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Cardiology Today Chief Medical Editor receives award for medical leadership, research to improve women’s heart health
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The National Coalition for Women with Heart Disease, also known as WomenHeart, has honored Carl J. Pepine, MD, MACC, professor of medicine at the University of Florida College of Medicine and Cardiology Today Chief Medical Editor, with the Wenger Award for Excellence in Medical Leadership and Research for his decades of work in the field of women’s heart health.
Pepine has been involved in research and treatment of women’s heart health for nearly 4 decades. His most recent research projects seek to understand the complexities of ischemic heart disease and addressing optimal management of women presenting with symptoms and signs of ischemic heart disease who have no obstructive CAD on coronary angiography.
“On behalf of my team, I am honored to receive the distinguished Wenger Award. It is incredibly gratifying to know that our work in nonobstructive coronary artery disease and coronary microvascular dysfunction has helped change the landscape for the diagnosis and treatment of ischemic heart disease. This has led to more women disabled by severe symptoms being addressed, reducing their disability and improving their quality of life,” Pepine told Cardiology Today.
In addition to his research in this area, Pepine maintains his practice at UF Health Cardiology – Springhill and also sees patients at the UF Health Heart & Vascular Hospital.
Pepine has published more than 900 papers, many of which have focused on women’s heart health. His research has led to improvements in the diagnosis and treatment of CVD.
“Receiving the distinguished Wenger Award is a great honor,” Pepine told Cardiology Today. “There is much, much more to be discovered in this area of women’s heart health. This award is particularly important for me since it is named after the person who first made the world aware that ischemic heart disease in women is ‘understudied, underdiagnosed, and undertreated’.”
The 19th Annual Wenger Awards were given out in Washington, D.C., in May.
How has women’s heart health improved over the years?
Pepine: We have made great strides in improving women’s heart health over the years. However, heart disease remains the leading killer of women. The decrease in CV-related mortality among women over the past decade is dramatic. However, several challenges remain, including a not-so-dramatic decrease in CV mortality among women aged 50 years and younger as well as in women in the minority populations, particularly black women.
The only cohort in which CV mortality has not declined in recent years is in these Americans aged 50 years and younger.
A particular focus, and challenge, is acute MI in the absence of obstructive CAD, or MINOCA, which is observed in an estimated 5% to 6% of patients with acute infarction who are referred for coronary angiography. Managing angina and ischemia relies on detecting obstructive CAD, as supported by evidence-based guidelines including medical and revascularization therapy. However, about 2 in 3 women and 1 in 4 men with such findings do not have obstructive CAD and their outcomes are not benign, yet we have no guideline-based evidence to direct their management.
Who has had the greatest influence on your work in the area of women’s heart health?
Pepine: My real motivators have been the patients. It was through my work treating cardiology patients that I first became acquainted with the differences between women and men, in terms of CV issues. Decades ago, I was seeing an increasing number of women disabled by chest pain, but I did not see the physical blockage that would cause it among men. Initially, I believed that such patients had relatively benign outcomes, and we wrote a paper describing such a cohort with that suggestion. However, the more I worked with such women, I realized that we had not observed enough of these women over a long enough period of time. Furthermore, we were comparing them with men.
Observing the differences between patients of different sexes allowed me realize that women had a number of female-unique risk factors for CV disease, in addition to the traditional risk factors described from mostly male cohorts, to post the research questions that I continue to raise today.
What are you most proud of, in terms of your work in improving women’s heart health?
Pepine: Other than calling attention to heart disease in women, I have been involved with a group that was the first to show that coronary microvascular dysfunction, in women without obstructive disease, actually predicts adverse outcomes. That finding has now been confirmed by a number of other groups over the last 10 years. I’m very proud of my involvement with the NIH-sponsored Women’s Ischemia Syndrome Evaluation (WISE) project over the past 2 decades. This includes the original WISE cohort, its ancillary mechanistic studies, the WISE-CVD cohort and the extended follow-up of these women. We are just about to start recruiting for another WISE cohort to address the links between coronary microvascular dysfunction and early HF with preserved ejection fraction (WISE-HFpEF).
It is gratifying to know that our work in this area has helped change the landscape for the diagnosis and treatment of ischemic heart disease in women. This has led to greater awareness and improved outcomes and quality of life among women.
What’s next for you?
Pepine: I am principal investigator for the WARRIOR (Women’s Ischemia Trial to Reduce Events in Nonobstructive CAD) trial that is being funded through a $14.9 million grant from the U.S. Department of Defense. WARRIOR is currently enrolling 4,422 women at a projected 50 U.S. sites who have signs and symptoms of ischemia (chronic angina or equivalent) but no obstructive CAD (ie, stenosis < 50%). The women are randomly assigned to intensive medical treatment — highly potent statin (atorvastatin or rosuvastatin), moderate-dose lisinopril or losartan, and aspirin for those not contraindicated, lifestyle counseling and QOL questionnaires — or to usual care. The hypothesis is that intensive medical treatment will reduce major adverse coronary events vs. usual care. The primary outcome is all-cause death, nonfatal MI, stroke/transient ischemic attack, and hospital visits for angina or HF. So far, about 350 of the women have been recruited and 23 sites approved. It’s too early to say what the 4- to 5-year study will show, but the results should be interesting. – by Katie Kalvaitis
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- Carl J. Pepine, MD, MACC, is Chief Medical Editor of Cardiology Today. He also holds the title of Eminent Scholar Emeritus and professor in the division of cardiovascular medicine at University of Florida, Gainesville. Pepine can be reached at cardiology@healio.com.
Disclosure: Pepine reports no relevant financial disclosures.