Redefining Women’s Heart Health: How Two Doctors are Changing the Beat of Care

Good morning, Christine and Eliza. Yay, I'm so happy to see you two again. We met earlier this year at the HBA Summit and we had such a nice panel, such good feedback. And I'm so pleased that you agreed to be on the podcast with me today. So thanks both for being here.

Thanks for having us.

Thank you, Sabine, for having us here.

Yeah, I feel like we've started a journey together. So I'm excited to see where this is going to go. Christina will see each other next week at another hackathon also on cardiovascular. So we're just excited about this journey. So the two of you, after our session that we had at the HBA summit, everyone was buzzing about the two of you and the energy and what you're doing. So

Yes.

We're gonna jump right into that. But one of the first questions that I wanted to ask you is that when did you first realize that also that women's heart health needed to have its own language and that you needed to step up and you needed to co-found this department that you're working in and the clinic and the research and the visibility of this topic? When did that start for both of you?

Do you wanna, or should I say Christine? You want to?

Christina. Yeah, Christina, do you want to start? Yeah, Christina, you start.

Yeah, okay. Yes, I'm happy to start. Yes, so it's been known for a while that women with heart attacks have different symptoms. That's like an old story. But we got more and more details within the last years about relevant physiologic differences in cardiovascular diseases between men and women. So the knowledge we always had was never translated into any action.

And now as we got more and more data and we saw that specialized care for women with cardiovascular diseases is already established in a lot of countries like the U.S., like Netherlands, where Lisa is from, or Germany where I'm from. We realized that we also need that in our Basel area where we work at the university hospital. Because also in clinical reality, we saw a lot of women who had complaints like cardiovascular or unspecific symptoms for a long time.

and they were presenting again and again in the emergency department, in the cardiology department, and nobody really took care of them. And sometimes they also came late and had already scars in the heart and reduction of the heart function. So we thought, okay, it's really time not to talk about sex differences anymore, but to take action to found this clinic.

And we were very happy that our chief of department, Professor Felix Mahfoud, helped us establishing it and was giving us the possibility to do this and gave us the drive and all the logistics to set up this clinic. so yeah, we started more than a year ago and it's crazy how many patients we see and how much we reached in this one year.

And maybe tell us a bit about that. That's where you are now. How did you get there? How did the two of you meet and decide we need to go on this journey together? Maybe each of you can share it Liza. You can start just tell a bit about why did you decide to go into the cardiovascular care and how did you end up where you are today?

that's a long one. The cardiology itself, you mean, I just found it the most...

That's it.

Yeah.

fascinating field. like that it's that you do your own diagnostics, that it's rounded field, that it's one organ. That's also what I liked. maybe it sounds silly, but also kind of out of a romantic point of view. It's the heart. I always thought that's the neurologist would say the brain is the most important organ, but I would say the heart is the most, that's the engine.

where everything evolves around, so where most songs are written about, so I just found it exactly so, yeah. And there were different diseases that I also found extremely fascinating, like a broken heart syndrome, which...

an endless number of songs.

happens when you have an acute amount of stress, mostly in women also, and you can just because of a big amount of stress, you could have a disease where it looks like as if you are having a heart infarction, but you don't. It's a temporary...

where part of your heart muscle just doesn't function anymore and it can be very dangerous of course. But then if you...

If you treat it well and if you reduce that stress trigger and you look at the heart again in a few weeks, then it looks like nothing ever happened. And that I found fascinating that our emotions, our brain is so connected with our heart as well. So there's just so many things that I find fascinating about this.

this topic. yeah, that's how I got in it. then, well, just, Christine and I just connected on general things and then we started talking about the future here in Basel and then we found out that we have the same interest and the same passion for this topic.

And we thought like, yeah, let's see if we can build something. Let's see if we can work together on this. And it's been great, I would say. Great that we could support each other in this way. And also, I really believe that we could have never reached so much in this year if we wouldn't have cooperated so well together. When I'm...

Bye!

When I can do something, she fills it in and vice versa. And it's very nice that you can just talk about what's your next step, how are we approaching this. There's a lot to do.

It's really nice to do this together with someone that has the same amount of drive, the same amount of positivity and yeah, it's been great, I would say.

Yeah. Christina, what about you? What drove you or was your guiding light to come to this profession?

