Katie Berlacher, MD

UPMC Cardiologist, Katie Berlacher, MD explains why members of the LGBTQ+ community may be at higher risk for cardiovascular problems and shares steps UPMC is taking to connect more patients to care.

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– This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider. Heart health is important for everyone, but there is growing evidence that members of the LGBTQ+ community are at higher risk for problems when it comes to cardiovascular disease. Hi, I am Tonia Caruso. Welcome to this UPMC HealthBeat podcast. And joining us right now is Dr. Katie Berlacher. She’s a cardiologist and the associate chief of Education in the Division of Cardiology at the University of Pittsburgh. Thanks so much for joining us.

– Thanks for having me.

– Such an important topic. And, really, when we talk about health disparities and the LGBTQ+ community, it can extend to all areas of medicine. What are some of the reasons why?

– One of the reasons that members of the LGBTQ+ community cite is that they have lack of access to care and are uncomfortable coming to the medical field, often because they’ve had poor experiences with the medical field. Finally, they cite an inability to find culturally competent providers.

– And when we talk about a culturally competent provider, what is that?

– One that is, quite simply, inclusive. One that will recognize the importance of individual care and learn the values of their patients, as well as understanding their life experiences.

– So much of a work of a doctor is not only the science, but it really is a lot of building relationships with their patients.

– It is.

– And, so, that’s really key when it comes to people finding someone they feel comfortable with.

– Right. It is. And part of that building relationship is using language that is inclusive. And that’s hard for those of us who may not have had experiences with members of this community before, or are learning the words and the appropriate ways that are helpful for this community to feel welcomed and invited.

– Right. And I know there is so much going on here at UPMC, and particularly in the area of cardiology. And we’ll get to some of that in the moment. But what are some of the reasons that heart health may be a bigger challenge for members of the LGBTQ+?

– Yeah, a great question. So, the LGBTQ+ community has been noted to have higher rates of mental health disorders, such as anxiety and depression. And we know that patients with anxiety and depression often have higher risk for cardiovascular disease. So that’s one of the things. We also know that members of the LGBTQ+ community have higher rates of tobacco use, alcohol use, substance use disorders, and those are also linked with cardiovascular disease. And then, finally, gender-affirming hormone therapy, in some ways, can increase cardiovascular disease risk. Providers need to understand that in order to better guide patients with regards to questions and choices that they make for those therapies.

– A lot of what we have talked about so far come from surveys and members filling out information. But there’s a real gap.

– Huge.

– You and I were talking earlier in that members of the LGBTQ+ community often aren’t included in research.

– Right. Unfortunately, this is a huge gap right now. The NIH started an office in 2015 to help us with this gap. But it’s still challenging because researchers are not actually doing the implementation of that and including these patients. Which is unfortunate because there are many things in this community that we don’t have data yet. And when we don’t have data to guide their care, we may not be giving them the best care that they need, or the best information, so that they can make those decisions moving forward.

– And we talked about this before. This used to be the case with women in general, that women were not a part of research.

– Right.

– So you fix that issue. And then this is really sort of the next phase.

– Unfortunately. And I think we are going to continue seeing this in areas where there are underrepresented patients or communities in medicine that have not been included in research for a long time. And it’s really important for us to, as a medical community, continue to focus on all of those unique individuals and the identities that make them unique.

– OK. So, there is lots underway at UPMC in this arena. Let’s just talk in general, and then I want to talk specifically about things you’re doing in cardiology.

– Sure. Sure. One of the things that UPMC did over the past year was to start a training program. So, there is an online virtual program that all providers and staff can go on to learn about the language used, the disparities, the inequities, and also the opportunities for better care. Those providers who have done that now have a badge that you can see online when you look them up in Find a Doc or Find a Provider, that members of the LGBTQ+ community can then identify providers who have gone through this to help them understand who is more culturally competent than others.

– I know in cardiology, you take this issue very seriously.

