The potential benefit of fish oil (omega-3 fatty acids) consumption to reduce cardiovascular disease (CVD) risk remains controversial. Some investigations report reduced CVD risk associated with fish or fish oil consumption while others report no benefit. This controversy is in part resolved when consideration is given to omega-3 blood levels in relation to CVD risk as well as blood levels achieved in clinical trials of omega-3 supplementation and CVD benefit. There is a wide variation in omega-3 blood levels achieved between individuals in response to a given dose of an omega-3 supplement. Many studies tested a daily dose of 1 gram omega-3 supplementation. The individual variation in blood omega-3 levels achieved in response to a fixed daily dose helps to explain why some individuals may obtain CVD protection benefit while others do not due to failure to achieve a therapeutic threshold. Recent development of a population range in a United States population helps to provide clinical guidance since population omega-3 blood level ranges may vary due to environmental and genetic reasons. Omega-3 supplementation may also be of benefit in reducing the adverse impact of air pollution on CVD risk.

Heart Centers for Women (HCW) developed as a response to the need for improved outcomes for women with cardiovascular disease (CVD). From 1984 until 2012, more women died of CVD every single year in comparison with men. Initially, there was limited awareness and sex-specific research regarding mortality or outcomes in women. HCW played an active role in addressing these disparities, provided focused care for women, and contributed to improvements in these gaps. In 2014 and 2015, death from CVD in women had declined below the level of death from CVD in comparison with men. Even though awareness of CVD in women has increased among the public and healthcare providers and both sex- and gender-specific research is currently required in all research trials, not all women have benefitted equally in mortality reduction. New strategies for HCW need to be developed to address these disparities and expand the current HCW model. The HCW care team needs to direct academic curricula on sex- and gender-specific research and care; expand to include other healthcare professionals and other subspecialties; provide new care models; address diversity; and include more male providers.

The American College of Cardiology (ACC) Women in Cardiology (WIC) Leadership Council hosted several sessions in the WIC Lounge at the ACC.23 Annual Meeting with the intention of collaborative discussion toward widening the pathway and furthering the opportunities to include WIC. Some sessions focused on empowering women, supporting leadership and career advancement, protecting women's health, and addressing the barriers in the work environment. Among the ACC members, the United States and international physician WIC members constitute approximately 15% according to the ACC member data in 2023. The purpose of this article is to share the efforts of WIC at the ACC.23 meeting and the actionable items discussed at these sessions toward a leveled playground for WIC and to create a safe space for open dialogue.

Medical education has entered the digital transformation era. The process of transitioning from paper journals to digital contents is ongoing. Scientific and professional societies are adapting to this revolution by implementing interactive websites, webinars, and podcasts and entering the world of social media (SoMe) to provide their users with a multimedia learning experience.

Racial disparities in cardiovascular disease are unjust, systematic, and preventable. Social determinants are a primary cause of health disparities, and these include factors such as structural and overt racism. Despite a number of efforts implemented over the past several decades, disparities in cardiovascular disease care and outcomes persist, pervading more the outpatient rather than the inpatient setting, thus putting racial and ethnic minority groups at risk for hospital readmissions. In this article, we discuss differences in care and outcomes of racial and ethnic minority groups in both of these settings through a review of registries. Furthermore, we explore potential factors that connote a revolving door phenomenon for those whose adverse outpatient environment puts them at risk for hospital readmissions. Additionally, we review promising strate-gies, as well as actionable items at the policy, clinical, and educational levels aimed at locking this revolving door.

