Lift as You Rise: Women in Cardiology Meet in Madrid to Talk Change

MADRID, Spain—Female cardiologists continue to face outright sexism and more subtle deterrents as they pursue their careers in medicine, but through the efforts of early pioneers in the field, soon trainees may not find themselves repeating the same narratives, panelists of the second annual RISE conference said.

The event—with more than 220 participants of all stripes, from clinicians to researchers to cardiologists in training—was organized by Women As One and took place in conjunction with the 2025 European Society of Cardiology (ESC) Congress and World Congress of Cardiology.

A common theme of the day: women who’ve already made the journey have a responsibility to ensure others can follow, hopefully with fewer barriers blocking their path.

“We are here today because we want to make sure 4 billion people—that’s about half of us on this planet—have access to the rooms, to the tables, to the buildings, to the hospitals, to the innovation and research centers that they need to enter to be able to improve healthcare, to be able to save lives, and to be able to give hope,” said Borjana Pervan, chief operating officer of the World Heart Federation (WHF), in her opening remarks.

This year’s ESC Congress is the first ever where equal proportions of faculty are women and men, pointed out Jean-François Riffaud, chief executive officer of the ESC. “It’s not enough,” he stressed, adding that female cardiologists continue to be in the minority and female patients still receive inequal care. ESC President Thomas Lüscher, MD (Royal Brompton and Harefield Hospitals, London, England), noted that these efforts continue year-round. Currently, women account for 40% of the society’s board, the largest segment to date.

At a “House of Cardiology” roundtable, leaders of the ESC, WHF, American College of Cardiology (ACC), and American Heart Association (AHA) discussed what initiatives their professional organizations have undertaken in the area of gender equality—and what strides have been made.

The ESC, for instance, has a Task Force on Gender, while the ACC has a Women in Cardiology member section. At the AHA, there’s the widely known Go Red For Women and support for female researchers, mentors, mentees, and even undergraduates.

Beyond mentorship, however, is sponsorship, said AHA President Stacey Rosen, MD (Northwell Health, Manhasset, NY). Sponsors who not only provide advice but also actively support a colleague’s career by making sure they gain visibility and leadership roles are a “very important [way] of putting women in the room where the magic happens and supporting them,” she explained.

There has to be some intentionality. There has to be some data, and then we have to hold ourselves accountable for that. Athena Poppas

WHF President Athena Poppas, MD (Brown University, Providence, RI), pointed out that their organization, by bringing together cardiology societies across the world, is uniquely positioned to think on a global scale. Number five on the United Nation’s Sustainable Goals is gender equality, Poppas noted. The empowerment of women is “really perceived as a fundamental human right” and is something the WHF is working towards for patients and for leaders in the field—according to their code of conduct, “no more than 60% of either a committee or board should be of any one gender,” she said.

It’s clear that, when developing policies, “there has to be some intentionality. There has to be some data, and then we have to hold ourselves accountable for that,” said Poppas. “[We also need to] have some programs and then to continue to refine those programs that really help women.” She highlighted the Emerging Leaders Program as an opportunity for both female and male health professionals to make a difference in promoting equality.

Rosen, too, had advice to women early in their careers: “Find the area in cardiovascular medicine that you love. Find your squad, whether they’re men or women, and then you’ll see that this doesn’t become work. [With] your passion and excitement for what we’re all doing together, it becomes almost easy.”

In addition to finding a local support system, “reach out globally in finding connections like in the room today,” Poppas suggested. “Don’t leave here today without making a new friend and a new mentor.”

Real-life Solutions

Barbara Casadei, MD, DPhil (Imperial College London, England), who led a panel devoted to addressing the challenges women face day-to-day in cardiology, agreed that it’s important to take intentional, specific steps when working towards equality. “Now more than ever, we are aware that progress is not linear and we cannot take progress for granted for one second,” she stressed.

The panel members, all established in their careers, offered advice based on their own experiences.

Dipti Itchhaporia, MD (Hoag Heart and Vascular Institute, Newport Beach, CA), for instance, said female cardiologists must start by learning to find their voice and make bold choices—“to learn to say yes but, also along the way, figure out the times when you do need to say no.”

