work to make it safe for individuals to come forward, to provide training for victims and for bystanders, and to abolish "locker room" talk that is demeaning to women.
- Brindis, C. D., Freund, K. M., Baecher-Lind, L., Bairey Merz, C. N., Carnes, M., Gulati, M., Joffe, H., Klein, W. S., Mazure, C. M., Pace, L. E., Regensteiner, J. G., Redberg, R. F., Wenger, N. K., & Younger, L. (2018). The Risk of Remaining Silent: Addressing the Current Threats to Women's Health. Women's health issues : official publication of the Jacobs Institute of Women's Health, 27(6), 621-624.
- Brown, H. L., Warner, J. J., Gianos, E., Gulati, M., Hill, A. J., Hollier, L. M., Rosen, S. E., Rosser, M. L., Wenger, N. K., & , A. H. (2018). Promoting Risk Identification and Reduction of Cardiovascular Disease in Women Through Collaboration With Obstetricians and Gynecologists: A Presidential Advisory From the American Heart Association and the American College of Obstetricians and Gynecologists. Circulation, 137(24), e843-e852.
- Dodson, J. A., Hochman, J. S., Roe, M. T., Chen, A. Y., Chaudhry, S. I., Katz, S., Zhong, H., Radford, M. J., Udell, J. A., Bagai, A., Fonarow, G. C., Gulati, M., Enriquez, J. R., Garratt, K. N., & Alexander, K. P. (2018). The Association of Frailty With In-Hospital Bleeding Among Older Adults With Acute Myocardial Infarction: Insights From the ACTION Registry. JACC. Cardiovascular interventions, 11(22), 2287-2296.More infoThe aim of this study was to determine whether frailty is associated with increased bleeding risk in the setting of acute myocardial infarction (AMI).
- Gulati, M., & Mulvagh, S. L. (2018). The connection between the breast and heart in a woman: Breast cancer and cardiovascular disease. Clinical cardiology.More infoCardiovascular disease remains the leading cause of death in women in the United States and is a major public health issue for all women, but it is of increasing concern to breast cancer survivors. Advancements in early detection and breast cancer therapy have resulted in over 90% of women surviving 5 years past their diagnosis of breast cancer. Nonetheless, with increased survivorship from breast cancer, there has been an increase in cardiovascular disease in these women. The consequences of the treatments for breast cancer may increase the risk for cardiovascular disease. Additionally, there is an overlap of risk factors common to both breast cancer and cardiovascular disease. The increased risk of cardiovascular disease in women who survive breast cancer must be recognized, with a focus on the prevention and early detection of cardiovascular disease.
- Gulati, M., & Wenger, N. K. (2018). You've come a long way, baby. Clinical cardiology.
- Kwok, C. S., Potts, J., Gulati, M., Alasnag, M., Rashid, M., Shoaib, A., Ul Haq, M. A., Bagur, R., & Mamas, M. A. (2018). Effect of Gender on Unplanned Readmissions After Percutaneous Coronary Intervention (from the Nationwide Readmissions Database). The American journal of cardiology.More infoWomen who undergo percutaneous coronary intervention (PCI) are at higher risk of adverse outcomes compared with men, but it is unknown whether gender affects early unplanned rehospitalization. We analyzed 832,753 patients who underwent PCI from 2013 to 2014 in the Nationwide Readmissions Database. We compared gender differences in incidences, predictors, causes, and cost of unplanned 30-day readmissions and examined the effect of co-morbidity. A total of 832,753 men and women who survived the index PCI and were not admitted for a planned readmission were included in the analysis. Overall, 9.4% of patients had an unplanned readmission within 30 days. Thirty-day readmission rates were higher in women compared with men (11.5% vs 8.4%, p
- Okunrintemi, V., Valero-Elizondo, J., Patrick, B., Salami, J., Tibuakuu, M., Ahmad, S., Ogunmoroti, O., Mahajan, S., Khan, S. U., Gulati, M., Nasir, K., & Michos, E. D. (2018). Gender Differences in Patient-Reported Outcomes Among Adults With Atherosclerotic Cardiovascular Disease. Journal of the American Heart Association, 7(24), e010498.More infoBackground Atherosclerotic cardiovascular disease ( ASCVD ) accounts for approximately one third of deaths in women. Although there is an established relationship between positive patient experiences, health-related quality of life, and improved health outcomes, little is known about gender differences in patient-reported outcomes among ASCVD patients. We therefore compared gender differences in patient-centered outcomes among individuals with ASCVD . Methods and Results Data from the 2006 to 2015 Medical Expenditure Panel Survey, a nationally representative US sample, were used for this study. Adults ≥18 years with a diagnosis of ASCVD , ascertained by International Classification of Diseases, Ninth Revision ( ICD-9) codes and/or self-reported data, were included. Linear and logistic regression were used to compare self-reported patient experience, perception of health, and health-related quality of life by gender. Models adjusted for demographics, socioeconomic status, and comorbidities. There were 21 353 participants included, with >10 000 (47%-weighted) of the participants being women, representing ≈11 million female adults with ASCVD nationwide. Compared with men, women with ASCVD were more likely to experience poor patient-provider communication (odds ratio 1.25 [95% confidence interval 1.11-1.41]), lower healthcare satisfaction (1.12 [1.02-1.24]), poor perception of health status (1.15 [1.04-1.28]), and lower health-related quality of life scores. Women with ASCVD also had lower use of aspirin and statins, and greater odds of ≥2 Emergency Department visits/y. Conclusions Women with ASCVD were more likely to report poorer patient experience, lower health-related quality of life, and poorer perception of their health when compared with men. These findings have important public health implications and require more research towards understanding the gender-specific differences in healthcare quality, delivery, and ultimately health outcomes among individuals with ASCVD .
- Palaniappan, L., Garg, A., Enas, E., Lewis, H., Bari, S., Gulati, M., Flores, C., Mathur, A., Molina, C., Narula, J., Rahman, S., Leng, J., & Gany, F. (2018). South Asian Cardiovascular Disease & Cancer Risk: Genetics & Pathophysiology. Journal of community health, 43(6), 1100-1114.More infoSouth Asians (SAs) are at heightened risk for cardiovascular disease as compared to other ethnic groups, facing premature and more severe coronary artery disease, and decreased insulin sensitivity. This disease burden can only be partially explained by conventional risk factors, suggesting the need for a specific cardiovascular risk profile for SAs. Current research, as explored through a comprehensive literature review, suggests the existence of population specific genetic risk factors such as lipoprotein(a), as well as population specific gene modulating factors. This review catalogues the available research on cardiovascular disease and genetics, anthropometry, and pathophysiology, and cancer genetics among SAs, with a geographical focus on the U.S. A tailored risk profile will hinge upon population customized classification and treatment guidelines, informed by continued research.
