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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.

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.

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.

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).

Sexual harassment is a global issue affecting an individual’s work performance by creating an intimidating and unsafe environment. In this article, we address the issues specific to cardiology, provide a brief background on the current regulations in academic medicine, and review some of the programs being championed by the American College of Cardiology (ACC) leadership.

Purpose of Review: Our aim is to highlight some of the current issues that prevent women from getting sex-specific and gender-specific cardiovascular care and provide recommendations for new approaches and delivery models to improve cardiovascular care for all women. Recent Findings: Cardiovascular disease remains the number one cause of death for women in the US. Many women remain unaware of cardiovascular risk factors and many healthcare providers who care for women are also poorly informed and feel ill prepared to assess women for cardiovascular risk. Women’s Heart Centers have tried to bridge the gaps in women’s care between primary care and cardiology. Many of the impediments to care in the current models are lack of comprehensive care and socioeconomic societal limitations. Summary: New models of care and delivery are essential to change cardiovascular outcomes for all women, especially women at high risk.

BACKGROUND: Assisted reproductive technology (ART) has emerged as a common treatment option for infertility, a problem that affects an estimated 48 million couples worldwide. Advancing maternal age with increasing prepregnancy cardiovascular risk factors, such as chronic hypertension, obesity, and diabetes, has raised concerns about pregnancy complications associated with ART. However, in-hospital complications following pregnancies conceived by ART are poorly described. METHODS AND RESULTS: To assess the patient characteristics, obstetric outcomes, vascular complications and temporal trends of pregnancies conceived by ART, we analyzed hospital deliveries conceived with or without ART between January 1, 2008, and December 31, 2016, from the United States National Inpatient Sample database. We included 106 248 deliveries conceived with ART and 34 167 246 deliveries conceived without ART. Women who conceived with ART were older (35 versus 28 years; P<0.0001) and had more comorbidities. ART-conceived pregnancies were independently associated with vascular complications (acute kidney injury: adjusted odds ratio [aOR], 2.52; 95% CI 1.99– 3.19; and arrhythmia: aOR, 1.65; 95% CI, 1.46–1.86), and adverse obstetric outcomes (placental abruption: aOR, 1.57; 95% CI, 1.41–1.74; cesarean delivery: aOR, 1.38; 95% CI, 1.33–1.43; and preterm birth: aOR, 1.26; 95% CI, 1.20–1.32), including in subgroups without cardiovascular disease risk factors or without multifetal pregnancies. Higher hospital charges ($18 705 versus $11 983; P<0.0001) were incurred compared with women who conceived without ART. CONCLUSIONS: Pregnancies conceived by ART have higher risks of adverse obstetric outcomes and vascular complications compared with spontaneous conception. Clinicians should have detailed discussions on the associated complications of ART in women during prepregnancy counseling.

Study objective: To examine the associations of education and income and blood pressure (BP) in a socioeconomically diverse cohort of African-American (AA) women attending community BP screenings. Design setting and participants: This cross-sectional analysis used data from AA women (n = 972) 53 ± 14 years, enrolled between 2015 and 2019 in the 10,000-women hypertension community screening project in the metropolitan Atlanta area. OLS linear regression were used to examine the associations between SES (education and income) and BP after adjusting for age, body mass index (BMI), smoking, and lipids. Main outcomes and measures: Outcomes were systolic and diastolic BP (SBP, DBP). Measures of SES included education [high school ≤(HS), some college, and ≥college] and income-[<$24,000, $24,000-<$48,000, $48,000-$96,000, and ≥$96,000]. Sociodemographics, health history, anthropometrics and point of care non-fasting lipids were obtained. Results: Compared to women earning <$24,000, an income of ≥$96,000 (β = -5.7 mmHg, 95% CI: -9.9, -1.5, p = .01) was associated with a lower SBP in the minimally adjusted model. Subsequent adjustment for cardiovascular risk factors attenuated the association and was no longer significant. College and above versus ≤HS education was associated with a higher DBP in the minimally (ß = 2.7 mmHg, 95% CI: 0.2, 5.2, p = .03) and fully adjusted models (ß = 3.4 mmHg, 95% CI: 0.2, 6.5, p = .04). Conclusion: Income of ≥$96,000 was associated with a lower SBP while a college and above education was associated with a higher DBP. Findings underscore the need for increased cardiovascular risk awareness and education targeting higher SES AA women attending community BP screenings.