Yes, I think similar like Lisa, I always wanted to be a medical doctor when I was three years old. It began and then it never stopped. And I was fortunate enough to get the possibility to study medicine. And I also think like the heart is like such a central organ. And it was always fascinating me throughout the studies. And yeah, so sometimes it's also kind of like fortune or luck in which kind of environment and department you come in.

I had really nice colleagues in my old university where I worked for 12 years. And there I already started to have interest into women's heart medicine. And we didn't have a specialized clinic in the beginning, but I was the one responsible also to educate the female population about cardiovascular risk, about the specialties in women. I...

always had such a nice feedback from the ladies. I had the feeling I really can move something. And when I then came to Basel, I got to know Elisa. yeah, Elisa, she was also active in this field in the Netherlands already. And then we said, okay, this is missing here. And we met every day when we had our morning rounds and there were a lot of situations when we saw that, there's a patient and again, it's a woman.

who had unspecific complaints and she comes now with a big myocardial infarction. then Elisa and me, we always said, okay, that's another case and we have to do something, we have to start it. And yeah, and then we just put it into reality and yeah, now we're really happy to offer this care to the women and we have a lot of nice feedback and yeah, we really hope that we can make a difference.

Yeah, yeah, you definitely are. And it's interesting to hear so that you started to compare notes. So was there this moment, especially looking at the patients, was there like this final one where like, okay, we need, now we need to do this. Sometimes we think about there are these aha moments and this is then what we need to do to move forward. Did you have that or was it a progression?

Yeah, so I had a moment when I already had met Elisanne, we had already like drafted what we want to do and I work a lot also in the echocardiography department and I saw a woman, she was like in her mid-50s and she came to ultrasound, she had a myocardial infarction and I saw that like a significant proportion, like almost third to half of the heart was not pumping anymore because that was the scar that resulted in that big myocardial infarction.

And she told me, she was at home and she was just feeling unwell. She had like vomiting, dizziness. She was very like sleepy, tired. then she went to her general practitioner and told him and they thought, okay, it might be like an infection of the GI tract or like something unspecific. And then it went on and on for like...

four days and in the end she couldn't breathe anymore and she was feeling really, really bad and then she came to that hospital in the rural area and then they found out, okay, there's something really wrong with the heart and she was transferred then to our university hospital and I saw that it's really late, like the part of the heart that has not been supplied with blood was already dead, it was like a scar and I thought, my God, and...

In this time where we live now, where we have a lot of data, this should not happen. And that was really like, again, like kind of shocking for me and also like an emotional thing to tell her, okay, see, there's like a big sky on your heart and you will have heart failure. You will need medication. And of course I want to give her hope and do we have good treatment for this condition? But that was kind of a turning point. And then after this, I called Elisa. said, okay, so now is the time you have to do something. I had another woman.

came so late and I think for me that was kind of a turning point to see this like in 2025 to have a 2024 it was to have a woman coming so late.

Yeah, it's shocking, isn't it? And we always, I think we had some conversations about this as well. And you hear it all the time, if it were a man, would he have been treated completely different and rushed off to the hospital? yeah, the awareness piece, I think, is obviously the work that you're doing, but also the awareness piece is so important too, that women really hear this and they don't put themselves aside and also devalue their symptoms that they're having.

and they think, I gotta keep going. I have to keep moving forward. yeah, so such an important piece, yeah.

Yes, absolutely.

or don't recognize their own symptoms because in this case I think the woman just didn't recognize it because they were not standard symptoms. I also think it's not unwillingness of doctor to not recognize. Every doctor wants to treat their patients as good as they can.

Yeah.

Mm-hmm.

But it is sometimes difficult if a woman has really... I would say not... I cannot say unusual because... just complains that you don't learn as being standard. And also for the woman themselves, they have to think also there's something wrong. So it's from every level.

Yeah.

patient level and from a doctor's level.

Yeah, so true. That leads me to actually two questions. So maybe I'll try to combine them into one. So tell us a bit about the clinic, Lisa. How did it start? How did you two decide to do this together? Because I think that that's an important point to talk about to encourage also other women who who could be in a similar position and say, I don't want to lead a department by myself. I want to, I want to work with someone else and push this forward. How did you decide to do this? And,

to your last statement about not recognizing your symptoms, do you also have educational programs as part of what you're doing?

