Alexandra Lansky (Director, Heart and Vascular Clinical Research Program, Yale University School of Medicine, New Haven, USA) decided to become a doctor at age 11 after a visit to Sri Lanka prompted her desire to help others. Now focused on clinical research, which is her passion, she talks to Cardiovascular News about what she feels have been the most important clinical breakthroughs in interventional cardiology and what she thinks the next big innovation will be.
Why did you decide to become a doctor and why, in particular, did you decide to become an interventional cardiologist?
I decided to go into medicine at the ripe old age of 11 after a trip with my family—none of whom are doctors—to Sri Lanka. I was so stricken by the poor health and extreme poverty of so many people there that I decided I wanted to help, and I would achieve that by becoming a doctor.
My initial passion in medicine was infectious diseases and tropical medicine; I had dreams of travelling the world helping people. However, I did my residency during the AIDS epidemic of the 1980s and very quickly became disillusioned by the lack of any foreseeable cure for my patients. At that time, HIV was a death sentence—seeing one of my favourite patients deteriorate within weeks of AIDs was plain frustrating —so I decided a career in infectious disease was just not for me after all. I was back to the drawing board and decided I wanted to get a taste of investigative clinical research.
It was towards the end of my residency that I was fortunate enough to meet Jeffrey Popma (Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA), who asked me to help him research methods of preventing kidney injury in patients undergoing coronary interventions. That was a turning point. Through that research project and many more that ensued, I went into cardiology and subsequently interventional—I actually spent the next 20 years working at the Cardiovascular Research Foundation (CRF), as one of five founding physicians of the Foundation, helping build one of the premier interventional clinical research programmes. I feel very fortunate for that career-changing encounter!
Who have been your career mentors?
Besides Jeffrey Popma, Martin Leon (Columbia University Medical Center / New York-Presbyterian Hospital, New York, USA), Kenneth Kent, Gus Pichard and Lowel Satler (both at MedStar Washington Hospital Center, Washington DC, USA) were all instrumental mentors for me and really helped to shape my early career. I was fortunate to work alongside some of the pioneers of the field when the great landmark discoveries in interventional cardiology were being made. Later, I worked alongside many wonderful colleagues including Jeffrey Moses, Gregg Stone, Ron Waksman and so many other friends and talented individuals. In those days CRF was an academic powerhouse on steroids! There was no limit to our energy, our work ethic, our enthusiasm for academic productivity—our passion was endemic. I was fortunate to be integral to so many aspects that contributed to the evolution of interventional cardiology from the very early days. After moving to New York, I joined the Interventional team at Columbia University Medical Center as Director of the Interventional Clinical service for the next six years; another unforgettable experience, where from day one, we collectively transformed this academic clinical service into a power house of transformative therapies for our patients.
What do you think have been the most successful and least successful interventional cardiology therapies during your career?
I think drug-eluting stents and transcatheter aortic valve implantation (TAVI) have been the biggest landmark innovations that have changed the course of patient care in our field in the past two decades. Actually, the rapidity of the transition from interventional therapies to manage acute coronary syndromes to minimally invasive applications to treat structural heart disease is mind-boggling! The many lessons learnt over the years understanding and overcoming the challenges of restenosis and stent thrombosis in the coronaries have been rapidly applied in an accelerated way to TAVI.
As for the least successful, in the early 2000s, we became very excited about intravascular brachytherapy (ie. using radiation within the vessel wall) to reduce the risk of restenosis associated with angioplasty. However, this did not prove to be case—it was found to be neither safe nor effective. Drug-eluting stents emerged at the same time and they were shown to be a clearly much better solution to reducing the risk of restenosis.
Looking to the future, what do you think the next big developments will be?
The ongoing work investigating the expanded use of minimally invasive TAVI in lower risk patients is very important. In addition, all of the emerging innovative work evaluating transcatheter options for the mitral valve, heart failure patients and continuous monitoring devices to reduce readmissions will be another major turning point in our field. I am also very excited about work I recently have been involved with evaluating the role of neuroprotection devices in patients undergoing TAVI and how the use of such devices may further improve the outcomes of interventional and possibly surgical cardiac procedures.
Throughout your research career, you have been involved in pursuing gender-based research outcomes. What do we know so far and what do we still need to know?
