Top Docs 2012: Matters of the Heart

Meet the Top Doctors who keep an eye on the rhythms of the city.

August 2012

Good Medicine

 Kaiser Permanente cardiologist Dr. Christopher Lang has worked at Denver’s Saint Joseph Hospital for 22 years. In that time he has witnessed major improvements in the way medicine treats heart disease and prevents heart attacks. We spoke with him about why he loves his field, what distresses him most about the risk factors for the disease, and the diabetes epidemic.

5280 Why is cardiology compelling to you?

Dr. Chris Lang Cardiovascular medicine has it all in terms of the different dimensions of medicine—preventive care, physiology, biology, surgical procedures, complex imaging.

What are the most common diseases you see?

Atherosclerosis, chronic heart failure, and arrhythmias.

What helps you treat these diseases every day?

We have the benefit of sitting on top of the biggest mound of hard evidence about how to handle problems compared to any other medical specialty. The most clinical trials have been done in cardiovascular medicine because it’s the most common clinical problem. The neat thing is there is always something new being published and there’s always clinical trial data that gives you some real scientific certainty about what you’re advising.

What’s the biggest change you’ve seen in cardiology over the course of your career?

If I look back over the past 20 years, it’s night and day how patients are now faring with coronary artery disease. If you had a heart attack in 1990, your chances of being back in the hospital in five or 10 years with a recurrent event because your atherosclerosis had progressed—despite the fact you were seeing a doctor—were probably a 30 percent chance at five years and a 50 percent chance at 10 years. Today those numbers are dramatically lower. That has to do with prescribing statins (like Lipitor) to treat cholesterol and using antiplatelet agents (like aspirin). Today, I can be confident that after a patient has a heart attack, he can live many years without a recurrence if we are treating him correctly.

Still, more than 500,000 Americans die every year from heart disease. What are the risk factors for atherosclerosis?

The risk factors haven’t changed—age, sex, smoking, diabetes, inactivity, obesity, blood pressure, weight, high cholesterol, sodium intake, and family history.

It’s hard to believe people are still lighting up, isn’t it?

Smoking is still an issue. The most distressing thing as a cardiovascular professional is to see young kids smoking. It drives you out of your mind. You know they’re on a trajectory toward trouble.

The epidemic of diabetes has to be a big issue these days, right?

Looking at national trends in cardiovascular outcomes, the morbidity and mortality have gone down progressively over the last 30 years. But people feel like that curve is now going to take an inflection upward because all that good that’s occurring after a heart attack has the potential to be undone by a wave of new heart disease in individuals who now have diabetes. These people are going to have atherosclerosis that’s related to their diabetes. It would be a shame if cardiovascular disease, which has been recently supplanted by cancer as the primary killer of Americans, regains its ascendancy because of lifestyle issues and the environment we live in.