Medical Director of the Doris and Harry W. Bass Jr. Clinical Center for Heart, Lung, and Vascular Disease
What are your top challenges in treating heart disease?
First, people are sicker. Ten or so years ago, most of our patients were in their 50s, and they had cardio-vascular disease but not a lot of extra medical problems. Now, partly because people are living longer, I see a lot of older patients with lots of other things wrong with them. I have to put what I do in the context of their other medical problems, and that can be tricky. Secondly, at the other extreme, we now see many young patients in their 30s – partly because of the growth of obesity and diabetes in this country and partly because everyone is working hard and not exercising in this current economy. Physicians feel a lot of pressure to make the right decisions for these young people, because they might live 50 years or more if you make the right choices.
What do you see as the big advances In cardiovascular care over the xext 10 years?
First, the identification of patients who are at risk for cardiovascular disease even before they have symptoms, using biomarkers and new genetic screening tests. Eventually, we’ll do this routinely as part of a physical, but initially it will probably be done on people with family histories of heart disease or markedly high cholesterol. Secondly, as technology develops, we’ll see more outpatient, minimally invasive procedures. In 10 years, we’ll likely be doing very few of the operations we’re doing now where a large incision is made. And I think we’ll be giving pharmaceuticals locally – delivering medicine to the spot it’s needed.
What's the Impact of the Increasing Incidence of type 2 diabetes?
It’s huge. With diabetes come heart and vascular problems – and diabetics have more severe vascular dis-ease, and they’re more likely to progress quickly through the disease process. Because of this diabetes epidemic, we’ll see very complex cardiovascular disease. To fix that, we have to change our lifestyle, eat less and change what we eat, and exercise more. We also have to start looking for diabetes earlier. If we diagnose it early and treat it appropriately, we can at least slow down the pace of complications.
John Warner, M.D., associate professor of internal medicine, received his medical training at Vanderbilt University School of Medicine and completed fellowships in cardiology and interventional cardiology at Duke University Medical Center. He sees patients at St. Paul University Hospital – and is available for second opinions, if required. To schedule an appointment, call 214-645-8300.