- Pershad, A., Gulati, M., Karmpaliotis, D., Moses, J., Nicholson, W. J., Nugent, K., Tang, Y., Sapontis, J., Lombardi, W., Grantham, J. A., & , O. C. (2018). A sex stratified outcome analysis from the OPEN-CTO registry. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.More infoWomen have been under-represented in trials. Due to the dearth of information about CTO-PCI in women and discordance of previous results, sex differences in outcomes in the OPEN-CTO Trial were investigated.
- Potts, J., Sirker, A., Martinez, S. C., Gulati, M., Alasnag, M., Rashid, M., Kwok, C. S., Ensor, J., Burke, D. L., Riley, R. D., Holmvang, L., & Mamas, M. A. (2018). Persistent sex disparities in clinical outcomes with percutaneous coronary intervention: Insights from 6.6 million PCI procedures in the United States. PloS one, 13(9), e0203325.More infoPrior studies have reported inconsistencies in the baseline risk profile, comorbidity burden and their association with clinical outcomes in women compared to men. More importantly, there is limited data around the sex differences and how these have changed over time in contemporary percutaneous coronary intervention (PCI) practice.
- Schultz, W. M., Kelli, H. M., Lisko, J. C., Varghese, T., Shen, J., Sandesara, P., Quyyumi, A. A., Taylor, H. A., Gulati, M., Harold, J. G., Mieres, J. H., Ferdinand, K. C., Mensah, G. A., & Sperling, L. S. (2018). Socioeconomic Status and Cardiovascular Outcomes: Challenges and Interventions. Circulation, 137(20), 2166-2178.More infoSocioeconomic status (SES) has a measurable and significant effect on cardiovascular health. Biological, behavioral, and psychosocial risk factors prevalent in disadvantaged individuals accentuate the link between SES and cardiovascular disease (CVD). Four measures have been consistently associated with CVD in high-income countries: income level, educational attainment, employment status, and neighborhood socioeconomic factors. In addition, disparities based on sex have been shown in several studies. Interventions targeting patients with low SES have predominantly focused on modification of traditional CVD risk factors. Promising approaches are emerging that can be implemented on an individual, community, or population basis to reduce disparities in outcomes. Structured physical activity has demonstrated effectiveness in low-SES populations, and geomapping may be used to identify targets for large-scale programs. Task shifting, the redistribution of healthcare management from physician to nonphysician providers in an effort to improve access to health care, may have a role in select areas. Integration of SES into the traditional CVD risk prediction models may allow improved management of individuals with high risk, but cultural and regional differences in SES make generalized implementation challenging. Future research is required to better understand the underlying mechanisms of CVD risk that affect individuals of low SES and to determine effective interventions for patients with high risk. We review the current state of knowledge on the impact of SES on the incidence, treatment, and outcomes of CVD in high-income societies and suggest future research directions aimed at the elimination of these adverse factors, and the integration of measures of SES into the customization of cardiovascular treatment.
- Stuebe, A. M., Auguste, T. C., Gulati, M., & Zahn, C. M. (2018). In Reply. Obstetrics and gynecology, 132(3), 785.
- Wenger, N. K., Arnold, A., Bairey Merz, C. N., Cooper-DeHoff, R. M., Ferdinand, K. C., Fleg, J. L., Gulati, M., Isiadinso, I., Itchhaporia, D., Light-McGroary, K., Lindley, K. J., Mieres, J. H., Rosser, M. L., Saade, G. R., Walsh, M. N., & Pepine, C. J. (2018). Hypertension Across a Woman's Life Cycle. Journal of the American College of Cardiology, 71(16), 1797-1813.More infoHypertension accounts for 1 in 5 deaths among American women, posing a greater burden for women than men, and is among their most important risk factors for death and development of cardiovascular and other diseases. Hypertension affects women in all phases of life, with specific characteristics relating to risk factors and management for primary prevention of hypertension in teenage and young adult women; hypertension in pregnancy; hypertension during use of oral contraceptives and assisted reproductive technologies, lactation, menopause, or hormone replacement; hypertension in elderly women; and issues of race and ethnicity. All are detailed in this review, as is information relative to women in clinical trials of hypertension and medication issues. The overarching message is that effective treatment and control of hypertension improves cardiovascular outcomes. But many knowledge gaps persist, including the contribution of hypertensive disorders of pregnancy to cardiovascular disease risk, the role of hormone replacement, blood pressure targets for elderly women, and so on.
- Wong, C. W., Kwok, C. S., Narain, A., Gulati, M., Mihalidou, A. S., Wu, P., Alasnag, M., Myint, P. K., & Mamas, M. A. (2018). Marital status and risk of cardiovascular diseases: a systematic review and meta-analysis. Heart (British Cardiac Society), 104(23), 1937-1948.More infoThe influence of marital status on the incidence of cardiovascular disease (CVD) and prognosis after CVD is inconclusive. We systematically reviewed the literature to determine how marital status influences CVD and prognosis after CVD.
- Wu, P., Gulati, M., Kwok, C. S., Wong, C. W., Narain, A., O'Brien, S., Chew-Graham, C. A., Verma, G., Kadam, U. T., & Mamas, M. A. (2018). Preterm Delivery and Future Risk of Maternal Cardiovascular Disease: A Systematic Review and Meta-Analysis. Journal of the American Heart Association, 7(2).More infoPreterm delivery (
- AlBadri, A., Wei, J., Mehta, P. K., Shah, R., Herscovici, R., Gulati, M., Shufelt, C., & Bairey Merz, N. (2017). Sex differences in coronary heart disease risk factors: rename it ischaemic heart disease!. Heart (British Cardiac Society), 103(20), 1567-1568.
- Benson, G., Witt, D. R., VanWormer, J. J., Campbell, S. M., Sillah, A., Hayes, S. N., Lui, M., & Gulati, M. (2017). Medication adherence, cascade screening, and lifestyle patterns among women with hypercholesterolemia: Results from the WomenHeart survey. Journal of clinical lipidology, 10(4), 937-43.More infoHypercholesterolemia is a major risk factor for cardiovascular disease. Women with hypercholesterolemia and familial hypercholesterolemia (FH) are a high-risk group often underdiagnosed, undertreated, and unaware of the need for cascade screening.