Yeah. Let me see, where do I start? Yeah, it's okay. So why?

I didn't need to hit you with two questions at once.

I think if you start working together, it's very important that you one, trust one another and that you have a greater goal as your goal. Not I want to do I, but...

a common ground that we have a goal to make the lives of certain women in our area a little bit better. And if you go for that common goal, then it's also, yeah, it's also, I think that's the best way because then, yeah.

the we.

It's not as important who does what. It's just who's on the forefront. We do this together. We are equal in this and I think that's the most important. We also, I am looking for the English word, I know the Dutch word. It's like you want the best also for each other. So if something is good for Christine and...

it will cost me time, I would do it, and vice versa. If that is what helps our program further. So that's one point, and I think we said from the beginning if something...

bothering us, we would address it, we are very open in our communication, we can say honestly if something is not going well or and I think that's also very important, definitely for women important to be upfront about problems and not so that's one thing I think works very well if you want to start you just have to be very honest and clear in your communication.

When we started our, before we started our clinical part, what we did is we looked at which players are very important for these women. So which other, we are not just one field. So we also work together very closely with say the gynecologist, with the rheumatologist, with psychosomatic. So what we did was

built like a group around us when we started before we saw the first patient going to different departments and saying this is we, we would like to cooperate. If you see this type of women, you can send this to us. We are always available for call to discuss a patient and that worked out really well. That cooperation also with different departments, not just looking at the heart, but looking at the woman as a whole.

that's our absolutely our strength and also not just looking at the clinical part but doing it as a full program so we do clinics we do research and what you just said your last question is we do teaching this afternoon I start a new program also for students to look at

differences in sex and gender and cardiovascular disease and this was because teaching is also part of our profession and we both teach, Christine and I, and I had the last session, I had a teaching about a man with chest pain and it was...

Classic, classic risk factors, classic how it developed first. He had just been with exercise, then in rest. He had diabetes, he was smoking. It was a clear-cut case. And then I thought, yeah.

It's not that difficult. you would put it in as a patient in Google, you would find this too, but patients are much more complex than that. They don't all have standard classical risk factors, standard classical stories. what they learn is exactly what I was taught 20 years ago. So even though all these changes happen for 30 years of research in this

Yeah.

field and awareness campaign still we teach our students exactly the same pictures exactly the same things as

same.

I was taught 20 years ago and that's also why we thought okay we need to address this and change this also in students. We still need to learn that a man that comes in with a high-risk profile and chest pain that you have to be super careful that he doesn't have a myocardial infarction. Of course that's the basis you also have to teach that.

Yeah.

Absolutely.

But you also have to teach students to think that if a woman has a different risk profile that you don't see her as low risk, you have to recognize that she could have different risk factors, such as diabetes during her pregnancy or autoimmune disease or extreme stress. All these things you have to take into account when you see a woman

or a man in the emergency department. that's our own experience led to develop this program and again in every step we do we do this together because it's too much to do by one with one person.

That's true. And the different perspective, because I think each of you obviously comes in with that and that just makes makes like the traditional one plus one equals 10. What you all are doing. It's incredible. And you're right, the educational piece is so important. It really is shocking to hear that that people are still being taught the same way as it was 20 years ago.

Yeah.

Like we are like in warp speed with research and information and awareness and what's happening. And it's shocking that that's still happening. So it's so important that you're doing that and tying along with the research and the patient care with the teaching. And I think too, sometimes it's the time to do it because looking at someone holistically can take time. And sometimes I think our systems, in Germany sometimes I feel like I'm pushed through.

So I think that that's an important piece too, is to, that especially doctors take time to hear people and to look and to listen. And yeah, to do that. So yay that you're doing that for all of us that are potential patients to push that thought through.

That's absolutely a really, really important part of what you're saying. And that is that we...

Most doctors are overstressed, overworked. We see a lot of patients and you need to take time to figure history out and figure out when certain complaints started, why someone is coming. And it takes time. And time often that is not given. So it's not...

Mm-hmm.

I wouldn't say a fault, it's just we are lucky that we can spend this time with our patients to talk to them.

