Eric Velazquez, MD, the new chief of cardiovascular medicine for Yale Medicine, knows what heart disease can do to a family. His paternal grandparents both died of heart attacks in their early 50s, at a time when people didn’t know all of the early warning signs and doctors were still determining the best care. Years later, his father was diagnosed with severe high blood pressure while he was still in his 40s. By then, there were effective medications, and as the years passed, continuing medical advances allowed his father to live well into his 80s.
Dr. Velazquez, who will start seeing patients this spring, is amazed at the dramatic changes he’s seen since becoming a cardiologist about 20 years ago. “We can mitigate the risk of progressive heart failure and prolong life in a way that—not that long ago—was only a dream,” he says.
As chief, Dr. Velazquez, who is also physician-in-chief of the Yale New Haven Health System’s Heart & Vascular Center, leads more than 150 specialists who focus on every area of cardiac medicine, tapping into a broad and diverse array of tools, technologies, and expertise. They treat patients from New York to Rhode Island, and throughout Connecticut. In addition to treating patients, Dr. Velazquez is putting new energy into such areas as population health, community care, genetics, discovery science, and translational and clinical research—all of which he says feed into better care for heart disease.
He spoke to us about his plans, his practice, and the message he would like to send to anyone who is concerned about heart disease.
What inspired you to pursue cardiology? Was family history a factor?
I do think my family history helped guide my decision to become a doctor. But when I started medical school, I thought I was going to be a neuroscientist. It soon became obvious that bench-based research alone wasn’t going to be the right fit for me. I preferred the human contact I found in cardiovascular medicine. I found my particular passion in heart failure, a syndrome where the heart is not pumping sufficient blood to the organs, which is the most common cause of hospitalization for people who are 65 or older. Now, a lot of my research and my clinical practice puts me at the intersection of heart failure and coronary disease, which is the blockage of arteries that supply blood to the heart and the most common cause of heart failure in developed countries.
You’ve also done extensive work to improve treatments, correct?
So, at the same time I was learning about cardiovascular medicine, I found mentors who showed me that I could fashion a career that could include developing and defining the best strategies to evaluate and treat large groups of patients. This focus on randomized clinical trials and population-based registries—using the information gathered from large patient populations to answer questions and improve care relatively quickly—was still a revolutionary approach in the late ‘80s and early ‘90s. In 1994, when I finished medical school, many of the medications and treatments we now have for patients with heart failure had not been studied to the point where they were considered standard, and they were not available. But by tracking patients who have had heart attacks and other heart-related problems, we now have information that we can use to better evaluate health and mitigate the progression of disease. Today, electronic medical records have made it much easier to gather valuable data to use in this way.
How can this information help a patient who is worried about their heart?
We are so fortunate in 2019 to have medical and device therapies, as well as surgical approaches that were only being tested a couple of decades ago, now be available to patients routinely. I can give the example of a patient who has an arrhythmia, where the heart beats too quickly, too slowly, or in an irregular pattern. This might put a patient at risk for sudden death. How many times do you hear about someone who seems very healthy, but then dies suddenly? In this day and age, because of the research we’ve done, we can identify patients who are at risk for this and treat them with defibrillators, which are devices that monitor the heartbeat and provide a lifesaving shock if a patient goes into cardiac arrest. So, sudden death can be avoided for some. But we have much more to do to avoid sudden death for all.
Are genetics an important piece of the puzzle?
Absolutely. We are at a point where we know that 10 people doing the same 10 things to treat a heart problem may have very different results. That’s because of inherent genetic differences. You may have heard the term precision medicine. The goal of precision medicine is to apply treatment strategies broadly to as many people as will benefit from them, while also identifying the unique and actionable genetic signatures of each patient to predict response to or risk from certain treatments. Precision medicine is already here, but it will play an increasingly important role in the coming years. To meet its full potential, we must strive to better interconnect treatment with what we can measure genetically. We need to measure what we can—through the technology we have—by asking patients about their lives. We can use that information to develop a greater understanding of the environmental and societal determinants at play in cardiovascular health and disease. It is a massive scientific undertaking whose success will be dependent on our capacity to measure, report, and analyze immense data sources, as well as define the best policies for implementation in serving our population. I am here at Yale now because I am confident that it is one of only a few academic health centers globally that can lead the way forward toward making the promise of precision medicine routine.
How do you envision the future of cardiovascular disease at Yale?
I’m very fortunate to be at the helm of a group of doctors who wake up every day and think about the patients they're going to see—and at the same time, pay attention to what it is about each encounter that they can look at critically, and maybe modify and apply in a research setting with the goal of bringing it back to a future patient. An important mission for us is to continue to try to understand what the next generations of cardiovascular therapies will be for our patients. To this end, we want the people who come to us for care to have a greater opportunity to participate in clinical trials that will inform how we treat future generations, which may include their children and grandchildren.
I want to address people’s heart problems not only in acute situations—when a patient comes into the emergency room with a heart attack—but also in the community. I go back to my father. He did see cardiologists, but he also had a strong relationship with his primary care doctors. When he first was diagnosed, a primary care doctor referred him to a cardiologist. We want to work with doctors and people in the community to make sure the appropriate diagnostic technology, expertise, and prevention aspects are in place.
Even with the best care, heart disease is tough. How do you talk to patients about it?
I have found that listening can be a doctor’s greatest tool. A patient can tell you a lot about what they need from you if you listen actively. I also think that in this era doctors should be walking the journey with patients throughout their lifetimes. Usually that starts early in life, then it kind of gets lost, and then as patients age they tend to come back to doctors to help them manage risk, prevent disease, and in some unfortunate situations, treat disease. Not all patients will make the same choices. But I think the conversation, the listening to what the patient wants, helps drive a lot of what we do.
Has this knowledge influenced the way you take care of yourself?
Yes, I’m certainly aware of the impact of cardiovascular risk factors and how they can impact my likelihood of having a healthy and appropriate lifespan. And I’m at that juncture in life—being a male in his early 50s in America—where I need to intensify my focus on healthy lifestyle habits. Like anyone, I have my ups and downs with weight, so I focus on fitness. I don’t smoke. I try to be consistent about the gym and focus on being leaner. I try to eat right and pay attention to cholesterol and blood pressure. Genetics and other factors that may be out of one’s immediate control play a role, but I know there are still many things I can do to keep my heart healthy.
What message would you like to send to patients about cardiovascular disease?
Don’t dismiss your symptoms. For instance, increasing fatigue and shortness of breath are not signs of aging. Don’t let anyone tell you these symptoms are OK. If you dismiss these symptoms and don't speak about them with your family doctor, we may lose the opportunity to treat your heart and prevent the disease from progressing over time. If we do diagnose your disease before it becomes advanced, there's so much more we can apply to your care that might make your future life much better. But we can only help you if you tell us about it.