- Brown, W. V., Gulati, M., & Lundberg, G. P. (2017). JCL roundtable: Cardiovascular disease risk reduction in menopausal women. Journal of clinical lipidology, 11(2), 316-324.More infoOvarian failure occurs in most women during the late fifth decade or early sixth decade of life. This causes a number of changes in physiology as estrogen and progestin concentrations decline. These involve lipoprotein metabolism and the vasculature. The risk factors for large vessel disease increase, and dysfunction of the small resistance vessels responds with changes in blood flow to the skin causing unpleasant symptoms. These and other changes result in visits to the physician. A reassessment of risk factors and symptoms is needed to develop a new plan for effective management, both short term and long term.
- Gulati, M. (2017). Early Identification of Pregnant Women at Risk for Preeclampsia: USPSTF Recommendations on Screening for Preeclampsia. JAMA cardiology, 2(6), 593-595.
- Gulati, M. (2017). Improving the Cardiovascular Health of Women in the Nation: Moving Beyond the Bikini Boundaries. Circulation, 135(6), 495-498.
- Gulati, M., & Merz, C. N. (2017). Advances in Lipid Therapy: The Role of Lipid Treatment in Women in Primary Prevention. Progress in cardiovascular diseases, 59(2), 178-189.More infoCardiovascular disease (CVD) remains the leading cause of death for women. Given the overall prevalence of CVD and its risk factors in women, primary prevention is an important focus. In 2013, the American College of Cardiology and the American Heart Association released guidelines for men and women on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk (ASCVD) in adults based on randomized-controlled trials. Fixed and appropriate intensity of a statin based on calculation of an individual's risk of ASCVD or in diabetics or those with severely elevated low-density lipoprotein cholesterol patients for primary prevention is recommended rather than cholesterol level goals. A more recent consensus statement regarding the role of non-statin therapies has been released, but like the prior guidelines released in 2013, there were no sex-specific recommendations. An evidence-based approach to ASCVD prevention should be used in women.
- Lewis, S. J., Mehta, L. S., Douglas, P. S., Gulati, M., Limacher, M. C., Poppas, A., Walsh, M. N., Rzeszut, A. K., Duvernoy, C. S., & , A. C. (2017). Changes in the Professional Lives of Cardiologists Over 2 Decades. Journal of the American College of Cardiology, 69(4), 452-462.More infoThe American College of Cardiology third decennial Professional Life Survey was completed by 2,313 cardiologists: 964 women (42%) and 1,349 men (58%). Compared with 10 and 20 years ago, current results reflect a substantially lower response rate (21% vs. 31% and 49%, respectively) and an aging workforce that is less likely to be in private practice. Women continue to be more likely to practice in academic centers, be pediatric cardiologists, and have a noninvasive subspecialty. Men were more likely to indicate that family responsibilities negatively influenced their careers than previously, whereas women remained less likely to marry or have children. Men and women reported similar, high levels of career satisfaction, with women reporting higher satisfaction currently. However, two-thirds of women continue to experience discrimination, nearly 3 times the rate in men. Personal life choices continue to differ substantially for men and women in cardiology, although differences have diminished.
- Lloyd-Jones, D. M., Huffman, M. D., Karmali, K. N., Sanghavi, D. M., Wright, J. S., Pelser, C., Gulati, M., Masoudi, F. A., & Goff, D. C. (2017). Estimating Longitudinal Risks and Benefits From Cardiovascular Preventive Therapies Among Medicare Patients: The Million Hearts Longitudinal ASCVD Risk Assessment Tool: A Special Report From the American Heart Association and American College of Cardiology. Circulation, 135(13), e793-e813.More infoThe Million Hearts Initiative has a goal of preventing 1 million heart attacks and strokes-the leading causes of mortality-through several public health and healthcare strategies by 2017. The American Heart Association and American College of Cardiology support the program. The Cardiovascular Risk Reduction Model was developed by Million Hearts and the Center for Medicare & Medicaid Services as a strategy to assess a value-based payment approach toward reduction in 10-year predicted risk of atherosclerotic cardiovascular disease (ASCVD) by implementing cardiovascular preventive strategies to manage the "ABCS" (aspirin therapy in appropriate patients, blood pressure control, cholesterol management, and smoking cessation). The purpose of this special report is to describe the development and intended use of the Million Hearts Longitudinal ASCVD Risk Assessment Tool. The Million Hearts Tool reinforces and builds on the "2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk" by allowing clinicians to estimate baseline and updated 10-year ASCVD risk estimates for primary prevention patients adhering to the appropriate ABCS over time, alone or in combination. The tool provides updated risk estimates based on evidence from high-quality systematic reviews and meta-analyses of the ABCS therapies. This novel approach to personalized estimation of benefits from risk-reducing therapies in primary prevention may help target therapies to those in whom they will provide the greatest benefit, and serves as the basis for a Center for Medicare & Medicaid Services program designed to evaluate the Million Hearts Cardiovascular Risk Reduction Model.
- Lloyd-Jones, D. M., Huffman, M. D., Karmali, K. N., Sanghavi, D. M., Wright, J. S., Pelser, C., Gulati, M., Masoudi, F. A., & Goff, D. C. (2017). Estimating Longitudinal Risks and Benefits From Cardiovascular Preventive Therapies Among Medicare Patients: The Million Hearts Longitudinal ASCVD Risk Assessment Tool: A Special Report From the American Heart Association and American College of Cardiology. Journal of the American College of Cardiology, 69(12), 1617-1636.More infoThe Million Hearts Initiative has a goal of preventing 1 million heart attacks and strokes-the leading causes of mortality-through several public health and healthcare strategies by 2017. The American Heart Association and American College of Cardiology support the program. The Cardiovascular Risk Reduction Model was developed by Million Hearts and the Center for Medicare & Medicaid Services as a strategy to assess a value-based payment approach toward reduction in 10-year predicted risk of atherosclerotic cardiovascular disease (ASCVD) by implementing cardiovascular preventive strategies to manage the "ABCS" (aspirin therapy in appropriate patients, blood pressure control, cholesterol management, and smoking cessation). The purpose of this special report is to describe the development and intended use of the Million Hearts Longitudinal ASCVD Risk Assessment Tool. The Million Hearts Tool reinforces and builds on the "2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk" by allowing clinicians to estimate baseline and updated 10-year ASCVD risk estimates for primary prevention patients adhering to the appropriate ABCS over time, alone or in combination. The tool provides updated risk estimates based on evidence from high-quality systematic reviews and meta-analyses of the ABCS therapies. This novel approach to personalized estimation of benefits from risk-reducing therapies in primary prevention may help target therapies to those in whom they will provide the greatest benefit, and serves as the basis for a Center for Medicare & Medicaid Services program designed to evaluate the Million Hearts Cardiovascular Risk Reduction Model.