Absolutely. but we also like hear a lot of times like women saying, yeah, you're the first doctor who looked me to the eye when he or she was talking to me because normally they sit on the computer, have five minutes time, type everything. And we currently have the luxury to have very big slots where we really have time. But that's also because the women who come to our clinics sometimes are complex. They have a complex history.

typed.

They've been to many doctors, they have unclear symptoms, unclear diagnosis. And so yeah, we are lucky to have this time. And I think the time is good invested to make a thorough medical history because then we are much faster in doing the right thing for the patient, selecting the right diagnosis, the right therapy. And also then we...

don't give the chance that they come back again and again and again. So we want to stop this, that patients are coming again with like different unclear symptoms. We take the time, we want to thoroughly work up the things and then give like our medications or like the things they need. Yeah, absolutely. Yeah.

Yeah.

And I think that saves time in the end. If you do one time very thoroughly and I explain everything detailed to the patient, next time I only need instead of a half hour, I would maybe only need five minutes. The first moment you need to invest time to explain what they're experiencing, what they're feeling, what kind of test, what it means, and then it's easier. And it's not just, yeah, it's of course we are

It does. Yes, exactly.

Yeah.

Mm-hmm.

Mm-hmm.

lucky but it's also it won't happen. This doesn't happen if you're not supported by your own department. If your department doesn't see it, if your chief doesn't see it as important that you invest this time in it then yeah then there's no availability either. yeah it's very important that if you start a program it's also well supported by your department.

Yeah.

Yeah.

That's actually a good segue, Christina, how did you get the buy-in for this? How did you get the ability to set up the department when you had the time, that you had the support? How was that journey? Was it difficult? Was it easy?

Yeah, think it depends a lot on the structures in the department and also of the people leading the departments. If they see that there's an unmet need for the women, in our case, our boss was supporting us right away. He knew these structures already also existed in Germany, where he's from. And so he knew that these women's heart clinics are really important, that it's important work for the women.

And also that it's a holistic way of seeing the women, also supporting them psychosomatic support and rehab support, et cetera, looking for hormones and all this stuff. And so I think we were really very lucky. We made a small concept, Elisa and me, we presented to him what is our plan and that it's also including research and education. And yeah, I think he supported us right away. And then we were really like,

free to set up the clinic in the way we wanted. yeah, for us, it was a very good start. Of course, it's a lot of work because if you start from zero, you have to design the letters. You have to look which secretary helps you planning in the patients. You have to see, write the research plans, get funding and talk to the university how you can implement gender medicine and cardiology into the student lectures. And yeah, it's a lot of work, but it's also fun.

gives you a lot of energy back if you see, okay, things are improving, things are going. so yeah, with this co-leadership, it's also like a perfect thing for us. I think it doesn't work with everybody, but with Elisa and me, it's absolutely perfect. From my side, I could recommend this to everybody to look for a partner in crime. Yeah, yeah, absolutely. also you have to like each other on a personal level because you spend so much time with each other.

Thank

It's like your business wife.

Yeah.

more than your family probably because if you work full time you see your family in the evenings and on the weekends. So yeah, in our case it's really perfect and I don't want to miss this and yeah, it's absolutely been great.

Yes, and it's also that what she says, know, have to, also, if you want or not, you will spend some time also in your free time working on it. If things have to be, there are deadlines that need met. yeah, that is, it is a fact. And then also in your...

Yes.

discouraged yourself or it takes time or you're overwhelmed with how much there is to be done. It's always good that someone says, no, come on, you know, that you remind each other why you do this and also that you say like, okay, let me take this and yeah, you help each other out. I think that's also very important. And yeah, we both know.

Yeah. Yeah. And we don't count who's doing more work. We just look for the situation. When I know, Lisa, she has like a student lectures now for four hours this afternoon. If then there's something left, I can jump in and the other way around. So I think that's very important to offer you help and not to count like she did this and this so many hours for this. did so many hours. And yeah, that's, I think that's the key of our success. Offer help and yeah, support each other.

Yeah.

Yes.

Yeah.

Exactly. Yeah.

Yeah, but yeah, do get like my daughter is like, is that Christine again on the phone?

Yeah.

That's true. But it is the we, and I think that that is also the collective good. think when we go in our, sometimes our worlds and we just think about I and what I'm doing, it can't, it can not be as productive. And to have someone else to partner with and to brainstorm with and to have ideas with and to

to celebrate in the successes with as well, because then you start to pull other people along with you. So it's the two of you, but what you're growing is incredible. And I think, hmm.

