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Roadmap to a career in preventive cardiology
  1. Charles A German1,
  2. Michael D Shapiro2
  1. 1 Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
  2. 2 Cardiovascular Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
  1. Correspondence to Dr Michael D Shapiro, Center for Prevention of Cardiovascualr Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston Salem, NC 27157, USA; mdshapir{at}wakehealth.edu

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While the concept of cardiovascular disease prevention spans a wide range of medical disciplines and specialties, few trainees receive dedicated, well-rounded training in this field which aims to curtail the burden of atherosclerotic cardiovascular disease (ASCVD). Increasing rates of cardiometabolic diseases, coupled with increases in sedentary lifestyle and poor diet during the COVID-19 pandemic, have highlighted the urgent need for ASCVD prevention, and preventive cardiologists are at the forefront of this public health emergency.

Fundamentally, the practice of preventive cardiology requires knowledge of cardiovascular physiology, epidemiology, genetics, metabolism, anatomy, multimodality imaging, stress testing, pharmacology, cardiac rehabilitation and lifestyle management.1 Unfortunately, preventive cardiology is not widely recognised or standardised, though some have outlined the basic components necessary for success in the field.2 3 We feel that expertise in the following domains is, at a minimum, necessary for the practice of preventive cardiology:

  1. ASCVD risk assessment

  2. Primary and secondary prevention strategies

  3. Diabetes

  4. Hypertension

  5. Lipid metabolism and therapeutics

  6. Vascular medicine

  7. Obesity and weight management

  8. Nutrition, physical activity and smoking cessation counselling

  9. Cardiac imaging (coronary artery calcium scoring, coronary CT angiography, carotid intima-media thickness, echocardiography, stress testing, cardiopulmonary exercise testing)

  10. Cardiac rehabilitation

  11. Research methods and interpretation

Additional training outside of general cardiology fellowship is usually desirable to attain proficiency. For those who enter the field after endocrinology fellowship or internal medicine/family medicine residency, extra training would be required (figure 1). Dedicated preventive cardiology training programmes throughout Europe are sparse, though the European Association of Preventive Cardiology (EAPC) recently put forth a document to better standardise, structure, deliver and evaluate training across the continent.4

Figure 1

Roadmap to a career in preventive cardiology.

Prevention programmes are typically 1 year or 2 years, and can be tailored towards the trainee’s career goals.5 The 1-year fellowship is typically clinical, suited for those preparing for a career dedicated exclusively to patient care. The 2-year fellowship adds an additional year of research, which may be better suited for those interested in an academic career. The National Heart Lung and Blood Institute also offers dedicated research training (T32 grant) in cardiovascular disease epidemiology and prevention which is open to US citizens or those with a green card.6

Developing a team of mentors can be crucial in helping to launch a productive career. Mentees should seek experienced clinical and research thought leaders that have a track record of success, and are willing to dedicate the necessary time to nurture those interested in the field. The EAPC, American Society for Preventive Cardiology and National Lipid Association are excellent resources for trainees interested in finding mentors.

Although careers in cardiovascular disease prevention can be difficult to identify compared with non-invasive cardiology or procedural-based cardiovascular subspecialties, senior-level mentorship and information from the aforementioned professional organisations can provide guidance on attaining a position after graduation. Networking at meetings, whether virtual or face-to-face, can also be helpful.

Preventive cardiology is arguably the most impactful subspecialty within cardiovascular medicine as practitioners have the ability to influence disease at both the individual and population levels. Recent advances in risk ascertainment, including subclinical atherosclerosis imaging and polygenic risk scores, coupled with new therapeutics have heralded a revolution in the assessment, prevention and management of ASCVD. We urge trainees to join the revolution and consider this exciting and rewarding field.

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Footnotes

  • Twitter @DrGermanMD, @DrMichaelShapir

  • Contributors CAG contributed to the planning, conduct and reporting of the manuscript. He also created the image. MDS is an expert in preventive cardiology, who reviewed the manuscript for its content and relevance.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Commissioned; internally peer reviewed.

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