A very focused issue on “Advances in Cardiovascular Disease Prevention” has been published in Cardiovascular Diagnosis and Therapy (CDT). It was our honor to invite its Guest-editors Prof. Nathan D. Wong and Prof. Ian Graham for an E-interview.
Prof. Nathan Wong (Figure 1) is a cardiovascular epidemiologist and Professor and Director, Heart Disease Prevention Program, Division of Cardiology at the University of California, Irvine in California. He holds MPH and PhD degrees in epidemiology from Yale University. He is a past president (2010–2012) of the American Society for Preventive Cardiology. He is also a fellow of the American College of Cardiology, American Heart Association, National Lipid Association, and American Society for Preventive Cardiology and is the current treasurer of the Pacific Lipid Association, and is on the board of directors of the InterAmerican Heart Federation and California Chapter of the American College of Cardiology. He also serves on the Member Services and Credentialing Committee and Prevention of Cardiovascular Disease Committee of the American College of Cardiology and is past chair of the American Heart Association Prevention Science Subcommittee.
Prof. Ian Graham (Figure 2) is Professor of Cardiovascular Medicine in Trinity College, Dublin, and Professor Emeritus of Preventive Cardiology at the Royal College of Surgeons in Ireland. He is Secretary-Treasurer of the European Society of Cardiology, Chairman of the Adelaide Health Foundation and of its Health Policy Initiative. He is a member of the 6th Joint European Societies Task Force on the Prevention of Cardiovascular Disease in clinical practice and of its Prevention Implementation Committee, having Chaired the 4th Task Force. He is co-Chair of the 2016 European Guidelines on the management of dyslipidaemias, and also co-Chair of an expert group that is advising the World Health Organization on cardiovascular risk estimation.
Questions regarding the focused issue
CDT: As the Guest-editors of this focused issue, could you tell us what the spotlights of this issue?
Prof. Wong and Prof. Graham: This issue will spotlight key current hot issues and topics in preventive cardiology, including the comparison of European and US guidelines for cholesterol management progress towards implementing World Health Organization priorities in CVD prevention, the latest results from the EUROASPIRE surveys, cardioprotective effects of the Mediterranean diet, nutraceuticals, and PCSK9 monoclonal antibody therapy in CVD prevention.
CDT: What are the goals of this focused issue?
Prof. Wong and Prof. Graham: A principal goal of this issue is to give the reader a perspective of key areas of current interest in preventive cardiology as well as an international perspective of work being done in certain countries and regions.
Questions regarding personal experience
CDT: Your research interests are focused on cardiovascular epidemiology and prevention. Could you share with us the recent progress in this field?
Prof. Wong: This continues to be a rapidly expanding field and one that is getting more and more appreciation as we move towards personalized healthcare and a focusing on promoting cardiovascular health as opposed to just managing the condition once it manifests. We have made great progress in better refinement of cardiovascular risk assessment through newer methods and therapeutic advances to address the remaining problem of residual cardiovascular disease risk thorough newer therapies such as PCSK9 monoclonal antibodies.
Prof. Graham: While there is great progress in cardiovascular risk assessment, investigations and new therapies, there is a huge challenge to research how to make these advances accessible to developing countries who face rapidly rising CVD in the presence of inadequate resources to avail of high technology investigations and expensive new therapies. But the challenge is even more basic—it is to facilitate simple risk assessment and public health measures to contain overweight, inactivity, raised blood pressure, tobacco use and raised blood cholesterol levels.
CDT: Prof. Graham, you are engaged in projects like SCORE, HeartScore, the interactive Guideline Learning Tool and SURF, the simple international risk factor audit that has become an EACPR flagship project. Could you give a brief introduction of the project which had the most significant impact on your career?
Prof. Graham: My research quest has been mostly applied, while I have been involved in basic science, my mission is to make research knowledge accessible to all health professionals. SCORE and its electronic, interactive equivalent, Heart Score aims to make CVD risk estimation simple and accessible to all. SURF is a simple and fast audit of risk factor control in subjects with coronary heart disease, and we seek participation by new centres!
CDT: You have served as a funded investigator and continue to collaborate and publish with groups nationally and internationally. How does such broad range of experience affect your career and life?
Prof. Wong: It certainly makes for an interesting life in meeting and developing collaborations with experts from around the world, not to mention being able to visit many interesting places. Of course it is always a challenge balancing international collaborations and activities with work and family life back home.
Prof. Graham: It is invaluable to exchange ideas with international colleagues, who may bring a totally new perspective to ones thoughts. Being involved in research internationally, a senior Board member of the ESC and advisor to WHO poses some difficulties in traveling too much.
CDT: During your studies, such as examining coronary calcium and other measures of subclinical atherosclerosis in relation to other cardiovascular risk factors and clinical events, what were the most difficult challenges you encountered and how did you solve them finally?
Prof. Wong: For many years the commercialization of coronary calcium got ahead of the research and it was to some extent considered a fad. But beginning with early studies we and others conducted going back over 25 years, and now with probably well over a thousand publications from around the world on the topic, its role in assessing cardiovascular risk has now become solidified, respected, and incorporated within the guidelines.
Prof. Graham: My main research interests have been in improving CVD risk estimation and in auditing the quality of risk factor control. Both of these areas can be solidly evidence-based. Sometimes political issues make the application of evidence-based conclusions challenging.
CDT: Prof. Graham, the 2016 European Guidelines on cardiovascular disease prevention in clinical practice was recently published. That is a huge achievement! How long did it take? What was your main role in this guideline? What are the novel developments of the 6th Joint Task Force guidelines?
Prof. Graham: I am a member of the 2016 Joint European Guidelines on CVD prevention in clinical practice, and co-Chair of the 2016 European Society of Cardiology/European Atherosclerosis Society Guidelines on the management of Dyslipidaemias. We have strived to ensure compatibility between both, firstly with more emphasis on an integrated lifestyle approach to prevention, including a total approach to nutrition, exercise, avoidance of overweight, no exposure to tobacco or tobacco smoke in any form, detection and control of both hypertension and hyperlipidaemia; and secondly by means of agreed defined targets in both Guidelines with regards to specific goals for the major risk factors for CVD prevention-tobacco (none), blood pressure and blood cholesterol levels, body weight and exercise.
CDT: If you could choose three future events in your career or life, what would have priority on your to-do list?
Prof. Wong: Important in this stage of my life is to teach others what I have learned over the years and to further help develop young investigators and to inspire them to publish and get involved with key collaborations and societies to further their academic careers. Having a team of talented young investigators and colleagues to further the goals of our research and identifying key funding opportunities for future projects are also important priorities.
Prof. Graham: I would pass on my work on risk estimation and audit to talented younger investigators to develop further, simplify the communication of the concepts of CVD risk, audit and Guidelines for both health professionals and lay people, and promote the involvement of non-medical people in CVD prevention and Governmental acceptance of their responsibility to promote CVD prevention.
On behalf of the editorial office of Cardiovascular Diagnosis and Therapy (CDT), I would like to extend my gratitude to Prof. Nathan D. Wong and Prof. Ian Graham for sharing their opinions with us.
Conflicts of Interest: The author has no conflicts of interest to declare.
(Senior Editor: Silvia L. Zhou, CDT, firstname.lastname@example.org)