- Pagidipati, N. J., Hellkamp, A., Thomas, L., Gulati, M., Peterson, E. D., & Wang, T. Y. (2017). Use of Prescription Smoking Cessation Medications After Myocardial Infarction Among Older Patients in Community Practice. JAMA cardiology.
- Ruckel, S. M., & Gulati, M. (2017). Coronary Calcium Scoring as the Gate Keeper for Stress Myocardial Perfusion Imaging: Antagonist. Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology, 24(3), 832-834.
- Sarma, A. A., Nkonde-Price, C., Gulati, M., Duvernoy, C. S., Lewis, S. J., Wood, M. J., & , A. C. (2017). Cardiovascular Medicine and Society: The Pregnant Cardiologist. Journal of the American College of Cardiology, 69(1), 92-101.More infoWomen are a consistent minority in the field of cardiology, with concerns regarding balancing career and parenting responsibilities often cited as a contributing factor to this under-representation. To investigate the impact that a career in cardiology may have on the family planning decisions of female cardiologists, the Women in Cardiology section of the American College of Cardiology conducted a voluntary anonymous survey. The following perspective highlights lessons learned from the survey, and potential solutions to the issues surrounding maternity leave, radiation exposure during pregnancy, and breastfeeding accommodations raised by these data. Given that most female cardiologists are pregnant at some point during their careers, particularly during the vulnerable periods of training and early career, improving the experience of pregnancy and early parenthood for all cardiologists may secure the best possible candidates to the field of cardiology.
- Schultz, A. E., Snider, M. J., Blais, D. M., & Gulati, M. (2017). Statin desensitization in a patient with probable familial hypercholesterolemia. Journal of clinical lipidology, 9(4), 597-601.More infoWith cardiovascular disease being the leading cause of morbidity and mortality in the United States, cholesterol-lowering medications have become a prominent focus of medical management and cardiovascular risk reduction, including the use of statins making them the most widely prescribed class of medications in the United States and are the cornerstone of management of hyperlipidemia. This case report describes a 29-year-old female with probable familial hypercholesterolemia (FH) who had allergic reactions to statin therapy on two separate occasions. She required statin therapy based on her elevated carotid intima media thickness test, historic LDL-C ≥ 190 mg/dL, elevated Lp(a), and family history significant for premature coronary heart disease. In this report, we document a case of successful oral desensitization to rosuvastatin and propose a replicable statin desensitization protocol.
- Shaw, L. J., Pepine, C. J., Xie, J., Mehta, P. K., Morris, A. A., Dickert, N. W., Ferdinand, K. C., Gulati, M., Reynolds, H., Hayes, S. N., Itchhaporia, D., Mieres, J. H., Ofili, E., Wenger, N. K., & Bairey Merz, C. N. (2017). Quality and Equitable Health Care Gaps for Women: Attributions to Sex Differences in Cardiovascular Medicine. Journal of the American College of Cardiology, 70(3), 373-388.More infoThe present review synthesizes evidence and discusses issues related to health care quality and equity for women, including minority population subgroups. The principle of "sameness" or women and men receiving equitable, high-quality care is a near-term target, but optimal population health cannot be achieved without consideration of the unique, gendered structural determinants of health and the development of unique care pathways optimized for women. The aim of this review is to promote enhanced awareness, develop critical thinking in sex and gender science, and identify strategic pathways to improve the cardiovascular health of women. Delineation of the components of high-quality health care, including a women-specific research agenda, remains a vital part of strategic planning to improve the lives of women at risk for or living with cardiovascular disease.
- Smilowitz, N. R., Mahajan, A. M., Roe, M. T., Hellkamp, A. S., Chiswell, K., Gulati, M., & Reynolds, H. R. (2017). Mortality of Myocardial Infarction by Sex, Age, and Obstructive Coronary Artery Disease Status in the ACTION Registry-GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines). Circulation. Cardiovascular quality and outcomes, 10(12), e003443.More infoSex differences in early mortality after myocardial infarction (MI) vary by age. MI with nonobstructive coronary arteries (MINOCA [
- Baldassarre, L. A., Raman, S. V., Min, J. K., Mieres, J. H., Gulati, M., Wenger, N. K., Marwick, T. H., Bucciarelli-Ducci, C., Bairey Merz, C. N., Itchhaporia, D., Ferdinand, K. C., Pepine, C. J., Walsh, M. N., Narula, J., Shaw, L. J., & , A. C. (2016). Noninvasive Imaging to Evaluate Women With Stable Ischemic Heart Disease. JACC. Cardiovascular imaging, 9(4), 421-35.More infoDeclines in cardiovascular deaths have been dramatic for men but occur significantly less in women. Among patients with symptomatic ischemic heart disease (IHD), women experience relatively worse outcomes compared with their male counterparts. Evidence to date has failed to adequately explore unique female imaging targets and their correlative signs and symptoms of IHD as major determinants of IHD risk. We highlight sex-specific anatomic and functional differences in contemporary imaging and introduce imaging approaches that leverage refined targets that may improve IHD risk prediction and identify potential therapeutic strategies for symptomatic women.
- Bates, C., Gordon, L., Travis, E., Chatterjee, A., Chaudron, L., Fivush, B., Gulati, M., Jagsi, R., Sharma, P., Gillis, M., Ganetzky, R., Grover, A., Lautenberger, D., & Moses, A. (2016). Striving for Gender Equity in Academic Medicine Careers: A Call to Action. Academic medicine : journal of the Association of American Medical Colleges, 91(8), 1050-2.More infoWomen represent approximately half of students entering medical schools and more than half of those entering PhD programs. When advancing through the academic and professional fields, however, women continually face barriers that men do not. In this Commentary, the authors offer ideas for coordinating the efforts of organizations, academic institutions, and leaders throughout the scientific and medical professions to reduce barriers that result in inequities and, instead, strive for gender parity. Specific areas of focus outlined by the authors include facilitating women's access to formal and informal professional networks, acknowledging and addressing the gender pay gap as well as the lack of research funding awarded to women in the field, and updating workplace policies that have not evolved to accommodate women's lifestyles. As academic institutions seek access to top talent and the means to develop those individuals capable of generating the change medicine and science needs, the authors urge leaders and change agents within academic medicine to address the systemic barriers to gender equity that impede us from achieving the mission to improve the health of all.
