By AMERICAN HEART ASSOCIATION NEWS
More than three decades ago, Lori Mosca, M.D., was studying for board exams late one night when there was a knock on her bedroom door.
It was her dad. There was sweat on his sternum. His fists were clenched.
He told his daughter, a second-year medical student, that it felt like he had a vice on his chest. She told him she thought he was having a textbook case of a heart attack. They made it to the hospital. Mosca’s dad was in agony. She was too, as she grappled with life-and-death decisions.
“The thing I remember most about the moment was asking myself, ‘What could we have done to prevent being here in the first place?’” Mosca said.
Since then, Mosca, who founded the NewYork-Presbyterian Hospital Preventive Cardiology Program, has made it her mission to prevent stories like her dad’s. She recently received the American Heart Association’s Physician of the Year award for developing guidelines that have changed patient care and for her steadfast work to improve women’s heart health.
Early on, Mosca thought allied health was the path for her, but at friends’ urging, she switched to medicine, getting her medical degree from SUNY Upstate Medical University in Syracuse. She went on to earn degrees in epidemiology from Columbia University, followed by her residency in internal medicine at Syracuse and a fellowship in preventive cardiology at Columbia University.
From there, being director of the preventive cardiology program at the University of Michigan was an eye-opening experience. Her patients’ simple questions — the ones she couldn’t answer — inspired her research.
“Because I was a rare woman in the field, I had a lot of female patients come to me and ask what to do to prevent heart disease and if they should take aspirin to prevent a heart attack like their husbands did,” she said. “But I realized that I couldn’t answer the most basic questions for women simply because there was no data.”
One of the first patients in her preventive cardiology clinic asked if antioxidant vitamins would help him avoid cardiac bypass surgery, which had been recommended. “In the early ’90s we did not know the answer to that question, so I proposed a clinical trial to test if taking a combination of vitamin E, C and beta-carotene helped make cholesterol less likely to cause heart attacks,” she said. “My patient funded the study and it became the topic of my dissertation for my Ph.D. from Columbia, where I’ve spent most of my career.”
Early on, Mosca was a vocal leader in shedding light on the fact that scarce data on women’s heart health pointed to an urgent need to include women in clinical trials. The American Heart Association Prevention Guidelines for Women were eye-opening, Mosca said.
“We had to make clinical recommendations for women based on data that was generated entirely from men in many circumstances,” she said. “It was just unacceptable. We had to create a new way to designate the limitations of making such recommendations, which I think helped stimulate more prevention research in women.”
This led to the birth of high-quality evidence-based prevention guidelines.
“The great thing about the first women’s guidelines is that they were built on the best science and interpreted by the best scientists, and they have stood the test of time,” said Mosca, who is a reviewer for several medical journals and has written more than 150 scientific publications. “It caused a transformation in the way we practiced medicine and write guidelines. We’re transparent and accountable for our decisions.”
Mosca said the seeds for helping lead a women’s heart-health movement were planted in an unexpected setting — at her high school, when she swam on the boys’ team because there was no team for girls in the pre-title IX era.
She quickly proved she deserved a spot on the team, breaking several men’s records, and was named female athlete of the year. Several decades later, as she worked to build support for the American Heart Association’s new heart-health awareness campaign Go Red For Women, she fought skepticism from prominent men.
“I was well-prepared,” Mosca said. “I knew how to play on a men’s team.”
She was determined to prove that a women-focused movement wouldn’t detract from the larger cause of heart disease.
“If you focus on women, who are the ‘heart keepers’ of the family, you’re focusing on everyone else,” Mosca said. In 1997, only about one-third of women knew that heart disease was their No. 1 killer, according to the American Heart Association. Within a decade of the women’s movement, awareness had doubled.
“Flash back to my father, who said it felt like there was a vice on his chest,” Mosca said. “What if it had been my mom instead and she had said, ‘I feel a little pain in jaw’? Back then I might not have realized that was an acute symptom of heart attack in women.’”
Mosca saw her dream, and the dream of many others, come true in 1997 when she stood on the steps of the Capitol with Martha Hill, who was the AHA’s president. It was the birth of what would become Go Red For Women, a major national movement for women, in 2004.
Since the AHA first tracked women’s awareness in 1997, fewer women are dying every year — from 505,000 a year to 398,000, according to the AHA. And awareness of heart disease as the leading cause of death for women is now 54 percent.
“I’m a triathlete and endurance is part of my fabric: patience, persistence, daily chipping away to accomplish what I believe in,” said Mosca, a Hawaii Ironman finisher. “That’s what I brought to the women’s movement. It took a lot of perseverance.”
Mosca’s mom, who died of a stroke “far too young,” is never far from her mind. But so is her dad, who survived that scary night 33 years ago. After multiple heart events, Mosca calls him “a success story of medical interventions.” At 86, he was able to watch his grandson Michael graduate from Harvard University as the top scholar athlete this spring. Mosca and her husband Ralph, a pediatric cardiac surgeon, also have a son Matthew, who is a cardiovascular perfusionist.
Mosca retired from Columbia just a few weeks ago, but Michael will attend medical school there next year.
“Life is coming full circle,” she said.