Yes.

Yeah. And it's also complimentary because Elisa, she's more coming from the interventional side. I'm more coming from the non-invasive prevention side. So it's also like a good complimentary thing. So the skills she has are addition to my skills. And that's also good because we are, profiles are not one-to-one the same. So that's also like, I think very important. Yeah. Also from the personalities that like one person is

perhaps like more representing this in the side, the other one like more the open side. And so I think that's really also for our patients, you know, so sometimes they see me, sometimes they see her. And so they see different kinds of personalities and different kinds of views. Of course, we have the same thinking about the woman's heart health, but like the approaches are a little bit different.

That's also nice. I think it's complimentary. You don't have to be one to one the same exact person, personality to be a co-leader.

Yeah, no, not at all. Actually, the differences are what make it more powerful. You're absolutely right. And we've talked a bit, you've shared about you do, so you do educational programs, you obviously treat patients, but you also do research. And Christina, I'd love to hear more about some of the research that you're doing.

Mm-hmm.

Yes, so we are very interested in small vessel disease in women and from the cardiology perspective women suffer more often from microvascular dysfunction in the heart meaning that the very very small vessels in the heart are narrowed, have endothelial dysfunction meaning they cannot like dilate so good and

That's also the kind of myocardial infarctions that women suffer more from compared to men. Of course, they can also have the classical one. And these small vessel disease is something that is very important also from a diagnostic point of view, because we can in the hospital now offer diagnostic procedures to have a special look in these vessels. And our idea is, Elisa and mine, that this small vessel disease is not only affecting the heart, but it's like a systemic.

disease like a systemic problem also affecting the smallest vessels in the brain. And what we see in the last years is that dementia and cognitive impairment in women is rising a lot. The mechanisms are not completely clear now. And we have hypothesized that women who have a problem in their small vessels in the heart may also have a problem in the small vessels in the brain relating to cognitive impairment.

to silent strokes, to anxiety, to depression, et cetera. And we want to see if we can see this link also by investigating the eye. Because in the eye, there are also very small vessels visible if you make like these eye diagnostic. And so our idea is that this small vessel disease in the heart is reflected by the eye. The eye can be like a screening tool, also like to offer a window into the brain.

Mm-hmm.

and to reflect these small vessel disease in the brain, which eventually can cause cognitive dysfunction in women, which we also want to prevent, of course. So that's the this link, mechanistic link and pathophysiological link we want to explore in our prospective study.

Can I say something off screen? That's not on screen. That's not on...

You can say anything.

wait a second then, let me...

That's okay, I can cut it out. I'll cut it out. So you can say, we'll stop.

Is it too much detail? So that nobody steals our idea.

Yeah, we're just into, if we would be at the end of our research thing, it wouldn't be an issue. But if it's so specific and it's at the beginning, it would be a problem even.

that other groups might get the idea. So let us say it a little bit more.

Yes, even financing, I mean, it's not that I don't want other research groups to do this, I do, but it will jeopardize our...

Yeah, okay, okay.

Yeah, you're right.

because it's our original research idea. So then I can say it a little bit more superficial, are investigating the connection between small vessel disease and heart and brain and... Okay, yeah, so then I'll say it again.

horse.

Yeah.

just read that there is a If you say how exactly, would you mind? Sorry Sabine.

Right. Yeah.

This is, I'm, no, not at all. This is fascinating. my God. Are you, have you already started trials and anyway, yeah.

No, no. Yeah.

Yes, that's why we're just at the beginning and that's why we are at a very vulnerable stage as well and it could jeopardize the whole finance of the project. That's why.

Yeah.

Yep.

Okay. Mm-hmm. Okay.

Okay, yeah, okay, so I say it again then, yeah.

Absolutely, yeah. Okay, so I'll ask the question again about the research and then you can keep it.

Or you answer, Alisa. Perhaps you can say it a little... Yeah.

No, it's fine. You really are fine. Go on. Just leave out that there is, that we think that there is a connection and we'll explore it. That's it.

Yeah.

Yeah.

Yeah, yeah, yeah.

