You list preventive cardiology as an area of expertise. What does this mean?
Preventive cardiology is simply decreasing a person’s likelihood of having an adverse cardiac event such as a heart attack, stroke or cardiac arrest. However, like many things having to do with people and human biology, this is more complicated than it seems.
First, one must determine a person’s risk of having an adverse cardiac event. As a cardiovascular specialist with a focus in this area, my job is to determine more than simply which of four risk categories an individual falls into, since if this is all that is needed, there is a smartphone app that can accomplish this. My task is to determine if a person is at risk, and what, if any, testing, of the myriad of tests available, will help refine the risk assessment. Finally, once that risk assessment is made, the next step is to determine what needs to be done, whether it has to do with behavior, medication or surgery, in order to decrease that risk. The best way to achieve that is to help patients decide what treatment strategy they desire for their risk profile, based on their personal preferences and risk tolerance.
When was the moment you knew cardiology was the field for you?
I had an affinity for cardiology from the time I was in medical school studying the different disciplines of medicine. I knew that cardiology was the field for me when I was a resident at Harborview being awakened in the middle of the night to go to the emergency room to take care of sick patients. I was always happy to jump out of bed and rush down to the ER for a cardiac patient.
How has your field changed since you began practicing?
The field has changed enormously with respect to the technology we can apply, in terms of both medications and our tools, such as coronary stents. At the same time, how it feels to me to take care of patients with heart disease, and the satisfaction it brings me to help someone with a cardiac problem, is the same today as it was when I first began.
If you could get one message out to readers who would like to stay heart-healthy, what would it be?
Where you begin with your heart health is in some ways the luck of the draw. Genetics, environment and resources all add up to a baseline cardiac risk that was not of your making. However, where you finish with your heart health is completely up to you. A healthy diet can be beneficial as well as energizing, and can reduce your cardiac risk. An active lifestyle and aerobic exercise can have a huge impact on your heart disease risk. Running is more efficient than walking, but, from a risk reduction standpoint, you can use either approach. Walking takes longer, but it is the steps you take that matter, much more so than how fast you are taking them. Finally, I would say that 15 minutes of exercise per day comes for free. Finding time to exercise for an hour can be difficult if you have a busy life, but exercising for 15 minutes is free because you will gain back at least as much time from having higher-quality sleep and more energy. I would encourage everyone to exercise for 30 minutes three days per week as a minimum, regardless of how busy your life is, because the benefits are not only better future health, but also an immediate return in how you live your day-to-day life.