Dr. Nicole Harkin, a preventive cardiologist, discusses persistent myths, early detection tools, and innovations reshaping modern cardiovascular care.
Nicole Harkin, M.D., FACC
Board-Certified Cardiologist; Owner, Whole Heart Cardiology
What’s one of the biggest misconceptions the public still has about heart disease, and how do you think we can shift that narrative?
A few huge misconceptions remain. The first is that cardiovascular disease is a disease for old people. Studies have actually shown that the earliest stages of heart disease can begin in our 20s! The second is that cardiovascular disease is a man’s disease. Unfortunately, cardiovascular disease is the top killer in women as well, with post-menopausal women at particularly high risk.
How important is early detection in preventing major cardiovascular events like heart attacks or strokes? Are there tools or screenings you believe should be more widely used?
Early detection is really important. It’s frustrating to me that even though cardiovascular disease is the leading cause of death in the United States (and worldwide), regular screening is not part of routine care. It’s important to regularly monitor important risk factors for heart disease, including cholesterol levels, blood pressure, metabolic health, and weight. We can also screen for early signs of cardiovascular disease, or subclinical atherosclerosis, with imaging tests including a coronary artery calcium scan (CAC) and carotid ultrasound with plaque analysis.
As a cardiologist focused on prevention, what lifestyle changes do you consider non-negotiable for protecting heart health?
My top lifestyle recommendations would be to eat a diet rich in whole foods with an emphasis on plants and lean protein. Aim for over 150 minutes of moderate to high intensity aerobic exercise per week, sleep 7-8 hours per night, and reduce stress as much as possible.
We know heart disease presents differently in women. What are some of the unique challenges in diagnosing and treating cardiovascular conditions in female patients?
Unfortunately, cardiovascular disease is prevalent among women. While the most common presentation in women is chest pain, we can also present differently, such as nausea, exertional fatigue, or abdominal pain. In addition to the traditional risk factors, women should also know that certain pregnancy complications — such as gestational diabetes, gestational hypertension, or preeclampsia — as well as early menopause increase the risk of cardiovascular disease later in life.
What innovations are reshaping how we prevent or treat cardiovascular disease?
There are so many exciting things happening right now! Currently, I am really excited about the expanding ability to better detect subclinical atherosclerosis at earlier and earlier stages with technology that takes advantage of CT angiogram data. The genetics space is also an exciting time, with clinical tests now available to help young patients better understand their genetic predisposition to coronary artery disease beyond traditional risk factors, in order to make early treatment decisions. I also think the ability of wearable technology has, and will continue, to help us better understand our patients. Wearable cuffless blood pressure monitors will be game changers when available. Lastly, artificial intelligence (AI) that allows us to crunch this wearable data and other biometrics in a way that produces meaningful interpretation will continue to move the needle as we get closer and closer to true personalized medicine.
In your experience, what are some of the most common signs that get missed, and how can both patients and providers do better at catching cardiovascular issues early?
Cardiovascular disease most commonly presents as chest pain. However, it can also manifest in sneakier ways, like shortness of breath, nausea, and shoulder or belly pain. Women in particular tend to dismiss their symptoms, because there is still this misconception that it can’t happen to them. If you are at risk — family history of early heart disease, high cholesterol, smoker, diabetes — it’s also better to get it checked out early than risk ignoring something serious. This is also why early detection is key; it helps individuals identify early heart disease before it ever has a chance to progress and cause symptoms.
How can healthcare systems and payers better incentivize preventive care in cardiology, rather than waiting for high-acuity intervention?
It’s quite frustrating as a preventive cardiologist that very expensive procedures and surgeries to help people after they have heart disease are covered by insurance (and well compensated), but much cheaper interventions that can help detect and prevent advanced disease are not. For instance, a coronary artery calcium scan (CAC) — a very well-validated test to detect heart disease and risk stratify — is still not covered by most payors. Many drugs are also not covered unless you’ve already had a cardiac event, but not when you are at high risk of one.
As digital health, remote monitoring, and AI continue to transform cardiology, which innovations do you believe have the most potential to improve outcomes?
I’m really excited about all of this innovation. AI will be instrumental for data analysis in research, as well as on a more individual level, helping us better understand and integrate all of our wearable data in a way that allows for meaningful interpretation and actionable steps. My caution is that in science and health, innovation can not outpace the research. These companies need to invest dollars not just in marketing, but in the science to prove validation and that we are actually moving the needle. There’s currently a lot of noise out there.
In your opinion, what defines success in a modern cardiovascular care model?
Patients are looking for care models that go beyond the basics. They need help interpreting all of this conflicting information coming at them and applying it to their personal situation. The future of medicine will be personalized and driven by data.