Okay, great, yeah, let's do that. Okay, so we've talked about that you're doing amazing things on education. You are also treating patients, which is crucial, but you're also doing research. So Christina, can you just give us an idea about some of the research that you're doing?

Yes. So, Elise and me, are very much interested in small vessel disease of women because the small vessel disease, so-called coronary microvascular dysfunction, has a high prevalence in women compared to men. And in our research, we want to explore the heart-brain interaction, the heart-brain connection to see whether these small vessel diseases are also reflected by brain abnormalities and also translating them in...

perhaps cognitive impairment, depression and anxiety. So we're very much interested in that hard brain link in small vessel disease in women.

Are you getting the support as well? do you feel that often, met a VC yesterday and we were talking about investment in women led research. Are you seeing any challenges in that or do you get the support and the funding that you need?

Yeah, of course we have already gotten funding for our study, luckily. And I think if we explain the topic very well, why it's needed, why it has to be done, I think then also some foundations are really interested and support us. They will be very happy and very lucky. But of course, this has to be said on a broader basis. And I know that like...

Thank

Many big studies currently are led by male teams and also like the studies that form the guidelines are often led by male teams and it's known if more women are authors in guideline based papers then also more questions on gender medicine will be answered and also more other women will be included as authors. So I think there's still a lot to do but in our project we're very lucky that we already got some

some funding, of course to make it a bigger program we even need more to like the more funding we get the more questions we can of course answer, but we have now a very good starting point I would say.

Okay, so this is a great opportunity. Whoever listens to this, reach out if you're able to do any funding. Yeah, very interesting. But if you look at, if we look at women and how they are diagnosed, how they are diagnosing, we're not diagnosing themselves or how they're aware of symptoms, what would you say are some of the most, yeah.

Yes sir.

actually, I'm going to stop that. Blah, blah, blah. That question went off into like, don't know where that went to. I want to talk about symptoms. I want phrase that. And because I think it would be a great platform to help to do a bit of like a mini education on some of the symptoms that women need to be aware of.

or perhaps also the risk factors. Because symptoms, think we already said in the beginning, perhaps a combination of both like symptoms, risk factors.

the risk.

Yeah.

That's also, we also kind of slide right.

We also like the menopause and...

Yeah. But maybe if we could summarize it again, because we've talked through that. So maybe just to do a few, a few keywords. Okay. So Aliza, do you go by Aliza or Eliza? I don't know. Cause I want to say Eliza, but I think Aliza. Yeah. Yeah. Okay. Okay. All right. So Eliza. Okay.

I don't even know myself. It depends on where I am, which country, or if it's in Dutch or if it's in English. I don't really care either. So it's how you want. Sorry.

Yeah.

Yeah

So Eliza, we've talked a bit, we talked about some of the symptoms because it is so important that, again, you're doing educational programs for women. But if you were to summarize and look at some of the risk factors that women should be aware of, could you do that in a few sentences for us?

Yes, hormones, estrogen plays an important role in the risks of women. So up to menopause, they protect us. And what women are often not aware of is as they enter menopause, the hormones that used to protect us then are gone. Your hormone level drops to before your puberty, different than

In male hormones they just really slightly and just go down a bit. In women it's a big change in hormone levels. that is also the moment where you become, you get a higher risk for heart disease. So that's also the moment where...

as a woman you should definitely know what is my blood pressure, what's my cholesterol, what's my... go to your GP and know your numbers and take good care of your health of course. That is one big moment. Another thing is pregnancy.

pregnancy-related high blood pressure, pregnancy-related diabetes, those we know that relate to a higher cardiovascular risk later in life. So if you had that, know that you can discuss this also with the doctor that you went to. And I think it's also important to have a good follow-up in those women. Also in your risk factors.

checked out well. I think hormone shifts are a big thing and another risk factor which is more common in women is autoimmune disease. We know that they are also, if you have an autoimmune disease you are at high risk for cardiovascular disease and that's good to keep that in mind. That's also why we

like to cooperate with rheumatologists for example in this. I think that's the important risk.

Yeah, that makes so much sense. Especially, I have to think back to when I was growing up. My mother was like, we cannot take hormones because we're all going to get the study that everyone refers to. And then I think my mother's generation is very much still into to say, no, you can't take hormones because you're going to have issues with breast cancer. But actually, it's such an important thing to be aware of that.

that hormones aren't necessarily the big taboo as what they used to be. And that we need to talk about that. We need to think about working and taking hormones. And that's why it's fantastic. Also working with the gynecology department obviously makes a lot of sense that you're doing this holistic approach.