They also must learn to trust their own abilities, said Sarita Rao, MD (Apollo Hospitals, Indore, India). Rao currently is director of her hospital’s cath lab, but she described how others attempted to block her path decades earlier. “In India, as women we were told, ‘You can’t do live cases—you’re a woman.’ We were told, ‘You can’t raise funding—you’re a woman. You can’t have your own conference—you’re a woman.’ So as it was my job to break all those walls and in India as a woman, I started the fact that women can do [things] like this successfully.”

The kinds of obstacles thrown in the paths of female cardiologists can be hard to talk about, said Liesl Zühlke, MBChB, PhD (University of Cape Town, South Africa), but “maybe we should own them.” She recalled how she often was the “first” in various career roles, including as the first woman of color to lead, as president, the Paediatric Cardiac Society of South Africa and the South African Heart Association.

“I’m a strong and proud African woman, and that in itself has a whole lot of other issues that goes along with it in terms of [being] undervalued and underrecognized and underrepresented,” she observed.

Closer to home, she said, she’s the mother to two young men. “I find that is a particular responsibility, as a woman in a field that is male dominated . . . , to actually teach young men and young women as well to be part of the movement to support equality in their workplace and in their home,” Zühlke said.

Casadei acknowledged that the women up on the stage could be intimidating to those who are just starting out, so reminded the panel to offer practical, approachable advice. “I am always an advocate for the average woman, not for the exceptional woman,” she said. “Everybody has the right to have a career, as a lot of average men do, right?”

To start, she asked whether anyone had regrets. For her, it was being “meek for too long,” said Casadei.

Others spoke about wishing they’d set aside more time for their children. Nouf Alanazi, MBBS (King Saud University Medical City, Riyadh, Saudi Arabia), agreed the rewards of a career in cardiology are great. “When I talk to my younger trainees now, I always tell them, ‘If you love it, you can do it. And you’ll always manage to find a way to succeed,” she said. But Alazani also advises them to prioritize family first as much as possible.

A solution to the work/family divide, Zühlke proposed, is for parents to bring their children into the fold as much as possible. Her first was born during her fellowship, and she recalls breastfeeding him in the on-call room and taking him on weekend rounds.

“I have my regrets about the moments where I didn’t go to this or that, but taking them along and showing them what it is that you do and why you do it is a whole different thing. . . . Explain what you’re doing, explain what it means, because when they understand your passion, they see it in a very different light,” she said.

Helping Future Generations

Women, particularly those living in places where fewer training opportunities exist, have historically had to travel elsewhere to get the education they need to excel in cardiology. This is one of the reasons it can be hard to find space for family life, said Carla Agatiello, MD (Hospital Italiano de Buenos Aires, Argentina).

Agatiello, who said there are now 350 female cardiologists in Latin America, is working to create training programs that don’t require a long journey. “We are focusing on training the young generation in their own countries, or in the continent, in Spanish not far from their families,” she said, adding that this will enable women to have the same possibilities as men, who don’t face the same pressures to stay close to home.

Casadei noted that these experiences speak to the tension that arises when people must strive to succeed in a world that holds values different from their own. “I am confident that if I had asked the same question here to a panel of men, no one would’ve mentioned their family and their children,” she commented. Only by increasing the number of women in the field will the tone begin to shift, said Casadei.

I am always an advocate for the average woman, not for the exceptional woman. Everybody has the right to have a career, as a lot of average men do, right? Barbara Casadei

Itchhaporia admitted that, in hindsight, she wishes she’d set more time aside “just to sit and think.”

“Reflection time is really important to understand where you need to go, what have you done, what’s coming next, instead of being sort of a chicken with your head cut off running around all the time, which is sort of what we do,” she commented.

Vijay Kunadian, MBBS, MD (Newcastle University, Newcastle upon Tyne, England), pointed out that amid all the chaos and pressure of cardiology, having a mentor can help keep the difficulties in perspective. Insights from someone further along can help, so that “you’re not exaggerating the problem, but you’re finding a solution to overcome it and address it and keep moving forward,” she explained.

Conferences like RISE raise the possibility that future generations won’t have to face the same stories of inequality, said Zühlke. Her mentor, a young Black man also from South Africa, instilled in her the message: “Lift as you rise.”

“The idea was that the barriers that we face as people of color in South Africa [don’t have to] become the barriers for the next one,” she explained. “These stories, inspirational and wonderful as they are and harrowing as they were when that happened to you, they don’t have to happen to all of you as well. . . . Whatever we do, because we’ve been through that, part of our responsibility being here today is that we lift as we’ve risen.”