– To heart. Yes.

– You’ve been quoted in national magazines, you know, scientific journals, on this topic. Why do you feel like, especially in your field of cardiology, you were all rallying behind this?

– Yeah. A good question. I think – you know, I was actually talking to some of the providers here, who are like, “Why cardiology?” And, you know, this community often gets attention for other things with regards to gender-affirming care and whatnot. But they are at risk for the No. 1 cause of death in the United States, which is cardiovascular disease. And the attention to detail on that and the welcoming community within the cardiology offices is vital to their care moving forward. We specifically are starting an LGBTQ+ clinic within the cardiology offices at UPMC that is in the same area where we see women for heart disease.

– Yeah. And so, really, what is your hope from that? What do you want the community to know about your hope and your plans for that, and really, your commitment to help in the community?

– My hope, first, is that patients can find us easily, that they feel comfortable coming to us, asking those questions, that other providers feel safe sending their patients once they have established a relationship. Oftentimes, referring patients to sub-specialists like cardiologists is challenging because it requires trust. And you are trusting them, that provider, to care for the patient that you have already established a relationship with.

– Right. And I know, no matter what, sometimes you go to the doctor and you don’t want to tell the doctor anything. You’re worried about judgment. So I can imagine that magnified 10 times.

– Exactly. And, you know, the important thing is not only thinking about the providers, but also thinking about the staff, the person that greets you at the window, the person that’s arranging your follow-up visit, that’s doing your checkout. Those people are just as important as everybody else. And those are the people that we’re asking to have the same training that our providers have.

– And there has been some real excitement by some of the providers really wanting to take part in this.

– Right. Exactly. Many of my partners are really excited to care for these patients and to provide them a welcoming home.

– Just in general: We started off by saying heart health is important to everyone. What do we need to know? I always hear, “Know your numbers.” But anybody listening to this, particularly someone in the LGBTQ+ community, what should we have as our baseline?

– Yeah, so the same numbers apply to the LGBTQ+ community. And that is focusing on things like blood pressure, your BMI, or your body mass index, your blood sugar, so your measurement of your glucose in your blood or your hemoglobin A1C, which is a short measure for diabetes. And then, finally, in the cardiovascular world, we focus on lipids or your cholesterol numbers. So, your LDL, which is your bad cholesterol, and your HDL, which is your good cholesterol.

– And, so, what is a decent blood pressure?

– Typically, ideal is 120/80 or less than that. We would accept less than 130.

– OK. And I know you always tell them this. It’s the trick so people can tell the difference between their bad cholesterol or good cholesterol.

– Yes, yes. This is my favorite one. So, LDL is the lousy or the bad cholesterol, and you want that one to be low. So, think LDL, low, lousy. And then, the HDL is your good cholesterol, your happy cholesterol. The higher the HDL is, the better it is.

– All right. So that’s what everybody needs to keep in mind. So what do you want to say to members of the community that are listening to this about really the importance of prevention and treatment?

– First and foremost is, you matter. You deserve access to care and providers that care about you. And we’re here for you. So, come find us. Come ask us your questions. We would love to take care of you.

– Why is this so important to you and your colleagues?

– Yeah. I think we just want to make sure that health equity for all, getting rid of all of the disparities and the inequities across the nation, is something that we are a part of, that we really lead the way on and not just deliver care.

– Right. And do you feel that, really, this is moving in that space nationally? But how much more work needs to be done?

– We have a lot more work. We have a lot more work in the realm of women’s cardiology and certainly in the realm of LGBTQ+ care. Certainly, the research that you talked about, but also the implementation of that research and that science to the individuals that are in that community. So, a long ways to go, but we are stepping in the right direction.

– Well, some great information. Dr. Berlacher, we thank you so much for coming in and spending time with us today. We appreciate it.

– Thanks for having me.

– I’m Tonia Caruso. Thank you for joining us. This is UPMC HealthBeat.

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