Background: Approximately 20% of the population has elevated circulating levels of lipoprotein(a) (Lp[a]), one of the most robust predictors of cardiovascular disease risk. This is particularly true for women. Hypothesis: Many female patients with "normal" traditional risk factors or low atherosclerotic cardiovascular disease (ASCVD) risk scores may harbor high risk related to elevated levels of Lp(a). Methods: A retrospective, cross-sectional study of consecutive female patients presenting to Heart Centers for Women was performed. Discordance between low-density lipoprotein cholesterol (LDL-C) and Lp(a) was determined. The ASCVD risk and Reynolds Risk Score models A (RRS-A) and B (RRS-B) were calculated, and level of agreement in patients meeting treatment threshold (≥7.5% for ASCVD, ≥10% for RRS-A and RRS-B) were compared. Results: Among 713 women, 290 (41%) had elevated Lp(a); however, LDL-C and Lp(a) were weakly correlated (r = 0.08). Significant discordance was observed between abnormal LDL-C and Lp(a) levels (McNemar P = 0.03). There was moderate correlation between RRS-A and ASCVD risk (r = 0.71, P < 0.001), and Bland-Altman plot showed diminished correlation with increased risk. More patients met treatment threshold by ASCVD risk estimation, but nearly 1 out of 20 patients met treatment threshold by RRS-A but not ASCVD score. Conclusions: There is high prevalence of elevated Lp(a) among women presenting to Heart Centers for Women. Although traditional risk markers such as elevated LDL-C or high ASCVD risk may be absent in some women, elevated Lp(a) may identify patients who may benefit from aggressive risk-factor modification and pharmacologic therapy.

The coronavirus disease-2019 (COVID-19) pandemic has highlighted the need to focus on psychological and physical well-being as cardiovascular clinicians who care for patients with inevitably higher rates of morbidity and mortality. The pandemic has offered us a unique opportunity to redress the concept of personal well-being. It is well known that clinicians’ well-being is linked to patients’ outcomes and cost containment. While organizations need to address systemic issues that impact well-being, creative skills can enhance the clinician’s ability to confront stress and burnout along their career by developing behaviors that adjust to new or challenging situations. Individuals should partake in hobbies and mindfulness activities to improve their personal resiliency. Arts have a significant impact on mental and physical health according to the World Health Organization Health Evidence Network Synthesis report (1). In this paper, we share various strategies (Figure 1) we have used as women in cardiology as approaches towards self-care and well-being.

Dear mentee, Cardiology is a challenging and exciting field of medicine, and we share your love and passion for taking care of patients with diseases of the heart, arteries, and valves. We experienced the same awe and wonder of the beating heart and the same desire to help patients with cardiovascular pathology as you do now. You remind us of our first love, the early infatuation of cardiology that has grown and developed into a comfortable passion, like a married couple after many years of marriage. You give us renewed joy in cardiology and make us optimistic about the future of our beloved field.

Sexual harassment is a global issue. It is widespread among age groups, races, genders, cultures, political beliefs, religions, and diverse workplaces. After a thorough review of the social scientific and legal literature, the National Academies of Sciences, Engineering, and Medicine (NASEM) defined sexual harassment as involving 3 components: gender harassment, unwanted sexual attention, and sexual coercion (2). Gender harassment is the most common type of sexual harassment. It refers to a broad range of verbal and nonverbal behaviors that convey hostility, objectification, exclusion, and degrading attitude towards members of 1 gender. Unwanted sexual attention entails unwelcome verbal or physical sexual advances without any professional rewards. Sexual coercion entails sexual advances with status or employment benefits conditioned on sexual favors (2). A meta-analysis focusing on sexual harassment in the workplace has shown that the prevalence of sexual harassment in U.S. academia is 58%, second only to the military at 69%, and outpaces that of government and industry settings (3). The prevalence of sexual harassment in academic medicine is almost double that of other science and engineering specialties, with nearly one-half of all trainees at surveyed institutions reporting harassment from faculty or staff (2).

Medicine is often characterized as a “high-stakes” profession, with an evaluative culture, little room for error, and a tendency to be populated by high achievers (1). From the outset, physicians are trained in a culture that expects excellence and the provision of superb patient care with little room for failure. As a result, when an error or expectation is not met, this can create inaccurate self-assessments streamed with anxiety, guilt, and self-doubt (1). Male and female physicians at all career levels have reported self-questioning and feelings of inadequacy, which tie into the imposter phenomena (1).