A conversation with Peter W.F. Wilson, MD
Endocrine Today Editorial Board Member Peter W.F. Wilson, MD, is professor of medicine in the division of cardiology at Emory University School of Medicine, professor of public health in the Rollins School of Public Health at Emory University, and director of epidemiology and genomic medicine at the Atlanta VA Medical Center. Wilson’s career has focused on the study of biomarkers related to heart disease, diabetes and genetics, and he was director of laboratories for the Framingham Heart Study and conducted early research that prompted the Women’s Health Initiative.
Wilson spoke with Endocrine Today about his research as a population scientist and the role of genetics in the field.
What area of endocrinology most interests you right now and why?
Wilson: In my research, I’ve focused on what I call cross-connections between fields. I started out as a researcher in diabetes, lipids and heart disease from the perspective of an endocrinologist working in the preventive cardiology environment with population-based data. That line of research for me has continued to this day and much of my energy has focused on prediction algorithms and risk equations for heart disease and diabetes and, now, genetics. Those are the areas that interest me, and I continue to work with collaborators on these topics. It’s a very fertile field.
What do you think will have the greatest influence on your field in the next 10 years?
Wilson: The coming years are going to be a very ripe time for science research related to metabolomic, proteomic and genomic risk factors. We can develop traditional risk factor approaches, but for many of the issues that endocrinologists face and are interested in, we need more information beyond traditional diabetes and cardiovascular disease approaches. Metabolomics should help to provide that. We do need large databases, lots of sharing and cross-validation in different population arenas. Within endocrinology and cardiometabolic studies, we have the experience of clinical trials, and those investigators are well aware of the opportunities. Saved samples from population studies and clinical trials can be used for these future investigations.
What are some of the most exciting advances that you have been a part of?
Wilson: The most exciting things in science are the things that are very new or findings that surprise us, results that we can’t clearly explain. Early in my career, I worked a lot on the lifestyle determinants of HDL cholesterol in the Framingham study, and it was a lot of fun because it was a new molecule that had not been investigated from the population perspective.
On a somewhat related topic, I and others investigated the role of estrogen replacement therapy and risk for heart disease in women. I wrote one of the papers that was an outlier and helped fuel what became the WHI. We needed a very large clinical trial to sort out the role of estrogen and whether postmenopausal estrogens had a protective role. The answer from the trials was that estrogen replacement therapy increased risk of atherosclerotic events, but some elements of controversy persist on this topic.
I started to get involved with risk prediction starting in the late 1980s. We focused on CVD, but I also was involved with prediction of the development of diabetes mellitus. We could predict outcomes like new diabetes or a first heart attack with a fair amount of precision, and this approach has worked its way into patient-doctor risk discussions to provide meaningful guidance to prevent clinical events, such as what is a patient’s risk to have a heart attack in the next 10 years. That experience started in Framingham, but has now taken hold across the U.S. and many other regions as well.
What advice would you offer to a student going into endocrinology today?
Wilson: Many endocrinologists who are past age 50 look at the traditional pathways, and we can see opportunities for young endocrinologists, but the landscape has changed. I encourage younger colleagues to especially look at going across disciplines as an opportunity. Genetics in endocrinology and metabolic disease are providing many opportunities, both at the lab level and at the population level. Research teams with many collaborators and different types of expertise are increasingly common. Younger endocrinologists are traditionally surrounded by senior endocrinologists who may be very laboratory based, but other types of investigators on campus can synergize with these scientists and clinicians. Newly developed collaborations may lead to areas that are perhaps more fruitful for funding opportunities.
What are your hobbies and interests outside of work?
Wilson: I’ve always been interested in music. I play the classical guitar in my spare time. I barely get by, but my son is quite accomplished as a classical guitarist and performs. He’s also a physician and investigator, so neither of us has much time to play. It’s especially fun when he shows me how to play a passage and says, “Oh, Dad, you need to do it this way.”