NEW ORLEANS — Stacey Rosen is a cardiologist who has been coming to American Heart Association meetings for 30 years. Executive director of Northwell’s Katz Institute for Women’s Health, she is also senior vice president of Women’s Health at Northwell, a professor of cardiology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and she also still sees patients. Now she leads the AHA as volunteer president for 2025-2026.

Both the AHA and medicine have evolved over those last three decades, still developing what in her view is an overdue recognition of fundamental, biological differences between men and women. One turning point came in 1985, when for the first time, more women died of heart disease than men. “I think the minute those mortality curves crossed, it was apparent to us,” she told STAT. “You couldn’t any longer deny that there was something different about women’s heart health. And that we had to do something different.”

Rosen talked with STAT on Saturday during the AHA’s 2025 Scientific Sessions. This conversation has been lightly edited for length and clarity.

What’s changed about AHA today and the field compared to the past?

There’s so much on prevention. There’s so much on looking at our patients and our communities as whole people rather than arteries or muscles or heart failures. Look at the American Heart Association. The mission and the vision when I first started was to lower death rates from heart disease and stroke, and that was impactful, but now it’s being a relentless force for longer, healthier lives. So the totality of that, the inclusiveness of that and the holistic approach to me is really inspiring.

What inspired you to study sex differences?

When I finished med school in the mid-80s, there were not that many women in cardiology. And it became clear to me that women were suffering from heart disease and not being treated fairly. I know that sounds very simplistic, but women were not included in trials. It became very clear, even in my training, that we were starting to see more and more women who were either undertreated, misdiagnosed, or more importantly, given treatments that had not really been studied in women.

I mean, even for something as simple as a baby aspirin a day, the Harvard Physician Study was 100% men. So that makes it to the front page of the paper and we don’t know what to tell women. And if we’re honest — and I was a pretty junior clinician then — we told them there were no women in the study. And that just didn’t make sense to me.

**How far does that blind spot go? **

It’s everything. Women’s health isn’t just reproductive organs. Every cell in your body has chromosomal makeup that is unique, most of us, XX, XY. And to not see that as a fundamental question when you’re setting up research defining best processes for care, diagnostic testing, treatment options, et cetera, to not have that be the very first question from a biology standpoint just always seemed illogical.

What happened after studies were supposed to include women?

The Reconciliation Act was passed in 1993. It didn’t really have teeth behind it, so even though it was highly recommended and the recommendations were strongly worded, it didn’t really require it. Looking at our evaluations of the last 10 years of cardiovascular research published in AHA journals, from about 2017 to 2022, we still see that women only constitute about 30% of research participants.

**Why do you think that is? **

I think it’s multifactorial. I think that there are not as many women scientists, cardiac scientists, as men. We know from data that individuals are more likely to participate in trials if they’re asked by people who either look like them or really understand their sex, socioeconomic status, et cetera. I think that it’s become almost a preconceived thought that women won’t participate.

What’s the solution? We need to rethink the way we do clinical trials, so that maybe there are ways, whether it’s telehealth, whether it is AI opportunities, that we don’t need to do it the old-fashioned way, coming in perhaps 45 miles from home to see a clinician. So I think if we really want to do it — and quite frankly, we need to do it — then we have to re-look at the whole process.

Is it something about cardiology? I oversee a holistic women’s health institute back at Northwell, so I spend my days with neurosurgeons and cancer doctors. I would tell you it’s the same throughout all of medicine. In general, health care was designed by men for men.

Why are women three times more likely to get migraines than men? Why is lung cancer worse in women who don’t smoke than in men who don’t smoke? Lupus is 80% women. We shouldn’t just shrug at those known clinical facts. We should be wondering why that is.

Cardiology is so prominent, I think, because we are the No. 1 killer in the world, the No. 1 source of research dollars throughout the world to better study diagnosis, treatment, prevention strategies. So that’s why I think we were ahead of the curve, honestly, in the cardiology world.

Is there any concern about grant applications for federal research dollars being tripped up by forbidden words such as sex or disparities?

There absolutely is, and what I’m optimistic about is the fact that this is simple biology. In other words, that this is science and it’s very basic, it’s chromosomes. So yes, many of us are concerned about having to re-address some wording, some approaches that we’ve taken. But when you get back down to the science, you know, it’s hard to argue that this is a fundamental question, XX, XY.

What does the future look like?

I think that now is an optimal time to really focus on ways to almost compensate for the years that we weren’t putting sex as a biologic variable in front. This can’t be done by women scientists alone. And you know, that has been the sort of assumption that improving health outcomes for women should be the priority of women clinicians and scientists. Our world in cardiology is only 20% female, so that is not going to work.

It’s bad science not to include men and women in the same prevalence that the disease exists. It’s not good science to not disaggregate data so that we know, did this work the same way for men and women? I think 80% of drugs that are pulled off the market are because there are more side effects in women than men, likely reflecting the fact that they weren’t tested in enough women to see any differential side effects.

What makes you hopeful?

I think the way we do research now with technology, with AI initiatives, we can hasten our ability to catch up and then make it foundational: Is that the same in men and women? Every medical student should be taught it. Every post-doc should be taught it. Every patient should ask it.

Where’s the greatest need? Maternal health. I think cardiovascular health and brain health start in our young people, in their 20s, 30s, 40s. I think the poor maternal outcomes in the United States is a horrific situation. And I think we know how to do this better. The science is getting better. The ability to collaborate is getting better between OB, MFM, cardiology, kidney doctors, stroke doctors. And I think that is a golden opportunity for all of us to have an enormous impact on the health of women.

The habits that you start in your 20s and 30s — remember, the pregnancy period is a time that women see clinicians so much more than they do at other times. So bringing all of us together to really optimize both the pregnancy and the health of the newborn, but also set the stage for a woman to really optimize the things she can do over a lifetime for heart health.

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