- Garcia, M., Miller, V. M., Gulati, M., Hayes, S. N., Manson, J. E., Wenger, N. K., Bairey Merz, C. N., Mankad, R., Pollak, A. W., Mieres, J., Kling, J., & Mulvagh, S. L. (2016). Focused Cardiovascular Care for Women: The Need and Role in Clinical Practice. Mayo Clinic proceedings, 91(2), 226-40.More infoOver the past decade, an emerging clinical research focus on cardiovascular (CV) disease (CVD) risk in women has highlighted sex-specific factors that are uniquely important in the prevention and early detection of coronary atherosclerosis in women. Concurrently, a 30% decrease in the number of female deaths from CVD has been observed. Despite this, CVD continues to be the leading cause of death in women, outnumbering deaths from all other causes combined. Clinical practice approaches that focus on the unique aspects of CV care for women are needed to provide necessary resources for the prevention, diagnosis, and treatment of CVD in women. In addition to increasing opportunities for women to participate in CV research, Women's Heart Clinics offer unique settings in which to deliver comprehensive CV care and education, ensuring appropriate diagnostic testing, while monitoring effectiveness of treatment. This article reviews the emerging need and role of focused CV care to address sex-specific aspects of diagnosis and treatment of CVD in women.
- Gulati, M. (2016). Global Risk Assessment and Coronary Artery Calcium Scoring in Low-Intermediate Risk Women: What Is a Picture Really Worth?. Circulation. Cardiovascular imaging, 9(4), e004817.
- Gulati, M., & Sharma, K. (2016). MY APPROACH to elevated cholesterol in women. Trends in cardiovascular medicine, 26(4), 389-90.
- Iadecola, C., Yaffe, K., Biller, J., Bratzke, L. C., Faraci, F. M., Gorelick, P. B., Gulati, M., Kamel, H., Knopman, D. S., Launer, L. J., Saczynski, J. S., Seshadri, S., Zeki Al Hazzouri, A., & , A. H. (2016). Impact of Hypertension on Cognitive Function: A Scientific Statement From the American Heart Association. Hypertension (Dallas, Tex. : 1979), 68(6), e67-e94.More infoAge-related dementia, most commonly caused by Alzheimer disease or cerebrovascular factors (vascular dementia), is a major public health threat. Chronic arterial hypertension is a well-established risk factor for both types of dementia, but the link between hypertension and its treatment and cognition remains poorly understood. In this scientific statement, a multidisciplinary team of experts examines the impact of hypertension on cognition to assess the state of the knowledge, to identify gaps, and to provide future directions.
- Kopecky, S. L., Bauer, D. C., Gulati, M., Nieves, J. W., Singer, A. J., Toth, P. P., Underberg, J. A., Wallace, T. C., & Weaver, C. M. (2016). Lack of Evidence Linking Calcium With or Without Vitamin D Supplementation to Cardiovascular Disease in Generally Healthy Adults: A Clinical Guideline From the National Osteoporosis Foundation and the American Society for Preventive Cardiology. Annals of internal medicine, 165(12), 867-868.More infoCalcium is the dominant mineral present in bone and a shortfall nutrient in the American diet. Supplements have been recommended for persons who do not consume adequate calcium from their diet as a standard strategy for the prevention of osteoporosis and related fractures. Whether calcium with or without vitamin D supplementation is beneficial or detrimental to vascular health is not known.
- McSweeney, J. C., Rosenfeld, A. G., Abel, W. M., Braun, L. T., Burke, L. E., Daugherty, S. L., Fletcher, G. F., Gulati, M., Mehta, L. S., Pettey, C., Reckelhoff, J. F., & , A. H. (2016). Preventing and Experiencing Ischemic Heart Disease as a Woman: State of the Science: A Scientific Statement From the American Heart Association. Circulation, 133(13), 1302-31.
- Sanghavi, M., & Gulati, M. (2016). Cardiovascular Disease in Women: Primary and Secondary Cardiovascular Disease Prevention. Obstetrics and gynecology clinics of North America, 43(2), 265-85.More infoCardiovascular disease remains the leading cause of death in the United States. Primary prevention of cardiovascular disease requires involvement of an extended health care team. Obstetricians and gynecologists are uniquely positioned within the health care system because they are often the primary or only contact women have with the system. This review article discusses initial assessment, treatment recommendations, and practical tips regarding primary and secondary prevention of cardiovascular disease in women with a focus on coronary heart disease; discussion includes peripheral and cerebrovascular disease.
- Smith, S. M., Huo, T., Gong, Y., Handberg, E., Gulati, M., Merz, C. N., Pepine, C. J., & Cooper-DeHoff, R. M. (2016). Mortality Risk Associated With Resistant Hypertension Among Women: Analysis from Three Prospective Cohorts Encompassing the Spectrum of Women's Heart Disease. Journal of women's health (2002), 25(10), 996-1003.More infoWomen are at greater risk of developing resistant hypertension (RH) than men, yet scarce data exist on RH-associated outcomes in women. We aimed to determine all-cause mortality risk associated with apparent RH (aRH) among women across the spectrum of underlying coronary disease.
- Vargo, C. A., Blazer, M., Reardon, J., Gulati, M., & Bekaii-Saab, T. (2016). Successful Completion of Adjuvant Chemotherapy in a Patient With Colon Cancer Experiencing 5-Fluorouracil-Induced Cardiac Vasospasm. Clinical colorectal cancer, 15(2), e61-3.
- Weng, L., Taylor, K. D., Chen, Y. D., Sopko, G., Kelsey, S. F., Bairey Merz, C. N., Pepine, C. J., Miller, V. M., Rotter, J. I., Gulati, M., Goodarzi, M. O., & Cooper-DeHoff, R. M. (2016). Genetic loci associated with nonobstructive coronary artery disease in Caucasian women. Physiological genomics, 48(1), 12-20.More infoNonobstructive coronary artery disease (CAD) in women is associated with adverse cardiovascular (CV) outcomes; however, information regarding genetic variants that predispose women to nonobstructive CAD is lacking. Women from the Women's Ischemia Syndrome Evaluation (WISE) Study and the St. James Women Take Heart (WTH) Study were genotyped with the Cardio-MetaboChip. WISE enrolled women with symptoms and signs of ischemia referred for coronary angiography; WTH enrolled asymptomatic, community-based women without heart disease. Analyses were conducted with a case (WISE)--control (WTH) design and multivariate logistic regression models to investigate genetic variation associated with likelihood of nonobstructive CAD. One genetic marker, single nucleotide polymorphism (SNP) rs2301753 on chromosome 6 in RNF39, achieved chip-wide significance for nonobstructive CAD (P < 9.5 × 10(-7)). After adjusting for baseline characteristics, we found no variants achieved chip-wide significance. However, SNP rs2301753 on chromosome 6 in RNF39 was associated with reduced likelihood of nonobstructive CAD [odds ratio (OR) 0.42 and 95% confidence interval (CI) of 0.29 to 0.68], at a nominal level of P = 5.6 × 10(-6), while SNP rs12818945 in the ATP2B1 locus on chromosome 12 was associated with increased odds for nonobstructive CAD (OR 2.38 and 95% CI of 1.63 to 3.45) and nominal P = 5.8 × 10(-6). The functions of RNF39 and ATP2B1 raise the possibility that genes involved in cardio-dysfunction may contribute to nonobstructive CAD in Caucasian women and may provide insights into novel approaches for therapy and prevention. If replicated, incorporation of these genetic variants into diagnostic evaluation may identify women at high risk for nonobstructive CAD.
