How a Cardiologist Started Studying the Brain: Q&A with a Former KL2 Scholar
Former KL2 Scholar Dr. Javier López is an associate professor at the University of California Davis and the medical director of the university’s Cardiac and Vascular Rehabilitation Program. He researches biological processes that put patients who had a heart attack and received treatments for it at risk of having another. He also works in a student-run clinic to provide free care to patients without health insurance.
Dr. López talks more about his work in the following interview, which has been edited for clarity and brevity.
Can you talk a little bit about your KL2 research?
I completed my KL2 in 2017. I was doing the clinical risk calculation of patients in the hospital after they had a heart attack. We essentially created a composite of multiple risk scores that are able to tell us the difference between people who have very, very low risk of having another problem within a year, and people who have very, very high risk and have a problem. Everyone had received all the treatments available.
The way I started using that was to ask the question: ‘What is the biological process or the biological processes that may be responsible or may explain this additional risk?’ The idea there is that if we can identify the leftover biological processes that are not being addressed by the treatments, then it opens the door to develop new therapeutics for patients.
We started looking at gene expression in the bloodstream to determine the biology associated with this risk. So, we built risk models from the clinical data for the high and low risk patients. And then we started doing blood draws from patients with high and low-risk and evaluated their gene expression.
How did that lead to what you’re doing today?
That research has taken me down the path of beginning to recognize the interaction of the brain and mental health with cardiac and cardiovascular health. Genes that are associated with cardiovascular outcomes are actually genes that are expressed when there is brain inflammation or stress. So that's what made me — as a cardiologist — think about mental health and the contribution that this may have from a biological point of view.
We started an imaging study to look at the brains of people who have had a myocardial infarction. This is the study that's now ongoing. We're evaluating patients with low risk and high risk to see if we can identify the activations with these areas of the brain.
Interestingly enough, we identified in the literature that there's some data to suggest that there are certain areas of the brain that can be activated by psychosocial stress, social determinants of health, such as crime rates, and poverty, and anxiety and depression. And it has been shown that when these areas of the brain are activated, people are at a higher risk of having future cardiovascular events.
How is the brain connected to cardiac health?
This is the question of the chicken and the egg, so we don't know the answer to that.
We have an association right now between having a heart attack, having activation of the gene expression in the blood, and having the activation of the brain. We do know that there is literature demonstrating that the activation of these areas of the brain is associated with future cardiovascular events.
We also know that when you look at the risk factors of having a heart attack, the usual risk factors we think about are smoking, high blood pressure, diabetes, but anxiety and depression are actually just as strong of a predictor of having a heart attack. Most people don't recognize that. But we don't know biologically speaking, whether anxiety and depression actually activates the brain before the event and that leads to the heart attack, or if it is the stress of the heart attack that leads to the activation of the brain and that leads to the signal that we're seeing.
In my clinical work, I do cardiac rehabilitation, which is where we treat the patients after they've had their heart attack. One of the components that traditionally has been part of helping patients recover after a heart attack is addressing their psychosocial stress.
You also helped start a free cardiac clinic at UC Davis. Can you talk a little bit about that?
The student-run clinic has been around for 20-30 years. Three years ago, I started providing a cardiac clinic too, which is free and available for patients who have no insurance for whatever reason. We don't ask why they don't have insurance. A lot of them are undocumented patients, but there are people who either for financial reasons or for literacy reasons, just don't have access to healthcare. So, the clinic will provide medical services for those patients.
The students have a program for lifestyle modifications, where they address stress, nutrition and physical activity. I work with the students to identify the patients that need these lifestyle interventions. The students are trained to then talk to the patient and spend time educating them about nutrition and physical activity and de-stressing activities for reducing anxiety. And then we’re left with having to make referrals out to people who have more serious mental health issues for them to seek more treatment.
What impact has this clinic had on the community and on the students?
We provide access to free primary care and I provide subspecialty access to patients for cardiovascular problems. So, it gets access to underserved populations in the community, and that's a big deal.
In terms of the students, I’m helping them learn how to speak to people, how to ask questions, how to listen to their answers, and then to try to understand better where people are and where they want to be. It's about the patient, not about the provider or the physician.
What got you interested in starting this part of the clinic?
I was born and raised in Puerto Rico, so I’m Latino in origin. Throughout my entire medical education, I have always taken an interest in making sure that people from the Latino community have access to two things: One is healthcare and the other is education.
I started looking into how I can be more involved with the students in teaching them. I can only take care of so many patients, but if I can train students to take care of patients in the same way that I think they deserve to be treated, then I can make a bigger impact in the long term.
Anything else you’d like to add?
My dream is that we can bring the results of my research and access to participate in these research studies to the Latino population in the community clinic. A lot of times in research, we favor the patients in the major health systems, which by nature, may not be the marginalized populations that may benefit most.