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A Career in Preventive Cardiology: It’s A Lot More Than Statins

I spent the finale of #AHA20 Tuesday evening at the “What You Need to Know for a Career in Preventive Cardiology” fireside chat hosted by the lovely Dr. Anum Saeed with experts Drs. Ann Marie Navar, Andrew DeFillips, Seth Martin, Michael Shapiro, and Martha Gulati. The panel discussed the following topics:

Exploring the field of prevention when your program may or may not have a prevention program 

Certainly, one month of exposure is not enough to truly get a taste of the multiple flavors within this field which includes exercise, cardiac rehab, hypertension, advanced lipidology, multimodality imaging and risk scoring, diabetes, and obesity. That being said, it’s important to find a way to get involved even if your program doesn’t have a prevention program. Request to spend elective time in other specialties including Endocrinology where SGLT2 inhibitors are routinely prescribed, clinics where weight-loss medications are frequently used, and other areas in medicine that may intersect within prevention. If you do spend time in cardiac rehab, don’t just spend time with the physicians but also hang out with the exercise physiologists on the floor who engage with cardiac patients- there’s a lot to be learned from them.

Finding an academic position in prevention

Unfortunately, the current reality is that reimbursement for preventive services does not pay the bills for a cardiology division. This means that it’s extremely important for you to find a niche or expertise within cardiology that gets you paid. This can include an imaging modality, interventions (yes, there are interventionalists who practice as preventive cardiologists!), quality improvement care, research, healthcare delivery, technology, and clinical care.  The hope is that in the not-too-distant future, we will transition to more of a value-based care model.

Another very insightful pearl from the panel: when you ask for your position, know what you need early on and ask for what you want. DEFINE WHAT YOU NEED UPFRONT and where you need that time to develop a program, work on research, or start an initiative that will be productive for your department.

A day in the life of an academic preventive cardiologist

This varies widely depending on the unique interests and expertise of the individual. This can range from spending 2 week blocks caring for patients in the cardiac intensive care unit to then being off for 2 weeks followed by an outpatient clinic and research time. If you are primarily research, this may mean having a clinic one day a week with 70% of the time focusing on writing/research and attending national meetings, and collaborating with preventive groups across the world.

The future of prevention

“We’re more than giving statins.” The exciting areas of prevention and late-breaking science that were highlighted during #AHA20 speak for themselves. SLGT2 inhibitors, the promise of Inclisiran, and the polypill are just the tip of the iceberg within the field of prevention. With artificial intelligence and machine learning, polygenetics, implementation science, health equity, and digital technology, the field of prevention will be pivotal in improving outcomes such as myocardial infarction, for example, by tailoring therapy based on individual risk rather than covering everything with all available treatments. Lastly, if there is a silver lining of this #COVID-19 pandemic, it is that the cardiovascular risk factors and health disparities that have come to the surface are now being prioritized as the path for future research trials and public health movements.

I’ll leave you with a Chinese proverb one of our panelists shared: “A superior doctor prevents sickness; A mediocre doctor attends to impending sickness; An inferior doctor treats sickness.”

Stay well, be well, and be safe. And wear a mask.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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A Possible Link Between That “Gut Feeling” and Heart Disease

Let’s face it- this #COVID19 pandemic has found us seesawing between embracing extra workouts and healthier homemade meals to lamenting over those extra pounds from those sourdough starters. Many of us can use a jump start to reclaim our #hearthealthy goals. #AHA20 has provided us a captivating session on the link between diet, the gut microbiome, and cardiovascular disease.

Drs. Katherine Tucker, Wilson Tang, and Caroline Genko presented the basics of how the quality of our diet affects the diversity of bacteria and level of systemic inflammation in the body, the role of the TMAO pathway in atherosclerosis, and how oral pathogens can affect both atherosclerosis and the gut microbiome:

SCIENCE: Epigenetics alter the transcription of genes through modification (DNA methylation, histone modification, and miRNAs). These processes can be affected by stress, diet, and the microbiome.

TAKEAWAY: We have some control over the expression of our genes if we adhere to healthy lifestyle changes that improve our stress, sleep, diet, and physical activity.

SCIENCE: Gut bacteria metabolize indigestible fibers into short-chain fatty acids (SCFAs) which have been associated with the prevention of chronic disease and are also important for muscle function.

TAKEAWAY: Continue eating more plants and whole grains to prevent heart disease and other chronic diseases.

SCIENCE: Animal-based diets increase bile-tolerant microorganisms that are responsible for pro-inflammatory pathways.

TAKEAWAY: Limit animal meat (especially red meat) to decrease the amount of inflammation in your body. Inflammation = heart disease!

SCIENCE: The more highly processed the diet is, the higher the risk of CV disease even after multivariable adjustment.

TAKEAWAY: Limit the middle aisles of your grocery store and go rogue on the perimeter aisles, which should be abundant in perishables (fruits and vegetables) and freshly baked whole grains.

SCIENCE: Increased TMAO levels are associated with atherosclerosis and are only one of the many pathways involved in the link between the gut and CV disease. Red meat is associated with elevated TMAO levels. There is also unique crosstalk between organs, with reduced excretion of TMAO by the kidneys with increased consumption of red meat. Lastly, caloric restriction and intermittent fasting have been associated with decreased levels of TMAO.

TAKEAWAY: As above, another reason to limit or avoid red meat!

SCIENCE: Animal studies showed those fed a Western diet and infected with P. gingivalis (oral pathogenic bacteria) had accelerated atherosclerosis. The gut microbiome composition was also affected by P. gingivalis infection.

TAKEAWAY: Be sure to take care of your oral health and see your dentist regularly for cleanings to help prevent cardiovascular disease.

After reading this, I hope you all reconsider how you think about going with your “gut” when deciding on your next meal.

Eat well, be well, and be safe. And keep posting #PetsofAHA20.

 

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”