One hundred years ago, Paul Dudley White, MD — the acclaimed father of modern cardiology — founded the nation’s first cardiac unit at Massachusetts General Hospital. Since then, generations of Mass General cardiologists have followed with their own influential contributions to the fight against heart disease. Deaths from heart attacks have gone down about 75 percent in the past 50 years.
Yet despite progress, heart disease is the number one killer and more people than ever before are developing heart disease. In this interview, Anthony Rosenzweig, MD — chief of Cardiology and co-director of the Corrigan Minehan Heart Center — talks about some of his intriguing research and how the division is expanding to meet the need.
Why is the burden of heart disease increasing?
There are three explanations. As a result of our successes, more people survive acute problems like heart attacks but may go on to develop heart failure (when the heart can’t pump enough blood and oxygen) and arrhythmias (irregular heartbeats). Heart disease is also increasing due to the current epidemic of metabolic diseases like obesity and diabetes and because of our aging population. People are living longer and heart disease, particularly heart failure, is tightly linked to aging.
Dr. Paul Dudley White was a huge advocate for exercise and a sensible diet. Are people finally listening?
It’s remarkable how far ahead of his time he was. We now have the evidence that a significant component of cardiovascular disease is due to lifestyle choices we make. But changing behaviors is one of the hardest things in medicine. People don’t see the effects of their lifestyle choices for many years. It’s much easier if there’s a pill to treat something. So it’s still a challenge.
But there are other things involved in heart disease, such as genetic contributors to our blood lipids (cholesterols). We still need to find ways to turn genes on and off to control their influence, in addition to promoting diet and exercise.
If we don’t support them, we’re at risk of losing a generation of young investigators who could have a major impact on the care we can offer our patients.
What are some of your key research findings on heart failure and the benefits of exercise?
Recently, we have been interested in understanding how exercise helps keep the heart healthy. Our idea is to take advantage of the molecular pathways involved to help patients who can’t exercise as much as they should. Patients with severe heart disease may have trouble getting out of a chair or walking across the room, and so may not be able to exercise enough to fully realize its benefits. Our recent findings have pointed to several contributing pathways. If we mimic the changes seen in these pathways after exercise, we’ve found that the heart is protected from stress and disease. Now we want to figure out if any of these pathways can be manipulated with a medicine to benefit heart failure patients.
Another intriguing finding is that the heart can repair and maybe even regenerate new heart muscle cells. When I was in medical school, we were taught that we could lose heart cells but not gain them. We now know that this isn’t true. The heart does have some capacity to grow new cells even in an adult. However, that capacity is too limited and we understand little about how it is regulated. We believe that exercise may be one of the physiological cues that drive the process of repair and regeneration. We hope that by identifying the pathways important in exercise, we can learn how to enhance repair after a heart attack or other damage.
Dr. White famously walked or biked everywhere. What do you do for exercise?
I’m a habitual exerciser but it’s been challenging since I took this job! I used to run most days, but now it’s usually three or four days a week. My wife bought me a treadmill desk for my office, so I walk on the treadmill while I read emails. I like to think this is the modern embodiment of Paul Dudley White’s philosophy of incorporating modest exercise into my everyday routine.
We’re also recruiting more clinicians to care for patients and investigators with an interest in discovering new approaches to heart disease.
What are your upcoming plans for the division and how can philanthropy help?
To confront the challenges of increasing heart diseases, the division is expanding. We plan to enhance the electrophysiology laboratories and create a new heart failure service and unit. We’re also recruiting more clinicians to care for patients and investigators with an interest in discovering new approaches to heart disease.
Having resources to do these things is vitally important. Young investigators need three to five years even after they complete their training to start their labs and become independent. If we don’t support them, we’re at risk of losing a generation of investigators who could have a major impact on the care we can offer our patients.
To learn more about supporting Cardiology’s research and clinical initiatives, please contact us.