- Wenger, N. K., Ferdinand, K. C., Bairey Merz, C. N., Walsh, M. N., Gulati, M., Pepine, C. J., & , A. C. (2016). Women, Hypertension, and the Systolic Blood Pressure Intervention Trial. The American journal of medicine, 129(10), 1030-6.More infoHypertension accounts for approximately 1 in 5 deaths in American women and is the major contributor to many comorbid conditions. Although blood pressure lowering reduces cardiovascular disease outcomes, considerable uncertainty remains on best management in women. Specifically, female blood pressure treatment goals have not been established, particularly among older and African American and Hispanic women, for whom hypertension prevalence, related adverse outcomes, and poor control rates are high. The Systolic Blood Pressure Intervention Trial (SPRINT) planned to clarify optimal blood pressure management in both sexes. Although confirming that a lower blood pressure goal is generally better, because female enrollment and event rates were low and follow-up shortened, outcomes differences in women were not statistically significant. Thus optimal blood pressure goals for women have not been established with the highest evidence. This review addresses SPRINT's significance and key remaining knowledge gaps in optimal blood pressure management to improve women's health.
- Abdelmoneim, S. S., Gulati, M., Mulvagh, S. L., Pack, Q., Scott, C. G., Barr, L., & Allison, T. G. (2015). Impact of utilizing a women-based formula for determining adequacy of the chronotropic response during exercise treadmill testing. Journal of women's health (2002), 24(3), 174-81.More infoA women-based formula for calculation of age-predicted maximum heart rate [age-predicted maximum heart rate=206-(0.88×age)] was established in asymptomatic volunteer women undergoing treadmill exercise tolerance testing (ETT). We sought to perform a comparison of the performance of this women-based formula for prediction of peak heart rate to the traditional formula [220-age] and our own database-generated prediction formula in a large database of women undergoing ETT.
- Balady, G. J., Bufalino, V. J., Gulati, M., Kuvin, J. T., Mendes, L. A., & Schuller, J. L. (2015). COCATS 4 Task Force 3: Training in Electrocardiography, Ambulatory Electrocardiography, and Exercise Testing. Journal of the American College of Cardiology, 65(17), 1763-77.
- Gulati, M., & Merz, C. N. (2015). New cholesterol guidelines and primary prevention in women. Trends in cardiovascular medicine, 25(2), 84-94.More infoCardiovascular disease (CVD) remains the leading cause of death for women in the United States. The role of primary prevention of CVD is a necessary focus of healthcare, given the overall prevalence of CVD and its risk factors in women. In 2013, the American College of Cardiology and the American Heart Association released new guidelines on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk (ASCVD) in adults that were based on results of randomized controlled trials. These guidelines apply to both men and women. Achievement of a target cholesterol level is no longer part of the guidelines. Rather, the guidelines recommend an appropriate and fixed intensity of a statin based on calculation of an individual׳s risk of ASCVD or in diabetics or those with severely elevated LDL-C for primary prevention. The new guidelines emphasize statin therapy over other lipid-lowering therapy. The new guidelines are evidence-based, coming from randomized control trials that have clearly demonstrated improved outcomes using statin therapy in those with ASCVD and those at high risk of ASCVD, not based on LDL targets but rather LDL lowering. This evidence-based approach to ASCVD prevention should be used in women. There were no specific sex differences in the new guidelines, and the focus of this article is to provide the evidence to support the use of these guidelines in women.
- Kiran Mehta, N., Hardebeck, C., & Gulati, M. (2015). The Significance of ST Depression in a Postmenopausal Woman on Estrogen Therapy during Regadenoson Myocardial SPECT Imaging. Case reports in cardiology, 2015, 653760.More infoThe incidence of false-positive stress tests has been noted in women, especially on hormone replacement therapy. Current literature describes this phenomenon in treadmill and adenosine stress tests. The introduction of regadenoson as a vasodilator agent has been widely adopted owing to its potency and specificity. To our knowledge, false-positive stress test with regadenoson in a postmenopausal woman on estrogen has never been described. Given the higher chronotropic response with regadenoson, we believe that normal perfusion images with a higher heart rate response indicate a good prognosis in such patients.
- Pepine, C. J., Ferdinand, K. C., Shaw, L. J., Light-McGroary, K. A., Shah, R. U., Gulati, M., Duvernoy, C., Walsh, M. N., Bairey Merz, C. N., & , A. C. (2015). Emergence of Nonobstructive Coronary Artery Disease: A Woman's Problem and Need for Change in Definition on Angiography. Journal of the American College of Cardiology, 66(17), 1918-33.More infoRecognition of ischemic heart disease (IHD) is often delayed or deferred in women. Thus, many at risk for adverse outcomes are not provided specific diagnostic, preventive, and/or treatment strategies. This lack of recognition is related to sex-specific IHD pathophysiology that differs from traditional models using data from men with flow-limiting coronary artery disease (CAD) obstructions. Symptomatic women are less likely to have obstructive CAD than men with similar symptoms, and tend to have coronary microvascular dysfunction, plaque erosion, and thrombus formation. Emerging data document that more extensive, nonobstructive CAD involvement, hypertension, and diabetes are associated with major adverse events similar to those with obstructive CAD. A central emerging paradigm is the concept of nonobstructive CAD as a cause of IHD and related adverse outcomes among women. This position paper summarizes currently available knowledge and gaps in that knowledge, and recommends management options that could be useful until additional evidence emerges.