Absolutely.

And it's very, that is very, very important that more research is done there. Because there has been big studies but not performed very well. The studies that were...

done and which concluded that could be dangers were done in women that were 10 years past their menopause, that had already risk factors. So we need definitely more studies there. you can definitely take hormones. just you have to really look at to which women you prescribe them.

Thank

What kind of risk profile do they have? Do they start very young in the menopause or not? Are they still in the window of the 10 years within starting menopause? All these add up to is it beneficial for you or could it harm you?

It's very important to look at it with more nuance and not just say hormones are bad or hormones are good. No, it really depends on your complaints, on the women, on your background, on your risk profile. You have to take all of this into account and we absolutely need more studies in this as well.

Yeah.

Yeah.

Yes, and we make a risk stratification in the women who have cardiovascular risk factors and who want to take hormones. There we have to look very in detail if they can take it, what kind of hormones they can take, transdermal, bioidentical, etc. These are the newer hormones that are also not tested in these old studies where it's always referred to. But I also agree with Elisa, we have to take a very differential look into the women. We cannot in general say you cannot or you...

Yes.

you should take hormones, it's an individual decision based on the cardiovascular risk profile.

And based on how much complaints also she had, people forget that it can be disabling the amount of complaints some women have. It can stop you from working normally, living a full, joyful life. So, yeah, you really have to take that into account too.

Yes, of course. Yeah.

Yeah.

Thank

Yeah, absolutely. Again, this holistic approach, looking at everyone, taking time. We were talking about taking time a little while ago. And I have to think back, there's this, when we were growing up in school, we always heard you should spend the most time, if you want to cut down a tree, you need to spend the most time sharpening your ax. And then you'll be able to chop the tree down much more efficiently and faster. And I think it is, I'd just like to really reiterate that again.

whether it is about yesterday we were having discussions about protocols for clinical trials, how sometimes enough time isn't spent on those in the beginning to make a really excellent trial moving forward and how much time can be saved and money can be saved. If you spend the time on the protocol, get great end points and really think about what you're doing in the clinical trial. It's with this too, it's spending time with patients in the beginning can have such a huge impact later. I think that that's with so many things that we...

We are at warp speed with everything that we do, but sometimes it's a really good thing just to stop and to breathe and to look and to really see people and to look at them as a full being and not just one symptom. And I think it's amazing that you're doing that and that that's what you're pushing also with the people that you're mentoring and the programs that you're putting together, the people that work for you, because that is going to have a ripple effect. This is called Be The Ripple Podcast.

this.

you all are starting these ripples and that's just such an incredible thing. I'm so proud to have gotten to know you. I'm so pleased that our journeys have crossed. And you know, this podcast has been about you, the research that you're doing, the work that you're doing, but it's also about two women working together and building something that is unusual. Starting a department, working together, supporting each other.

Thank you.

Thank you.

for a greater good. And that is just can be such an inspiration to other women out there to do this. You don't have to take the typical route. You don't have to do, you know, what we're told to do is how a department is run. You're setting, yeah, you're breaking and setting trends on how to do that. So thank you both for doing that. It's an incredible thing.

And if you think about the future, what's your hope? What do you see? you hopeful of the future? There's so many things that are such challenges that we have to deal with. But if you look forward, what do you hope for your department and where do you see yourself and the department growing?

So in general, I think in a general medicine perspective, I would be very happy if these gender and sex differences are taken more into account in studies. Of course, we always have data like subgroup analysis looking on differences, but sometimes they're not powered to give us really results that could change any guidelines. So I would be very happy if these aspects are more taken into account if studies are adequately powered.

to show what is better in women, what is better in men, what is better in other genders. So I think that's one basis because if we don't have these data, we can also not recommend sex specific treatment in cardiovascular medicine or also in other fields of medicine. So I think this is very important that this is taken into account. Then of course, all the gender differences in cardiology, we are aware of, we have to transfer this.

to the new generation of doctors, to the medical students, but also to the younger doctors. And that's what Elisa and Mia are also trying to do in our research group, in our department group, to transfer this knowledge, to show them the differences, to also show what kind of impact you can make in these women. So I think these are two factors that are very important.

