Sripal Bangalore, MD, MHA, explores multiple aspects of ischemic heart disease
The many interests of Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI, associate professor of medicine, director of research of the cardiac catheterization laboratory and director of the Cardiovascular Outcomes Group in the Cardiovascular Clinical Research Center at NYU Langone Health, can be traced to a common theme: improving the lives of patients with or at risk for ischemic heart disease. An interventional cardiologist whose research focuses on comparative effectiveness of drugs and devices in patients with CAD, hypertension and dyslipidemia, Bangalore has become an authority on a wide range of important topics in cardiology.
Bangalore, a member of the Cardiology Today Editorial Board and a Cardiology Today Next Gen Innovator, received his medical degree from Bangalore Medical College in India in 1999 and his MHA from Western Kentucky University in 2002. He completed his internship in 2003, his residency in 2005 and his cardiology fellowship in 2008 at St. Luke’s Roosevelt Hospital and Columbia University, and his interventional cardiology fellowship in 2010 at Brigham and Women’s Hospital and Harvard Medical School.
Among other topics, Bangalore’s research has focused on comparative effectiveness of beta-blockers in patients with and without CAD, comparative effectiveness of renin-angiotensin-aldosterone system blockers, residual risk for CV events in patients with CAD, comparative effectiveness of revascularization vs. medical therapy and of PCI vs. CABG and comparative effectiveness of various stent types.
Bangalore, who was named the Douglas P. Zipes Distinguished Young Scientist by the American College of Cardiology in 2016, serves on the editorial boards of Circulation, Future Cardiology, International Journal of Clinical Cardiology and Progress in Cardiovascular Diseases, and is principal investigator of the NHLBI-funded ISCHEMIA-CKD trial, which is the largest trial assessing invasive vs. conservative strategies in patients with chronic kidney disease and moderate ischemia.
Who has had the greatest influence on your career?
Dr. Bangalore: Several people have had a lot of influence on my career. Early on, my family was a huge influence given that my father and others are in the medical profession, and that was what made me, even as a child, consider being in this field. In my early training days, it was the late Farooq A. Chaudhry, MD, who was director of echocardiography at The Mount Sinai Hospital, who gave me the opportunity to start working on research projects. He was open to new ideas. Very soon, we contributed heavily to the field of risk stratification and prognosis using stress echocardiography.
Subsequently, I was fortunate to have worked with many luminaries, each with their own different style of working, who have shaped my career, including Franz H. Messerli, MD, professor of medicine at the Icahn School of Medicine at Mount Sinai and the Mount Sinai Health System, from whom I learned the art of writing and to never accept evidence for its face value; Deepak L. Bhatt, MD, MPH, executive director of interventional cardiovascular programs at Brigham and Women’s Hospital Heart & Vascular Center and professor of medicine at Harvard Medical School, from whom I learned the art of attention to detail and the passion to do clinical trials; and Judith S. Hochman, MD, Harold Snyder Family Professor of Cardiology, associate director of the Leon H. Charney Division of Cardiology, senior associate dean for clinical sciences, co-director of the Clinical and Translational Science Institute and director of the Cardiovascular Clinical Research Center at NYU Langone Health, from whom I learned the art of grant writing and how to meticulously conduct large multicenter clinical trials. All of them are mentors and now colleagues who have been vastly influential in my research career. I have been very fortunate to be able to get different perspectives from different groups of people during my career. This is only a short list. I am constantly influenced by my peers, medical students, trainees and patients, from whom I constantly learn.
What has been the greatest professional challenge in your career thus far?
Dr. Bangalore: The biggest challenge is to balance the various roles we do: as a researcher, clinician and teacher, and of course with my family and nonprofessional life — I like to travel and get to know people and places, and I also like to listen to music and follow sports. It has been a major challenge to make sure none of these important areas are ignored, and to find time for everything, including my wife and kids.
What advice would you offer to a student in medical school?
Dr. Bangalore: For a student in medical school, since these are their formative years, it is very important to have an open view and to try to explore as many things as possible. It becomes critically important that if they do find something that interests them, to hang on to it and try to develop that, because in the end, it is very important to be passionate about what you do. For your career choice, it is important to pursue what drives you.
Have you ever been fortunate enough to witness or to have been a part of medical history in the making?
Dr. Bangalore: The only thing that comes to mind is being there for the transition in stent technology. We were in a stage where drug-eluting stents were viewed with caution, and I think now we are at a phase where they are much safer, and there has been a dramatic change in the efficacy and safety of those devices. While this may not be considered a major landmark, I am pleased to have been a part of something this significant.
What’s up next for you?
Dr. Bangalore: On the clinical front, I am delving more into complex coronary interventions, especially chronic total occlusions. On the research front, I am trying to conduct more comparative effectiveness randomized clinical trials. A main area of interest is comparative effectiveness of drugs and devices in patients with CAD and hypertension.
I have been part of some major ongoing trials that will likely reshape the way we practice medicine. We are evaluating the comparative effectiveness of invasive vs. conservative strategies in patients with stable ischemic heart disease through the NHLBI-funded ISCHEMIA and ISCHEMIA-CKD trials. I am principal investigator for ISCHEMIA-CKD, which is a multicenter, international trial comparing an initial invasive strategy of cardiac catheterization and optimal revascularization with a conservative strategy of optimal medical therapy alone in patients with advanced chronic kidney disease and moderate ischemia on stress testing. This is the largest treatment strategy trial asking the question of how to manage ischemia in patients with chronic kidney disease, who have traditionally been excluded from CV outcome trials.
I am also a co-investigator for an NIH-funded project to develop a collaborative training program in comparative effectiveness research and biomedical big data for imagers and imaging trainees.
We have plans for future trials evaluating efficacy of beta-blockers in stable CAD. – by Erik Swain