- Raman, S. V., Sharkey-Toppen, T. P., Tran, T., Liu, J. X., McCarthy, B., He, X., Smart, S., Gulati, M., Wexler, R., Simonetti, O. P., & Jackson, R. D. (2015). Iron, inflammation and atherosclerosis risk in men vs. perimenopausal women. Atherosclerosis, 241(1), 249-54.More infoAge at first atherosclerotic event is typically older for women vs. men; monthly iron loss has been postulated to contribute to this advantage. We investigated the relationship between an MRI-based arterial wall biomarker and the serum inflammatory biomarker high-sensitivity C-reactive protein (hsCRP) in perimenopausal women vs. men.
- Sanghavi, M., & Gulati, M. (2015). Sex differences in the pathophysiology, treatment, and outcomes in IHD. Current atherosclerosis reports, 17(6), 511.More infoHeart disease is the number one killer of women. Although there are many similarities between men and women, the evolving understanding of ischemic heart disease in women allow us to emphasize the important differences that need to be recognized. These differences, including symptoms at presentation, importance of particular risk factors, pathophysiology of disease, and treatments/outcomes, will be discussed in this review.
- Breathett, K., Muhlestein, D., Foraker, R., & Gulati, M. (2014). Differences in preeclampsia rates between African American and Caucasian women: trends from the National Hospital Discharge Survey. Journal of women's health (2002), 23(11), 886-93.More infoAfrican Americans are at higher risk for preeclampsia compared with Caucasians, but longitudinal changes are unknown. We hypothesized that preeclampsia rates among African Americans would be higher than that of Caucasians and over time would maintain a consistent divergence.
- Mieres, J. H., Gulati, M., Bairey Merz, N., Berman, D. S., Gerber, T. C., Hayes, S. N., Kramer, C. M., Min, J. K., Newby, L. K., Nixon, J. V., Srichai, M. B., Pellikka, P. A., Redberg, R. F., Wenger, N. K., Shaw, L. J., , A. H., & , C. I. (2014). Role of noninvasive testing in the clinical evaluation of women with suspected ischemic heart disease: a consensus statement from the American Heart Association. Circulation, 130(4), 350-79.
- Platts, S. H., Bairey Merz, C. N., Barr, Y., Fu, Q., Gulati, M., Hughson, R., Levine, B. D., Mehran, R., Stachenfeld, N., & Wenger, N. K. (2014). Effects of sex and gender on adaptation to space: cardiovascular alterations. Journal of women's health (2002), 23(11), 950-5.More infoSex and gender differences in the cardiovascular adaptation to spaceflight were examined with the goal of optimizing the health and safety of male and female astronauts at the forefront of space exploration. Female astronauts are more susceptible to orthostatic intolerance after space flight; the visual impairment intracranial pressure syndrome predominates slightly in males. Since spaceflight simulates vascular aging, sex-specific effects on vascular endothelium and thrombotic risk warrant examination as predisposing factors to atherosclerosis, important as the current cohort of astronauts ages. Currently, 20% of astronauts are women, and the recently selected astronaut recruits are 50% women. Thus there should be expectation that future research will reflect the composition of the overall population to determine potential benefits or risks. This should apply both to clinical studies and to basic science research.
- Sydó, N., Abdelmoneim, S. S., Mulvagh, S. L., Merkely, B., Gulati, M., & Allison, T. G. (2014). Relationship between exercise heart rate and age in men vs women. Mayo Clinic proceedings, 89(12), 1664-72.More infoTo analyze a large cohort of patients who underwent exercise testing and also report sex differences in other exercise heart rate (HR) parameters to determine whether separate sex-based equations to predict peak HR are indicated.
- Fletcher, G. F., Ades, P. A., Kligfield, P., Arena, R., Balady, G. J., Bittner, V. A., Coke, L. A., Fleg, J. L., Forman, D. E., Gerber, T. C., Gulati, M., Madan, K., Rhodes, J., Thompson, P. D., Williams, M. A., & , A. H. (2013). Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation, 128(8), 873-934.
- Kaminsky, L. A., Arena, R., Beckie, T. M., Brubaker, P. H., Church, T. S., Forman, D. E., Franklin, B. A., Gulati, M., Lavie, C. J., Myers, J., Patel, M. J., Piña, I. L., Weintraub, W. S., Williams, M. A., & , A. H. (2013). The importance of cardiorespiratory fitness in the United States: the need for a national registry: a policy statement from the American Heart Association. Circulation, 127(5), 652-62.
- Sharma, K., & Gulati, M. (2013). Coronary artery disease in women: a 2013 update. Global heart, 8(2), 105-12.More infoCoronary artery disease (CAD) is a leading cause of death of women and men worldwide. CAD's impact on women traditionally has been underappreciated due to higher rates at younger ages in men. Microvascular coronary disease disproportionately affects women. Women have unique risk factors for CAD, including those related to pregnancy and autoimmune disease. Trial data indicate that CAD should be managed differently in women. In this review, we will examine risk assessment for CAD in women, CAD's impact on women, as well as CAD's female-specific presentation and management strategies.
- Gulati, M., Black, H. R., Arnsdorf, M. F., Shaw, L. J., & Bakris, G. L. (2012). Kidney dysfunction, cardiorespiratory fitness, and the risk of death in women. Journal of women's health (2002), 21(9), 917-24.More infoChronic kidney disease (CKD) is associated with increased risk of cardiovascular (CV) events and death. However, the effect of cardiorespiratory fitness on the CKD-mortality relationship remains unknown, particularly in women.
- Gulati, M., Shaw, L. J., & Bairey Merz, C. N. (2012). Myocardial ischemia in women: lessons from the NHLBI WISE study. Clinical cardiology, 35(3), 141-8.More infoCardiovascular disease (CVD) remains the leading cause of death for women. For almost 3 decades, more women than men have died from CVD, with the most recent annual statistics on mortality reporting that CVD accounted for 421 918 deaths among women in the United States. Although there have been significant declines in coronary heart disease (CHD) mortality for females, these reductions lag behind those seen in men. In addition, where there has been a decrease in mortality from CHD across all age groups over time in men, in the youngest women (age
- Sharma, K., Kohli, P., & Gulati, M. (2012). An update on exercise stress testing. Current problems in cardiology, 37(5), 177-202.More infoExercise stress testing is the most commonly used noninvasive method to evaluate for coronary artery disease in men and women. Although emphasis has been placed on the diagnostic value of ST-segment depression, the exercise stress test provides other valuable diagnostic and prognostic data, beyond ST-segment depression. The value of these variables, which include exercise capacity, chronotropic response, heart rate recovery, blood pressure response, and the Duke Treadmill Score, are reviewed in this article. In addition, the gender differences seen with these exercise testing variables are reviewed. In this modern era of exercise stress testing, making use of all the information from a stress test and creating a comprehensive stress testing report are recommended in the evaluation of patients with suspected coronary artery disease who undergo exercise stress testing.