I think it's very important that women cooperate more, that they see that they can support each other, that they are not a threat to one another.

they can go and have a beer, a glass of champagne or something. But yeah, whatever they want. And that's why we organize also these dinners and these events, because I think it's a two-way thing. One thing is I think we should be...

Whatever they want.

supportive of each other and cheering each other on. That's one, otherwise you won't make a change and that's one part and the other part is that you do this together with the men, men in your surroundings, in your department because you need...

You need them as much as you need any woman who's supporting this topic. You won't make a change without them. You need to do this together. that's also what makes me hopeful that I see these things, that I see that the women want to cooperate together, want to support each other, and that I see that we get great support from the men around

as well and that's the change we hope to make.

I also think on the one side we want to improve the medical conditions in women with cardiovascular diseases. We want to improve healthcare, but we also want to improve careers for women in medicine and in science. That's why we have planned a very big symposium in Basel on the 15th of December, the Women's Heart Symposium Basel, where we focus on both things. One, the medical side.

Yeah, definitely.

where we have top speakers, international speakers, where we see the medical side, including gynecology, endocrinology, neurology, et cetera. And on the other hand, we also have roundtables and discussions planned to see young women in clinics and science, to give them role models, to show them what can be done to get a very good position to be...

be an author of a very important trial, like to cooperate, to spread your network. What are the tips young females and of course also male doctors and students can be given. And so I think it's a combination of both and we're very happy also to see everybody who's interested in Basel in 15th December on our symposium.

Fantastic. Networking is the key thing, isn't it? And how to network well. Have you had to adjust how you network? Is that something that you've learned? it come natural for you? Because that's key in what you're doing, right? You need to build that network to grow all of this.

Yeah, I think we both knew that this was important and we both did this before starting this Women Heart Program, but it's been, I think...

exponentially increased. So we are very, very much aware of how important it is to have this network and to have connections and support. And we again also got advice from other women in this field like

which is a pioneer also in the states who set up this, who has a women heart center and also explained to us how important these networks are. yeah, that's also what we try to teach the next generation that it is very important, as important as every other...

it is.

part that we do as the research, as the teaching, it's important to build a solid network of supporters and also critical people because we need those people as well. We need also to have critical people because that will teach us what's wrong and how we can improve ourselves.

We need each other.

We are also kind of overwhelmed that we got to know all this big network of women fighting for the same thing, for equal care, and also from the HBA side, and so many people, foundations and circles and groups we know now. So that's really nice to see that we can connect with them.

So that our message is spreading. That's just really wonderful to see. I would not have expected this, from so many sites, women are coming and also males are coming to support this topic, to close the gender gap. yeah, so we're very happy about this.

And I think what I want to say, what for me personally is very important, it's not just by closing the gender gap, it's not just about women, it's also about men in the sense that...

We know, for example, that men suffer from depression in a very different way and I believe if there was a program specifically for men to deal with this or, yeah, so they get better treatment, then...

I would fully, fully support this. It's not about men or women. It's about getting the same outcomes, being recognized when you have different complaints, recognizing your own complaints, that it just is more equal, I would say. I think that's important. So I would celebrate any initiative where if it's in the

Yeah. Yes.

disadvantage to men that they would get like more research and a special program in this done too or more support I would absolutely so it's not just for me just of course it's part of the program is women empowerment of course that's but on the other hand we just want good care for all and yeah

what we want for everyone. Yeah, so true. Well, thank you for bringing that to us all, bringing better care and raising awareness and teaching and research and everything that you're doing. As I said in the beginning, I'm so happy that our paths crossed. I'm happy that they're continuing. Christina,

Alisa, you can't be there next week, but we're going to be at the hackathon. So Christina, thanks for that. That I think is going to lead to bigger things as well and raising more awareness. It's the first step of a journey that we have, especially within the HBA. So there's so much to do and you're right, we all have to do it together. So thank you both for the incredible work that you're doing and yeah, look forward to seeing you soon.

Yeah, thank you. Thank you for giving us the platform also to present our ideas and our message. So thank you very much from our side.

Thank you. Thank you for having us. Absolutely.

Yeah. All right. Thanks.

Thank you.