General Articles

You have always had an interest in cardiovascular health - why?

My initial interest in the heart came from when I was a biomedical engineering student at MIT. I liked studying an important organ for our health, plus the heart is super interesting for engineers as it combines a mechanical pump with an electrical circuit and complex blood flow in the heart itself and its blood vessels. 

Fast forward to my cardiology career, I specialise in developing new techniques to see early heart disease and then mobiles devices for early detection and prevention to help reverse the #1 killer around the world, which affected my family in addition to my patients.  

 A lot of your research surrounds the prevention of ill cardiovascular health - is this area largely misunderstood? And, why do you think this is?

The good news is that there is broad awareness about the importance of physical activity and a healthy diet to prevent heart disease. But what's misunderstood is that, to fully prevent heart attacks, we need to screen for risk and, when appropriate, initiate preventive medications.

That's why I say we need to fight heart disease like cancer. Cancer is also less likely to occur with regular physical activity and a healthy diet, but we all know regular screening to detect disease early and prompt treatment is important. 

The other part of heart disease that is misunderstood is thinking about it as a mechanical problem (narrowed pipes) rather than a biological problem (growing plaques). Like cancer, plaques can grow silently in our heart arteries and become "malignant" - meaning they are biologically active and can burst to cause a heart attack as the first (and even last) symptom, like how my father in law died.

You have done a lot of work in the area of mobile health and tracking - what's exciting about this? 

The exciting thing about mobile devices, such as our phones and wearables, is that they're with us all the time. Health happens every day rather than the 1-2x per year we see a doctor. Our devices can be our daily health coach and even doctor for some conditions. We've shown they can help people increase their physical activity and detect silent heart rhythm problems. I wrote about the opportunity for everyone to have access to a preventive cardiologist in their pocket, and we're even closer to that reality as generative AI capabilities have accelerated.

How have approaches to cardiovascular health changed throughout your career?

The big changes have been:
1) relearning that the main form of heart disease is a biological growth that can be reversed with modern therapy that targets "growth factors," rather than focusing on mechanical solutions (stents, bypass surgery), which treat late-stage disease.

2) We now have several noninvasive imaging tests that can detect early plaque development.

How can AI be used to prevent bag cardiovascular health? 

So many ways!  One major AI topic I discuss is "machine learning" where we show computers lots of data and it learns. Thanks to AI, computers can see patterns on medical images or electrocardiograms (ECG/EKG) that indicate cardiovascular disease - sometimes when doctors can't. 

I do say that we actually want AI to "replace" doctors for certain things, especially to give everyone access to specialist-level diagnosis as there aren't enough specialists for all.  

Your books compares heart disease to cancer - how are the two similar? 

The big ones are:

1) they share many risk factors,

2) the main form of heart disease involves growing tumours that can become "malignant," driven by growth factors that we can reverse with medications (chemotherapy) in addition to lifestyle, 
3) imaging tests for cancer can detect heart disease, and vice versa, and so screening can be combined, 

4) they are both impacted by the immune system and blood vessel growth, with new therapies being developed in these areas for both diseases.

What's one interesting thing that you know about cardiovascular health that you wish more people knew? 

Know your "growth factor" numbers - blood pressure, bad cholesterol, and blood sugar. Know your risk score, which guides preventive therapy and is available online. And, when appropriate, know your coronary artery calcium score, which tells you about the level of any plaque development in your heart.