Beating Heart Disease
Robert E. Gerszten
During a typical stint in the cardiac intensive care unit, Robert E. Gerszten, M.D., will often evaluate patients experiencing their first heart attack. Many are easy to identify based on traditional risk factors of age, gender, hypertension, high cholesterol levels, or smoking history. But those aren’t the patients that keep the chief of the Division of Cardiovascular Medicine up at night. “The problem is that if you look at the entire segment of people who develop heart disease, lots of them don’t have those risk factors,” he says of the individuals who do not show the traditional warning signs to trigger immediate life saving care. “We need to uncover better risk factors, and we need to understand the biology much better.”
Gerszten, who took the helm of the division two years ago, is a national leader in translational research to identify new biomarkers and pathways for more accurately predicting and diagnosing heart disease in all patients and for understanding who will respond to therapies. He has focused most of his work on the relationship between cardiac and metabolic diseases, such as heart disease and diabetes, a field known as cardiometabolic disease. “I started off as a basic scientist working in a lab that was completely divorced from the clinical world,” he recalls. “The work certainly had clinical implications, but now we are really at a time where implementation is not way off in the future. We are talking about it daily.” The “it” they are talking about is not only diagnosing heart disease decades before patients feel the effects, but treating it as well.
Now as chief of a division rich in clinical innovation, Gerszten’s goal is to integrate the outstanding, cross-disciplinary research into the clinical arm and secure BIDMC’s place as a premier academic medical center for cardiology in the United States.
BIDMC is certainly set up for the task. The Division of Cardiovascular Medicine operates one of the highest volume cardiac catheterization programs in New England, and its Structural Heart Center is using innovative surgical and interventional techniques to provide patients with the most advanced therapies. “It’s always nice to be in a division that has that legacy of innovation, but that legacy should motivate you to innovate even more,” Gerszten says, noting that with technological advances in the field and an influx of talented new staff to complement his stalwart team, they are poised to do just that.
In the last few years, the unique combination of advanced blood screening technologies and more readily available health information databases have provided researchers with the necessary tools to make some headway and bring better diagnostics and more personalized treatments directly to patients. Not only is his team equipped with two of the most sophisticated blood analyzer machines on the market today, but Gerszten also has access to extensive health and clinical trial databases and skilled statisticians through the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology. “We need to convert big data into information to help us to take care of patients in the future.”
Recognizing the value of shared information, Gerszten insists that all of his results are publically available for other researchers and clinicians to use. He is following the lead of the landmark Framingham Heart Study—the first study to identify the common characteristics that contribute to cardiovascular disease by tracking the health of a huge cohort of participants spanning three generations for almost 70 years. The famed project still shares its results with the research community today, and Gerszten and others are applying new approaches to the study’s existing blood samples and patient health information to glean knowledge that may help them pinpoint new, more specific risk factors.
Our work consists of high-risk, high-reward projects that few people are doing.
Robert E. Gerszten, M.D.
Chief, Division of Cardiovascular Medicine
Now, using emerging proteomic technology, which analyzes more than 1,100 proteins in a single blood sample, Gerszten and his team are getting an even closer look at the telltale molecular signs of cardiac disease. In a recently published study, BIDMC researchers used this approach to identify nearly 200 new proteins in the blood that increase within one hour following myocardial injury, or heart attack. These new biomarkers could be an early diagnostic for heart disease, and clinicians are beginning to validate this discovery at BIDMC. “If you come into the emergency department and have an equivocal EKG, we hope to leverage those markers to make a very early diagnosis—as soon as 10 minutes after myocardial injury—and know that you are having a heart attack,” he says of the treatment-altering blood test. This discovery is critical to guide faster care for traditionally low-risk patients who are not showing obvious signs of a heart attack and may eventually lead to more predictive diagnoses well before injury occurs.
Gerszten is also using this sophisticated technology to understand how physical activity improves and maintains health. Supported by an $11 million grant from the National Institutes of Health (NIH), Gerszten and his team are investigating the molecular changes that occur in our bodies during and after exercise and have teamed up with seven other cardiovascular centers across the country to start collecting pilot data. “We know exercise confers these beneficial effects, but how it does so is not entirely clear,” says Gerszten, who is leading the biochemical profiling of all samples across the study. “This is going to be the largest exercise trial ever.” At each location, researchers will be evaluating the molecular response of healthy patients engaged in endurance, bicycle, or weight-resistance training. At BIDMC, clinicians are going to use the same approach to assess patients with heart failure and diabetes. The first step is to determine if the molecular changes in the body during physical activity can predict who may benefit from which type of exercise depending on age, gender, body type, and fitness level. The ultimate goal is to tailor a highly precise exercise program to each individual. “It is early on, but we are already starting to get hints of who responds to which particular type of training,” Gerszten says. Eventually, researchers hope to use the biochemical snapshot of what happens in your blood during exercise to determine important pathways with the aim of identifying drugs that will produce the same beneficial response.
While the support from the NIH is essential for a study of this magnitude, Gerszten understands that, with the threat of significant cuts to federal funding, individual philanthropy is crucial to his success in executing outside-the-box projects. “The NIH often likes to fund things that have already been done,” he says. “A lot of the research we do is admittedly a little risky.” Despite this concern, in the last two years, the NIH has increased its funding to the BIDMC Division of Cardiovascular Medicine, which also boasted three American Heart Association Young Investigator Award finalists for the first time. “Our work consists of high-risk, high-reward projects that few people are doing,” Gerszten says. “That is usually where the big results happen. I really think that’s where philanthropy must figure prominently.”
Gerszten has only just begun to put his own mark on the division, but his collaborative and transformative approach is already changing the face of cardiac health. “I wake up every day, and my wife says, I can’t believe you love your job so much,” he laughs. “It is impossible to explain. It gives me enormous gratification. I like to be on a winning team, and this is a winning team. This team was always a good team, but I think now we are becoming the Pats.”