- Mieres, J. H., Heller, G. V., Hendel, R. C., Gulati, M., Boden, W. E., Katten, D., & Shaw, L. J. (2011). Signs and symptoms of suspected myocardial ischemia in women: results from the What is the Optimal Method for Ischemia Evaluation in WomeN? Trial. Journal of women's health (2002), 20(9), 1261-8.More infoMuch of our understanding of gender differences in chest pain was derived from noncontemporary reports. The aim of the current report was to compare the frequency of chest pain by measures of ischemia in 824 women with suspected myocardial ischemia prospectively enrolled in a clinical trial of exercise testing with electrocardiography (ETT-ECG) alone compared to myocardial perfusion single photon emission computed tomography (SPECT) (ETT-MPS).
- Shaw, L. J., Mieres, J. H., Hendel, R. H., Boden, W. E., Gulati, M., Veledar, E., Hachamovitch, R., Arrighi, J. A., Merz, C. N., Gibbons, R. J., Wenger, N. K., Heller, G. V., & , W. T. (2011). Comparative effectiveness of exercise electrocardiography with or without myocardial perfusion single photon emission computed tomography in women with suspected coronary artery disease: results from the What Is the Optimal Method for Ischemia Evaluation in Women (WOMEN) trial. Circulation, 124(11), 1239-49.More infoThere is a paucity of randomized trials regarding diagnostic testing in women with suspected coronary artery disease (CAD). It remains unclear whether the addition of myocardial perfusion imaging (MPI) to the standard ECG exercise treadmill test (ETT) provides incremental information to improve clinical decision making in women with suspected CAD.
- Balady, G. J., Arena, R., Sietsema, K., Myers, J., Coke, L., Fletcher, G. F., Forman, D., Franklin, B., Guazzi, M., Gulati, M., Keteyian, S. J., Lavie, C. J., Macko, R., Mancini, D., Milani, R. V., , A. H., , C. o., , C. o., & , I. C. (2010). Clinician's Guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association. Circulation, 122(2), 191-225.
- Gulati, M., Shaw, L. J., Thisted, R. A., Black, H. R., Bairey Merz, C. N., & Arnsdorf, M. F. (2010). Heart rate response to exercise stress testing in asymptomatic women: the st. James women take heart project. Circulation, 122(2), 130-7.More infoThe definition of a normal heart rate (HR) response to exercise stress testing in women is poorly understood, given that most studies describing a normative response were predominately based on male data. Measures of an attenuated HR response (chronotropic incompetence) and age-predicted HR have not been validated in asymptomatic women. We investigated the association between HR response to exercise testing and age with prognosis in 5437 asymptomatic women.
- Kohli, P., & Gulati, M. (2010). Exercise stress testing in women: going back to the basics. Circulation, 122(24), 2570-80.
- Sparano, D. M., Kohli, P., & Gulati, M. (2010). A 63-year-old woman with a pericardial effusion, bilateral pleural effusions, and ascites: is the whole greater than the sum of its parts?. Echocardiography (Mount Kisco, N.Y.), 27(4), 454-9.More infoA 63-year-old female presented with dyspnea, leg edema, and abdominal distention. Exam revealed blood pressure of 104/58, pulse 108/min, jugular venous pressure of 8 cm, no pulsus paradoxus, a pericardial rub, muffled heart sounds, decreased basilar breath sounds, ascites, and ankle edema. Electrocardiogram showed low voltage. Imaging revealed thickened pericardium and a pericardial effusion. Hemodynamic tracings postpericardiocentesis revealed elevated right-sided pressures. The patient was diagnosed with effusive constrictive pericarditis. The case and review of this condition are described. Patients with a pericardial effusion and symptoms unresponsive to pericardiocentesis or with pericardial thickening should undergo evaluation for effusive-constrictive pericarditis.
- Gulati, M., Cooper-DeHoff, R. M., McClure, C., Johnson, B. D., Shaw, L. J., Handberg, E. M., Zineh, I., Kelsey, S. F., Arnsdorf, M. F., Black, H. R., Pepine, C. J., & Merz, C. N. (2009). Adverse cardiovascular outcomes in women with nonobstructive coronary artery disease: a report from the Women's Ischemia Syndrome Evaluation Study and the St James Women Take Heart Project. Archives of internal medicine, 169(9), 843-50.More infoWomen with clinical findings suggestive of ischemia but without findings of obstructive coronary artery disease (CAD) on angiography represent a frequent clinical problem; predicting prognosis is challenging.
- Gallitano-Mendel, A. L., Hale, T., Herbst-Kralovetz, M., Gonzales, R. J., Titelbaum, A. R., Federico, G., Mahnert, N., Garcia-Filion, P., Omalley, C. W., Nelson, L. R., Muhammad, S., Parrish, J., Lucio, F., Mallin, E., Hartmark-Hill, J. R., Gulati, M., & Thomas, T. C. (2019, November). . Strategic initiative to create a Women in Medicine and Science (WIMS) program at a recently established and independently accredited College of Medicine. AAMC-Learn, Serve, Lead. Phoenix: AAMC.
- Gallitano-Mendel, A. L., Hale, T., Herbst-Kralovetz, M., Gonzales, R. J., Titelbaum, A. R., Federico, G., Mahnert, N., Garcia-Filion, P., Omalley, C. W., Nelson, L. R., Muhammad, S., Parrish, J., Lucio, F., Mallin, E., Hartmark-Hill, J. R., Gulati, M., & Thomas, T. C. (2019, November). Strategic initiative to create a Women in Medicine and Science (WIMS) program at a recently established and independently accredited College of Medicine. AAMC-Learn, Serve, Lead. Phoenix: AAMC.
- Herbst-Kralovetz, M., Thomas, T., Mallin, E., Gulati, M., Garcia, P. C., Hartmark-Hill, J. R., Lucio, F., Nelson, L. R., Gallitano-Mendel, A. L., Martinez, G. F., Herbst-Kralovetz, M., Thomas, T., Mallin, E., Gulati, M., Garcia, P. C., Hartmark-Hill, J. R., Lucio, F., Nelson, L. R., Gallitano-Mendel, A. L., & Martinez, G. F. (2019, November). Strategic initiative to create a Women in Medicine and Science (WIMS) program at a recently established and independently accredited College of Medicine. AAMC Learn Serve Lead. Phoenix, AZ: AAMC.