Why did you choose cardiology as a career path?
In 1988, I was finishing my Internal Medicine residency in Vancouver and it seemed like all of medicine was undergoing tremendous change. Specifically, those fields that were highly precise and focused on diagnostic skills, such as cardiology and neurology, were becoming more interventional and introducing measures that would change the outcome of patients (and not just diagnose their problems). Neurology was also becoming more interesting, and with improved imaging, disorders of the brain were easier to study and potentially intervene upon.
I applied to both cardiology and neurology training programs with the intention of being a part of this new wave of intervention and research. After interviewing at the Montreal Neurological Institute, I was accepted into their program. But I was also accepted into the cardiology program at the Ottawa Heart Institute which was just taking off as a very exciting center for cardiac care with transplants, stents and great teachers.
In the end, I chose cardiology and was very happy that I did, as cardiovascular medicine progressed at a rate that I never anticipated. While serving as the Chief Cardiology Resident in Ottawa, I was fortunate to be mentored by Dr. Don Beanlands, who took great interest in my career and encouraged me to go away and train at an American center. I then spent three years at the University of Washington in Seattle, where I learned how to perform coronary interventional procedures, as well as study molecular biology in the arguably the best center for fundamental studies of blood vessel disease.
Being the new research director at the Libin Cardiovascular Institute, what are your biggest challenges/achievements so far?
The most important attribute of the Libin Cardiovascular Institute are the people, some of whom I have known for two decades, so this is what makes my job somewhat easy, as I can work to ensure that this individuals continue to have the opportunities to excel. The biggest challenges relate to trying to keep pace with the growing demands of providing cardiovascular care to a city that is expanding, that is adding a fourth hospital and an institute that is just coming into its own as it approaches the end of its first decade of existence.
We are undergoing tremendous recruitment, developing new in-hospital service models and steadily expanding our technological expertise. We have some cardiologists with fantastic talent who are ready to be more and more innovative, develop new ways of treating heart problems and really pushing the envelope but all of this takes time and money. We are trying to create capacity for this wave of innovation. To do so, we need to find more operating or clinic time, and perhaps of equal importance, we need to expand our capacity to measure our success.
For us to get better at providing cardiovascular care, we have to be able to prove to ourselves, our patients, our government, and our national or international colleagues in medicine that our innovations are having a beneficial impact on the symptoms or survival of patients, that our services are safe and cost-effective and that they are relevant to the needs of our community. If we cannot measure our efforts, we cannot improve.
Tell us about Libin’s new research strategic plan.
It was developed in the first six months of my tenure and involved input from as many stakeholders as possible, within the Institute as well as from a number of relevant external bodies. The contributions from our newly formed Research Executive Committee have been very helpful and facilitated the development of a strategic plan that will guide us through the next three years.
How are the institute’s main research focus areas defined?
We are now embarking on a new priority in our research plan entitled “Heart Health Services”. Essentially, this program will constitute the “engine house” for teams of analysts to pour over data and better understand some of the questions about patient outcomes.
In addition, we will continue to emphasize research in three other areas. First, heart rhythm disorders and how they may cause sudden death. We already have a comprehensive team of investigators in this area, and so future investment will allow this priority to become more competitive nationally and internationally by recruiting more investigators and expanding the research that already exists into areas such as the genetic causes of heart rhythm disorders.
Second, we have a number of investigators studying blood vessels ranging in size from tiny tubes that allow the passage of one cell at a time to the aorta, the largest blood vessel in our body. Using multiple avenues of investigation, researchers in this area are asking important questions ranging from the role of inflammation in blood vessels disease to how to fix the aorta once it develops a life threatening dissection.
Finally, the third priority relates to the pandemic of heart failure. For a variety of reasons, the pumping action of the heart may be inadequate to support blood flow to vital organs and/or result in congestion in the lungs and swelling of the extremities. Proper diagnosis and treatment of these patients is a challenge, yet through a multi-disciplinary approach, can be achieved. To this end, we are very excited about what our Advanced Heart Failure team will look like in the next 1-2 years as it grows through recruitment and important collaborations with, for example, specialists who focus on novel methods of imaging the heart.
What does the future of cardiovascular research at Libin look like?
In a word? Bright. We are very excited about our strategic plan for research and how this will provide us with a blueprint to develop the three priority areas plus the Heart Health Services Center in the next three years and beyond. One important point that we often forget is that the Libin Cardiovascular Institute is relatively young, as it only came into formal existence in 2004.
Hence, what we are striving for in the next three years is be a “Top Three” cardiovascular institute in Canada by focusing on the research areas where we are currently strong and making not only the individual laboratories / investigators better but also the institute as a whole. With that success will come more recruits, more trainees applying to study at our institute and more positive investment from peer review agencies as well as our community. Alberta is a generous province, and because of provincial government investment we have a research advantage. Our task is to seize this opportunity and take the Institute to a level that is incomparable in Canada.
I am confident that not only will our patients continue to have the lowest death rate in Canada for those individuals unfortunate to have a heart attack, but we will emerge as a leading center for complex problems relating to heart failure or aortic diseases. Our research will also lead to innovations in how we manage patients in the community and ensure that they have timely access to advanced cardiovascular care, as well as understand the benefits of preventive medicine. Finally, in a few select areas of research we anticipate leading the way with genetic or molecular analyses that align with personalized health care solutions and the development of new therapies.
Tell us about your own research work in vascular biology and what kind of work you’re doing in your new lab here.
For the past 20 years or more, I have taken insights that I gain from seeing patients in the clinic or at the bedside, and gone back to my basic research laboratory to study them in more molecular detail. In particular, I focus on blood vessel disease, and over the last 10 years, my work has looked at the question of why women have heart attacks less often than men—at least until after menopause. Most likely, this problem has something to do with hormones, and my laboratory has discovered a protein that is in part controlled by estrogens, and may, in fact, act as its “foot soldier” to provide benefit to blood vessels – yet without the unwanted hormonal effects associated with estrogens.
There are two very interesting perks to pursuing this research. First, we may be getting closer to developing a new treatment strategy for patients. The second reason relates to the excitement of training young researchers and working collaboratively, not only with other researchers at the University of Calgary but abroad. For example, my laboratory now has established collaborations with researchers in England, Australia and China and we interact scientifically using the internet. I have a guest professorship in China and our collaboration looks very promising for future scientific collaborations. Research is a universal language. We may not always understand each other’s verbal communications but the science is crystal clear.