Top Docs Q&A: Paula Johnson

This post is part of our Top Docs Q&A series where we ask a physician who was selected as one of our Top Docs questions about their field, life as a doctor, and practicing in the Greater Boston area. 

Name: Paula Johnson

Hospital affiliation: Brigham and Women’s Hospital

Title: Executive Director of the Connors Center for Women’s Health and Gender Biology; associate professor of medicine at Harvard Medical School

Field: Cardiology

Specialty: Heart disease in women; women’s health research

Paula Johnson is the Executive Director of the Mary Horrigan Connors Center for Women’s Health and Gender Biology, and she is also the director of the Center for Cardiovascular Disease in Women at Brigham and Women’s Hospital. Johnson’s research focuses on gender differences in cardiovascular disease, and she is known as a pioneer for gender equality in health care and research. On March 3, Johnson co-hosted the first-ever National Summit on Women’s Health, which raised public awareness that biomedical research needs to be more gender specific. 

Why did you choose cardiology?

When I was training in internal medicine I had phenomenal role models in cardiology. I also had a very significant interest in the research end of cardiology, which for me was focused on how do women, men, and minorities experience cardiovascular disease differently and how is their care impacted. It’s really only been in the last 20 years that this field of understanding sex differences in medicine has developed.

What do you love most about the field of cardiology?

Part of what I enjoy about this field is that the work we do has a significant impact on the population, especially considering that cardiovascular disease is the number one cause of mortality for both women and men. Also the whole area of studying and understanding sex differences in cardiovascular disease is at a point where it has the real ability to be translated into clinical care, which is also very exciting because that’s a relatively new area as well.

How has cardiology changed in the two decades?   

The field of cardiology has evolved tremendously in terms of what we understand today about prevention and treatment, and overall there’s been a tremendous amount of research in the field. Particularly in the area of sex differences, we have discovered how women and men experience heart disease differently. This is in terms of symptoms, what it look like from a pathologic standpoint, differences in risk factors, how to diagnose the disease more appropriately in women, how women experience the disease differently, etc. All of that has been discovered I’d probably say in the last 10 years or so.

What are the latest advancements happening in this field?

I would say there are a lot of advancements on the understanding of what actually leads to cardiovascular disease. There are also tremendous opportunities and advancements in all of the subspecialty areas. In my specific area of women’s health [the latest research] is really about understanding of how risk develops over a lifetime—that’s from the fetus, to the child, to the young women, and onward—and how those differences in risk impact cardiovascular disease. This will then help us figure out how can we better treat it, diagnose it, and prevent it.

How does heart disease look different in men and women? 

For example, in ischemic heart disease, which is lack of blood flow to the heart, women can have different symptoms. Although women and men both experience chest pain, women can more frequently experience shortness of breath and upper abdominal symptoms. We also know that if you experience certain diseases during pregnancy, like preeclampsia or gestational diabetes, then not only are you more likely to get cardiovascular disease, but you are more likely to get it at an earlier age. Also we now know that sometimes in women the plaque in the arteries is laid down more diffusely than in men, and so women may require different tools [to examine their arteries] like an intravascular ultrasound.

What do you hope for the future of cardiology?

I think the opportunity to really prevent disease. This is going to really take not only understanding the sex differences but is also going to require understanding the important contributions of behavior and environment. It’s really going to be a complex scientific endeavor to fully understand that, but I think that’s the promise. If we can prevent the number one killer of women and men, imagine what we can accomplish.

In your TEDtalk you mention multiple times that “every cell has a sex,” how does this affect the way we look at biomedical research? 

The whole point is that women have two X chromosomes and men have an X and a Y, so down to the cellular level we are different. This means we have to do the research differently. If you are doing stem cell research you have to know which sex your stem cells are, or if you are doing animal research you have to know the sexes of the animals. It’s just important at every level. It’s important in clinical trials not only to include women but to include women in adequate numbers so that we can understand how whatever you are testing impacts women and men differently.

On March 3, you co-hosted the first National Summit on Women’s Health, what did it accomplish? 

It went very well, and I think that there’s a significant momentum in this area. There was very significant coverage of the summit report, which will help raise awareness amongst different sectors of the population. Also Senator Warren, who was there at the meeting, vowed to really address this issue from a legislative standpoint. Dr. Rita Redberg [editor of JAMA Internal Medicine] has also made changes already to her editorial policy. Overall, we had multiple sectors together; academia, advocacy organizations, legislators, etc., and the point now is that those different groups go out and take on this issue in their own way.

What are your hopes for the future of women’s health research?

That sex is considered in all forms of research, everything from stem cell research, to research in physiology, to animal research, to clinical trials, and to evaluation of health systems. We also must analyze our data to understand the impact that sex has, and to understand how sex may also intersect with other variables, and this must be done routinely and without exception. Today that’s just not the case.

What is your favorite part about practicing in Boston? 

It’s an incredibly stimulating place to be; there’s tremendous strength academically as well as clinically. I have phenomenal colleagues and there is phenomenal level of care. We are very forward thinking, and I think we set the tone for the whole country.