Laboratory-Based Research Supports Great Medical Care
When it comes to caring for his heart patients, W.H. Wilson Tang, MD, finds himself in a unique position to help people. He’s both a physician and a researcher. As a clinician in Cleveland Clinic’s Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Dr. Tang is a member of one of the world’s leading heart centers. Here, he sees firsthand how diseases progress and how patients respond to therapies. He’s on the front lines of cardiac care.
The other aspect to Dr. Tang’s care is the research he conducts in Cleveland Clinic’s Lerner Research Institute. As a laboratory-based investigator in the Department of Cell Biology, he searches for the genetic and biochemical causes of human heart failure and diseases and disorders of heart muscle. Dr. Tang is a “physician-scientist,” a role that bridges the gap between traditional laboratory-based research and clinical cardiac care. It’s an example of the cycle of cardiac care at Cleveland Clinic – leading cardiovascular research improves care for heart patients, and those clinical experiences feed back into laboratory investigations.
“I pursue laboratory-based research in addition to my clinical work because it provides a level of understanding of the processes in cardiovascular diseases and treatment beyond what can be learned at the patient’s bedside,” Dr. Tang says. “Quality research is an extremely important contributor to the level of care we can provide to cardiovascular patients.
“I strongly believe there are fewer and fewer physician-scientists who balance clinical practice with laboratory-based research. But there is a need to apply basic science findings to patient care. Likewise, questions are raised at the patient’s bedside that can be tested in the laboratory.”
A Magnet for Talent
The presence of cardiac research facilities also provides essential training opportunities and can help to recruit talented professionals, says Dr. Tang, himself recruited from Stanford University Medical Center in 2004.
“The proximity and availability of research facilities is important, as well as the availability of [Lerner] Institute researchers who are willing to be mentors and collaborators with physician-scientists,” he says. “Careers are built upon existing infrastructure and expertise. The collaborative research programs that you find at Cleveland Clinic and the Institute are key to the success for young faculty, especially those who have primarily clinical training.”
An ‘Engine’ For Care
“Research is the engine that drives the clinical mission in cardiovascular care,” says Roy Silverstein, MD, Chair, Cell Biology. “We’re among the top institutions for cardiac research, and without research, there would be less recognition for our world-class patient care. The advances we’ve made in the laboratory during the past several decades impact the level of care and prognosis for many people with cardiovascular disease.”
“There’s been a drastic decrease in cardiovascular disease deaths in the last generation,” Dr. Silverstein says. For example, according to the National Heart, Lung, and Blood Institute’s Framingham Heart Study in 2004, the risks of sudden cardiac death and coronary heart disease decreased by 49 percent to 64 percent from 1950 to 1999, a decrease attributed largely to a better understanding of cardiac diseases and prevention.
Additionally, in December 2007 the American Heart Association (AHA) released a study that showed death rates from heart disease and stroke are falling in the United States, though heart and artery disease remains the leading cause of death. The AHA reported an estimated 869,724 people died from heart disease in 2004, compared to 911,163 in 2003. The group predicts that in 2008, 770,000 people in the United States will have a heart attack and 430,000 will have a recurrent attack, and another 175,000 will have a silent first heart attack.
“In the 1950s, heart attacks among men in their 50s and 60s were more common than today. When President [Dwight] Eisenhower had his heart attack, the common treatment was several weeks or months of bed rest,” Dr. Silverstein says. “Today, most people who have heart attacks can expect to live long lives. Discoveries made in laboratories about statins [a class of drugs that reduce serum cholesterol], aspirin, stents and drugs called beta-blockers that treat angina and hypertension, among other conditions, have contributed to that success.”
An Array of Projects
Among the Lerner Research Institute’s laboratory-based research are projects to understand the growth of blood vessels, unlock how and why plaque deposits form on blood vessel walls, identify new diagnostic tools to predict cardiac events, and find ways to use the body’s own stem cells to repair damaged heart tissues. There are even multi-investigator projects in the Department of Biomedical Engineering to develop miniature heart-assist pumps and a total artificial heart.
“Coronary arterial disease is a lifelong accumulation of causes, and curing coronary diseases is a complex task,” Dr. Silverstein says. “Clearly our goal is to cure disease. But we also want to be able to slow its pace, make it chronic and, therefore, manageable. The more we can unravel the causes of coronary diseases, the more options will be available to clinicians who treat cardiac patients.”
Significant measures of the Lerner Research Institute’s status include its prestigious grants and centers devoted to cardiovascular diseases. “We have a large and successful group of investigators with a sense of collaboration,” says Dr. Silverstein, who is the Principal Investigator for two such research projects. “We’ve seen the growth of multi-investigator programs. Once you have one successful program, it attracts interest and it’s easier to establish more.”
Excerpted from the Lerner Research Institute Magazine, Spring 2008.
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