Unlocking Secrets of Heart Health
David Gutterman, MD
Medical College of Wisconsin Cardiologist;
Associate Director, Cardiovascular Research Center
"Clinical trials give our community access to some of the most cutting edge therapies, which if proven effective, can be implemented very early on in our area"
The Cardiovascular Research Center encompasses scores of researchers in multiple specialties all of whom are investigating some aspect of heart disease, stroke or heart care. The Cardiovascular Center's research programs rank among the top 5 in the country. David Gutterman, MD, gives us a peek at the breakthrough investigations going on right here at Froedtert & Medical College.
Q. What's the most exciting research going on right now at the center?
Much of the exciting research is basic research, but there are often clear clinical implications. For example, the laboratory of Kirkwood Pritchard, PhD, is studying a compound called D-4F that builds up your levels of HDL ("good cholesterol") tremendously. This substance improves blood vessel function in a variety of diseases, but most strikingly it has a very powerful beneficial effect on atherosclerosis. Atherosclerosis, or hardening of the arteries, is the main cause of death in the world. This compound has the potential to revolutionize how we treat atherosclerosis, and some of the critical research work on D-4F is being done here.
Q. Are there any recent research findings that surprised you?
There is a very large Women's Health Initiative center here. Jane Kotchen, MD in the Medical College of Wisconsin Epidemiology Department was involved in a large national trial of 60,000 women treated with estrogen therapy. For years we thought estrogen therapy was helpful from a cardiovascular standpoint, but the studies that generated that impression were not conducted in an ideal manner. Dr. Kotchen and colleagues conducted a proper prospective trial. The results were surprising. We expected the incidence of breast cancer might increase, but that heart disease would diminish substantially. It turns out breast cancer rates did increase, but heart disease events also went up, suggesting that estrogen treatment may not be a good therapy for many women. This study has markedly changed how we prescribe hormone replacement for post-menopausal women. Froedtert & Medical College was a big part of that study.
Q. How important are clinical trials to the program?
They are important in helping answer very practical questions such as "does drug A work better than drug B for a given condition." Most of our current effective treatments are based on clinical trials. These studies can be done exclusively at Froedtert & Medical College or they can be done here as part of a larger consortium of sites investigating a particular problem, as with the Women's Health Initiative. There are two major benefits to clinical trials. First, it is good to have Wisconsinites involved so that the results of the trial are more apt to be applicable to people in Wisconsin. Second, clinical trials give our community access to some of the most cutting edge therapies, which if proven effective, can be implemented very early on in our area.
Q. How will current research change heart care 10 to 20 years from now?
I think genetics will create some of the largest changes in healthcare for the next decade or two. I anticipate that we will tailor most of our treatments — not just drugs — on the patient's genetic background. We will know what risk factors you're going to develop and which ones we need to treat or prevent. This will be the era of "personalized medicine" and will improve outcomes but also reduce side-effects and complications.
Another thing we're working on at the Cardiovascular Center is preventive cardiology. We envision the ability to look at blood vessels in patients — non-invasively, no needles, using an ultrasound probe over the arm — and be able to predict which patients are more susceptible to developing hardening of the arteries than others.
Q. What attracts people to the field of research?
There are two aspects to medicine that I find very interesting. One is taking care of patients and making sure they are offered the best treatments available. The other is to come up with new ideas in terms of what needs to be done to improve healthcare and begin to develop new approaches. This is the most invigorating of experiences.
Going from what's already known to actually identifying new information relevant to patient care — to me that's the exciting aspect of research in medicine.
Author: David Gutterman, MD
Source: Every Day
Date: May-August 2004