Cardiology recently sat down with Pamela Bowe Morris, MD, FACC, to discuss her career path in cardiology and her thoughts on the future of population health. She is currently the director of preventive cardiology, co-director of Women’s Heart Care, and an assistant professor of medicine at the Medical University of South Carolina. Morris serves as the chair of ACC’s Prevention of Cardiovascular Disease Section Leadership Council, and is a member of the ACC Scientific Session Program Committee, ACC’s Population Health Policy and Health Promotion Committee, the ACC Expert Consensus Clinical Pathway Task Force, and the LDL: Address the Risk Oversight Committee. What initially drew you to medicine? How did you come to specialize in cardiovascular disease prevention? As a student I was torn between careers in medicine or in teaching. I come from a large extended family of educators with numerous outstanding role models and mentors. Fortunately, however, I did not have to choose. A career in academic medicine has enabled me to pursue both career pathways. During my cardiology fellowship at Duke Medical Center I was initially attracted to basic science research and spent one year in a protein chemistry lab working to isolate growth factors involved in angiogenesis. However, at the completion of my fellowship I was asked to remain on faculty as medical director of the Duke University Preventive Approach to Cardiology program, now known as the Duke Center for Living. My lifelong passion for fitness and healthy nutrition seemed like a natural fit for one of the largest cardiac rehabilitation, nutrition and wellness programs in the nation. The program’s comprehensive lifestyle management approach to cardiovascular health and disease prevention was the brainchild of Andrew Wallace, MD, in 1975. That was the beginning of my nearly 30-year-long career in prevention. How has this training shaped your career? Dyslipidemia was highly prevalent among these high-risk patients, but our pharmacological therapies were quite limited until the approval of the first statin in 1987. At that time, in collaboration with endocrinology colleagues, we established the Duke Lipid Clinic. The exercise and nutrition resources at Duke, the diabetes expertise of endocrinology, and my interest in dyslipidemia provided the perfect clinical setting for comprehensive management of dyslipidemia and cardiovascular risk reduction. In 1990, I joined the faculty of the Mayo Cardiovascular Health Clinic in Rochester, MN. During that time my colleagues, John Rumberger, MD, PhD, FACC, and Jerry Breen, MD, were investigating the prognostic role of imaging coronary artery calcium by electron beam computed tomography scanning. As patients were identified with subclinical atherosclerosis, they were referred to the Cardiovascular Health Clinic for development of protocols for risk factor modification depending upon the extent of disease. I have maintained an ongoing interest in preventive imaging, and certainly decades of research have now validated the important role of calcium scoring in atherosclerotic cardiovascular disease (ASCVD) risk assessment. What do you find most rewarding about teaching? What do you hope to impart on your medical students? My greatest joy in teaching is seeing “the lights go on,” when a student or mentee truly understands an important concept in patient care. It’s that moment when they understand my passion for prevention and connect with the patient’s priority – quality of life. Patients really value a focus on wellness rather than disease management. As chair of ACC’s Prevention of Cardiovascular Disease Section Leadership Council, what would you say are the main priorities of the Section as the College looks to define ‘population health’? The ACC has long been a leader in the transformation of care for patients with established cardiovascular disease. The formation of the Prevention of Cardiovascular Disease Leadership Council and Section in 2014 affirmed ACC’s position that reduction of morbidity and mortality from ASCVD also demands effective preventive strategies, including lifestyle interventions and risk factor modification with evidence-based pharmacotherapies. The multidisciplinary members of the Council bring broad expertise and interest in the areas of the genetics of ASCVD and risk factors; health care disparities; nutrition; physical activity and cardiac rehabilitation; smoking cessation; preventive imaging; the management of complex dyslipidemias, diabetes and cardiometabolic disease; and hypertension. As the ACC broadens its focus from the prevention of disease or recurrent events in the individual patient to preserving the cardiovascular health of populations, the Council is well-positioned to provide support and guidance. What are some of the challenges to implementing preventive health initiatives in populations at high risk for cardiovascular disease? Significant disparities in access to health care and heart-healthy nutrition are critically important barriers to successful implementation of preventive health initiatives in high-risk populations. These disparities are the focus of the Disparities Work Group of the Prevention Council, led by Gladys Palacio Velarde, MD, FACC. In collaboration with the Nutrition Work Group, co-chaired by Penny M. Kris-Etherton, PhD, and Andrew M. Freeman, MD, FACC, the Disparities Work Group is currently exploring the concept of “nutrition deserts” and their impact on cardiovascular health. How will ACC.16 address prevention and population health more so than in years past? As part of a strong program addressing prevention at the ACC.16, a “Lifestyle Intensive” will be offered focusing on effective implementation of nutrition counseling and “deep-dives” into important issues in exercise counseling and prescription, controversial and misunderstood issues in heart-healthy nutrition, and updates on smoking cessation counseling and use of electronic cigarettes. Learn more about the intensive at accscientificsession.org. What role do you see technology playing in the prevention and population health sphere? The ACC has been at the forefront of developing mobile apps to provide clinicians with fingertip access to evidence-based guidelines. The ACC Statin Intolerance app guides providers with a systematic approach to the patient with muscle-related symptoms on statin therapy. Compliance with evidence-based statin therapy is suboptimal and this approach can help the clinician evaluate for secondary causes of myalgias, risk factors for statin intolerance, drug interactions that may predispose to myalgias and can ultimately encourage the patient to continue long-term treatment. This and other ACC apps are available at ACC.org/apps. How have your ACC membership and mentors impacted the course of your career? My membership in the College has immeasurably enriched my career satisfaction by providing mentors, opportunities for networking, involvement in advocacy, lifelong education, and the chance to play a role in advancing cardiovascular disease prevention. However, the words of my mentor, Salvatore Chiaramida, MD, FACC, have guided me and truly impact the daily joy I experience in my career in cardiovascular disease prevention: “Do what you love and do it for yourself, not for greatness.”
Published by American College of Cardiology. View All Articles.