Laurence S. Sperling, MD, FACC, is the Katz Professor in Preventive Cardiology at the Emory University School of Medicine, Professor in the Rollins School of Public Health, and founder of the Emory Heart Disease Prevention Center. He currently serves as the Executive Director of Million Hearts®, a national initiative co-led by the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare and Medicaid Services (CMS) with the goal of preventing one million heart attacks, strokes, and cardiovascular events in the U.S. within a five-year period.

What led you to a career in cardiology?

My interest in cardiovascular medicine stems from my family. My maternal grandfather developed heart disease in his late 40s and died in his early 60s. Because of this, the impact of heart disease on individuals and their families has always been at the forefront of my mind. And at every stage of my medical school training, the heart continued to stand out to me. As a first-year medical student, I was fascinated by the anatomy and pathophysiology of the heart. When we dove into the physical exam and diagnosis stage of the curriculum, I discovered I loved auscultation – it's a real art.

During your training, preventive cardiology had not yet blossomed into the field that it is today. Did you have a sense, at the time, that cardiovascular disease prevention was a big part of what you wanted to do in the future?

One of the defining moments for me in recognizing the need for preventive cardiology was when I rotated on the Gruentzig interventional service as a cardiology fellow. I realized we had created this revolving door – we would "fix" people's blood vessels with a balloon, but not address the underlying causes of disease. We were providing a temporizing therapy, improving how people felt, but failing to get at the root of the problem. I recognized through my training in molecular and vascular biology that the future of cardiovascular care would be, and needed to be, a greater focus on cardiovascular disease prevention.

Marschall Runge, MD, PhD, FACC, Emory's fellowship director at the time, helped me pursue a molecular & vascular biology fellowship sponsored by the National Heart, Lung, and Blood Institute, which gave me an important foundation. After my molecular & vascular biology fellowship, I moved on to my clinical cardiology training. There was no formal preventive cardiology fellowship – as there was in interventional cardiology, heart failure, and so on – so I designed my own preventive cardiology fellowship training pathway. I feel very fortunate that the program was supportive of my plan.

How is the field of preventive cardiology taking shape today and what's on the horizon?

All cardiologists – regardless of whether they are an electrophysiologist, heart failure specialist or adult congenital specialist – should focus on prevention as it relates to their work. There will be a greater need in the future for individuals who have subspecialty training in preventive cardiology. If you look at where the field is going, we are moving into unique therapies and biologic agents: PCSK9 inhibitors, lipoprotein(a) antisense oligonucleotide therapy, RNA interference agents, and enhanced evidence for optimal medical therapy and comprehensive cardiovascular risk reduction. Looking at the intersection between diabetes and cardiovascular care, the SGLT-2 inhibitors are going to be mainstay therapeutic agents prescribed by cardiologists – maybe more so than endocrinologists.

How do you see the current state of cardiovascular health, on a population level, in the U.S.? How do you see it progressing over the next years?

In the U.S., advances from 1950 to 2010 led to a 50% reduction in cardiovascular disease mortality. However, since 2010, there has been a leveling off of those gains. Recently, there has been a concerning trend in two-thirds of the U.S., with increasing rates of cardiovascular disease and stroke mortality, especially in young adults.  We are losing ground in cardiovascular population health, even though our knowledge base is growing and our therapies are improving. There are proven and effective evidence-based strategies to control blood pressure and manage hypercholesterolemia; however, we are challenged by a health care delivery system that provides fragmented, episodic, and catastrophic care. We must move beyond describing the problem to addressing it. We must identify opportunities now and recognize the COVID-19 pandemic was not only related to an infectious disease, but also to the underlying poor health of the population.

Do you have any parting advice for aspiring cardiologists currently in medical school?

Medical school is a time for exposure to many experiences. It is a time to think about future possibilities. One of the highlights of my career has been working with medical students, helping to guide those looking toward their futures. A piece of advice is to remain open-minded. Where I am today was not by design; it was by keeping an open mind and embracing opportunities that appeared before me. On the door of my first faculty office, I had a quote from former President John F. Kennedy: "Things don't happen, they're made to happen." Sometimes you meet individuals or encounter a new discipline that will fuel the fire for your career.

This article was co-authored by Christian Faaborg-Andersen, BS, medical student at Emory University School of Medicine and member/editor of the ACC's Medical Student Leadership Group and Samip Sheth, BS, medical student at Georgetown University School of Medicine and chair of ACC's Medical Student Leadership Group.