Women and Coronary Heart Disease: A Century After Herrick

Among the accolades most valued by a clinical cardiologist is to be selected to deliver the annual James B. Herrick Lecture. This lecture honors the legacy of James Herrick as an icon for the cardiac clinician/scientist. I am enormously grateful to the Council on Clinical Cardiology for this singular recognition.My choice to address “Women and Coronary Heart Disease: A Century after Herrick” will show that this problem remains understudied, underdiagnosed, and undertreated.First, to James Herrick and his landmark contributions. As we know, in the 1900s, myocardial infarction was considered a uniformly fatal event, and its etiology was largely unknown. Herrick's scholarly 1912 presentation to the Association of American Physicians, subsequently published in the Journal of the American Medical Association , highlighted that survival could occur after myocardial infarction, albeit often for only a few days. Buttressed by meticulous autopsy data, he documented coronary artery thrombosis as the mechanism for myocardial infarction.1 Although dismayed by lack of response from colleagues to this carefully detailed scenario, Herrick continued to study and to publish, advocating treatment with digitalis to enhance myocardial contractility and maintain blood pressure, rather than use of nitroglycerin, which did not perform satisfactorily. Always a mentor, he encouraged Dr Fred Smith to explore the diagnostic potential of the newly available precordial ECG for recognition of myocardial infarction in a living patient,2 and the rest is history. Herrick's precise case presentations (incidentally all of male patients) and autopsy confirmation established thrombogenesis as pivotal in myocardial infarction and paved the way for antithrombotic therapy, coronary thrombolysis, and percutaneous coronary interventions later in the 20th century.In his 1926 article, “The Clinician of the Future,” in the Journal of the American Medical Association, Herrick cited the usefulness of physicians to society as a whole as the physicians' reason for …