Q&A With a Pioneer in Cardiology and Women’s HealthDevin Lynn Feb 8, 2021
The Ludeman Family Center for Women’s Health Research connects scientists and community members from around the country and advocates for women’s health and sex differences research. One key element is the Ludeman Center’s Scientific Council. This group consists of pioneers in the field that help guide the scientific mission of the Ludeman Center. Nanette Wenger, MD, professor emerita of Medicine at Emory University School of Medicine, is a longtime member of the Scientific Council and a living legend in the field of cardiology and women’s health and sex differences research. We recently interviewed her about the role of innovation in women’s health and sex differences research.
Responses have been edited for length.
How did you get involved with Ludeman Center?
My involvement with the Ludeman Family Center for Women’s Health Research began in conversations with Judy Regensteiner, PhD, and some of the women who were part of the community board. I made several trips to Denver that were really memorable because of the people with whom I interacted. Some were scientists, some were community activists and philanthropists, but all had a passion for women’s health.
Why is it so important to involve the community?
Involving the community gave the Ludeman Center a very different perspective. It allowed the community to learn about the Ludeman Center, its work and its scientists. This also allowed the Ludeman Center and its scientists to interact with the community. I must admit that I have shamelessly stolen this idea, giving credit where credit is due.
As we have lived through COVID, what we have learned is that what we considered scientific parlance is now dinner table conversation. People learn about science, they learn about evidence-based research and clinical trials, regulatory, etc., and I expect that some of that sharing with the community is what has enabled huge enrollment in the vaccine trials.
Why was a center dedicated to women’s health innovative?
Let me go back to the 1980s which is when I became interested in women’s heart health. What you have to realize is that for most of the last century women’s health is what I have termed “bikini medicine” meaning it involved the areas of the body covered by bikini bathing suits – the breasts and the reproductive system. Everything else was not considered relevant.
Why was it vital to recognize women’s health and sex differences in medicine?
An important feature to emphasize is that when we study women’s health and when we study sex and gender differences, we are really studying men’s health as well. Anything that we do that will improve women’s health and identify important sex and gender differences will have major ramifications for improving men’s health.
Twenty years ago, could you see what women’s health research would look like today?
I don't believe when I started asking the questions that I would ever dream how far we have come. In the 1980s, as I was caring for women who had heart disease in the hospital and in the clinic, I found nothing in the scientific literature to guide my care for those women. We were using therapies and tests that had been validated in middle-aged men — almost exclusively middle age Caucasian men — and applying it globally. We began to see that women had adverse outcomes compared with their male peers and this is why the questions became important. I challenged the organizations with whom I worked such as the American Heart Association, American College of Cardiology, National Institutes of Health, and the National Heart Institute (now known as the National Heart Lung and Blood Institute). People just shrugged their shoulders. As a matter of fact, my chief at the time, who was both one of my colleagues and my mentor, said, “You know you're developing a wonderful reputation as a clinical trialist and clinical cardiologist. Why are you sidelining your career to examine something that is not paramount?” Well, I thought it was paramount, and over time I was able to enroll other people in my vision.
After many prompts the NIH had a conference on women and heart disease. It derived from a workshop that had occurred about six years earlier. It was my privilege to co-chair the conference and the result was the New England Journal of Medicine paper for which I was lead author. The paper talked about women and coronary heart disease, and it was the first time that women and heart disease had been linked in a prestigious journal publication. What ensued was a number of clinical scientists, both women and men, suddenly realizing that there was a huge knowledge gap and that the knowledge gap adversely affected women's health.
What role has mentorship played in your life?
During my career I have had fantastic mentors but most all of them were men. During my time in medical school, I was fortunate enough to have very senior cardiologists who mentored me.
When I arrived at the Emory University School of Medicine as a brand-new faculty member, Dr. J. Willis Hurst, who was both a mentor and a colleague, had a mantra of excellence. As long as I did quality work, I was supported in it. Even though he thought that my venturing into women's heart health was sidelining my career, he supported me just as he previously had. Again, it was a matter of having a mentor who supported something with which at least early on he did not agree. When women's heart health came to the forefront, his comment to me was, “Nanette, I am so delighted that you didn’t listen to me.”
What advice do you have for junior faculty in cardiology?
I’m delighted by the Ludeman Center’s focus on cardiovascular disease because that is the major killer of women. Therefore, we have a long way to go in terms of trying to remedy that problem. The question that I've often asked in lectures is whether this is biology, bias or both. I think it's both.
Again, the Ludeman Center’s support for women studying women's heart health is extremely important. Mentors, both the academic mentors and the community mentors, identify the relevance of the research to the community and relevance of the community to the research and provide guidance. A mentor is a sounding board. A good mentor keeps someone from doing something that would be disadvantageous to their career but other than that it is a forum for discussion. I suspect that having mentored so many men and women throughout my career, I've learned just as much from them as I've given.