In the mid 1990 cardiovascular disease in women was ignored for the most part. Women with cardiovascular disease had worse outcomes and higher death rates compared to men. Women were not receiving the preventive or therapeutic treatments known to be beneficial; in fact during the early 90s primary prevention in women was not thought to be “cost-effective”! Over the last couple of decades, through heightened awareness and research exposing women’s risk, we have witnessed a dramatic improvement in death rates among women in the USA. There are still some remaining challenges facing women particularly with higher death rates following heart attacks, with higher risk of bleeding after coronary interventions and a continued need for more education. We are currently launching the Global Lumen Organization for Women “GLOW” programme, to address the continued excess mortality and gross under-treatment facing women with heart attacks worldwide. This ambitious international collaboration seeks to leverage lessons learnt from programs such as Mission Lifeline in the US and Stent for Life in Europe, with a focus on breaking down barriers to the access to healthcare in the emergency management of acute myocardial infarction in under-served countries.
As one of the few women to work in interventional cardiology, what are the challenges?
I practised interventional cardiology for 10 years after my fellowship when my attention was pulled away by the priorities of my growing clinical research commitments and my three beautiful young children (Olivia now 15, Scott 13 and Natalie 10). Being an interventional cardiologist, a busy clinical researcher and a working mother was all consuming and something had to give. My decision to step away from interventional practice was not an easy one, and I still very much miss my cath lab days. At the same time, I am passionate about my current career path now at Yale, and I cherish the time I carve out for my family. Having said that, interventional cardiology is a spectacular and fulfilling career for women and balancing work with family commitments is entirely feasibly so long as you are willing to be creative and reach out for a little help on the home front. I personally run a full service economy in my own home, and at least for now, everyone seems to be happy!
Do you agree with the view that there should be a greater emphasis on shared care between men and women so that the burden of family life does not disproportionately fall to the woman?
I personally do not see family life as a “burden”, rather it is a journey and a privilege to be cherished! I may have evolved to this state of mind. My advice to women is to make sure you choose the right partner if you want to be a career woman with crazy hours. Make career choices you can assume and with your eyes wide open. Set your priorities, manage your expectations and for those around you, communicate openly, and actively set up an infrastructure both at home and at work that works for you. Be proactive and assume responsibility, because no matter what, balancing home and work will be challenging at times. Never forget to make time for yourself and your loved ones. Of course, shared responsibilities in the mundane duties of every day life is necessary for ones sanity, but when it comes to children you might just find that spending time with them is rather addictive!
What is the value of attending conferences in this digital age when most information is accessible online?
Having near instantaneous access to the latest medical information is revolutionary and we all benefit from it. Having said that, it is lonely at your computer terminal and the great value of attending a conference is the tremendous exchange of ideas, dialogue, interaction and networking. The explosive growth of clinical research and innovation in our field over the past decades stems in large part from these interactions. If we were to only access information remotely, I think the networking aspect of attending conferences would get lost in translation and the field would definitely suffer as a result.
What advice would you give to someone who was starting their career in interventional cardiology?
Follow your passion—do not hold back! Push yourself and go beyond your comfort zone, this is how you will learn. Find a good mentor(s) and learn from them; set high expectations and goals for your self and you will discover the most amazing journey ahead of you.
Outside of medicine, what are your hobbies and interests?
First and foremost, being with family—movie night with the kids and playing chess with Natalie is a treat! I also enjoy reading history and watching documentaries, always learning new stuff; currently I am onto the Renaissance. I am an exercise addict; I jog virtually every day if I can, I love skiing and ice-skating in winter, hiking and mountain biking in summer… and yes, I do love to cook on weekends and having friends over for diner. Life is good!
- Tenured professor, Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, USA
- Honorary reader, Division of Medicine, Faculty of Medical Sciences, University College London, London, UK
- 1986–1990 MD, Medical College of Virginia, Richmond, USA
- 1983–1986 BSc, College of William and Mary, Williamsburg, USA
- 1982–1983 BSc, McGill University, Montreal, Quebec, Canada
Professional honours & recognition
- 2014:Thomson Reuters 2014 Worlds Most Influential Scientific Minds for Clinical Medicine
- 2012: Visiting Professor of Cardiology; Fu Wai Hospital, National Center for Cardiovascular Diseases of China, Beijing, China
- 2012: Wender Award of Excellence in Women’s Helath Care. WomenHeart: the National Coalition of Women with Heart Disease awarded the annual Wenger Award for Excellence in Women’s Health Care, for excellence in medical leadership, and a lifelong commitment to pursuing gender-based outcomes research
Speaking engagements (selected)
- 2015:EuroPCR; China Interventional Therapeutics; American College of Cardiology (ACC) 64th Annual Scientific Session and Expo; Cardiovascular Research Technologies
- 2014: International Conference for Innovations; European Society of CardioThoracic Surgery (EACTS); Transcatheter Cardiovascular Therapeutics; Transvalvular Therapeutics