EP 152: From Risk Factor to Treatment Target: The New Era of Cardiometabolic Medicine

In this fascinating episode of Parallax, Dr Ankur Kalra is joined by Dr Benjamin Levine, Director of the Institute for Exercise and Environmental Medicine and a pioneering figure in the field of space cardiology. Together, they explore the remarkable cardiovascular adaptations that occur in microgravity, and what they are teaching clinicians about treating patients on Earth. Dr Levine unpacks the haemodynamic realities of spaceflight, from the counterintuitive finding that central venous pressure actually drops to zero in microgravity, to the physiologic cardiac atrophy that results when the heart no longer pumps against gravitational load. He shares how this research has transformed the understanding and treatment of POTS, reframing it not as a disorder of the autonomic nervous system, but as a consequence of reduced stroke volume - and how horizontal exercise training borrowed directly from astronaut countermeasure programmes is now changing clinical practice. The conversation also turns to the emerging cardiovascular risks of long-duration spaceflight, including earlier onset atrial fibrillation, upper body venous thrombosis, and the intracranial pressure dynamics underlying spaceflight-associated neuro-ocular syndrome. Dr Levine discusses the Astro-CHARM risk score, NASA's approach to coronary calcium screening, and the forthcoming scientific statement on cardiovascular management in tactical athletes. Questions and comments can be sent to [email protected] and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

In this special TIO Congress edition of Parallax, Dr Ankur Kalra is joined by two of interventional cardiology's most influential voices: Professor Roxana Mehran, incoming President of the American College of Cardiology and Co-Course Director of TIO, and Professor Nicholas Van Mieghem, TIO Course Director. The conversation spans the evolution of online medical education, sex-specific differences in cardiovascular disease, and the challenge of translating clinical evidence into everyday practice. The guests explore sex as a biological variable across valve disease, plaque formation, and left ventricular remodeling, address the underdiagnosis of microvascular dysfunction in women, and examine persistent access barriers for female and non-white patients despite advances in trials such as SMART and RHEA. Professor Van Mieghem adds insights on modern TAVI planning and lifetime valve management, while Professor Mehran shares promising data on Factor XI inhibitors and the case for simplifying antithrombotic regimens. The episode closes on clinical inertia - with intravascular imaging uptake in the US still at just 12–15% despite a Class 1 indication, Professor Mehran outlines her ACC presidential vision: closing the gap between evidence and bedside practice, and reversing the troubling rise in cardiovascular morbidity and mortality. Questions and comments can be sent to [email protected] and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

In this episode of Parallax, Dr Ankur Kalra speaks with Dr Sameed Khatana, Assistant Professor of Medicine at the University of Pennsylvania and clinical cardiologist at the Philadelphia VA Medical Center. Their conversation examines the growing connection between environmental factors and cardiovascular health. Dr Khatana explains why conditions like air quality and temperature represent important determinants of cardiovascular outcomes. He shares observations from his Philadelphia practice: patients unable to exercise outdoors during extreme heat, medication challenges for those on diuretics during heatwaves, and economic pressures that force difficult choices between cooling costs and other necessities. The discussion explores both clinical interventions and systemic solutions, including programs like LIHEAP (Low Income Home Energy Assistance Program) and municipal heat action plans. Dr Khatana presents research showing that vulnerable populations—particularly older patients with multiple cardiovascular risk factors—face disproportionate impacts from environmental stressors. Dr Khatana encourages cardiologists to engage with this evolving aspect of patient care, advocating for collaboration between professional societies, environmental scientists, and policymakers to develop effective strategies that support cardiovascular health in changing environmental conditions. Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

In this episode of Parallax, Dr Ankur Kalra welcomes Dr Rakesh Shah, a former interventional cardiologist, Oxford MBA graduate, and founder of DRS.LINQ. Dr Shah brings a unique perspective on addressing critical delays in heart attack diagnosis through the intersection of clinical medicine, engineering, and business strategy. The conversation explores a pressing challenge in cardiovascular care: the majority of cardiac damage occurs within the first hour of symptom onset, yet treatment activation often takes several hours. Dr Shah introduces mHeart, a mobile EKG platform designed to create a "virtual cardiology office." Unlike consumer wearables that lack critical chest leads, this technology enables patients to initiate comprehensive cardiac evaluation anywhere—at home, at work, or while traveling—transmitting diagnostic-quality data directly to cardiologists. The episode delves into Dr Shah's diverse career path and offers candid advice for physician-entrepreneurs, emphasizing the importance of collaboration with professional business leaders to achieve scalability. Looking ahead, Dr Shah discusses the integration of AI and machine learning into mobile diagnostic platforms as essential tools for an aging workforce and overstretched healthcare system. Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

In this key episode of Parallax, Dr Ankur Kalra sits down with Prof Naveed Sattar to explore how recent therapeutic breakthroughs are fundamentally reshaping the cardiologist's approach to diabetes management. Through real-world case discussions, Dr Sattar demonstrates practical decision-making for patients across the spectrum - from pre-diabetes to established CAD with Type 2 diabetes. He addresses the tension between robust evidence and cost barriers that limit widespread implementation, while acknowledging unprecedented patient demand driven by genuine quality of life improvements. The conversation concludes with insights on obesogenic environments and the hope that increased competition will ultimately democratize access to these transformative therapies. Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

In this highly anticipated annual year-end episode of Parallax, Dr Ankur Kalra welcomes back Dr Sukh Nijjer, an interventional cardiologist in London, for their seventh consecutive year reviewing cardiology's most significant developments. This annual review offers a comprehensive look at the trials and breakthroughs that shaped cardiovascular medicine in 2025. Dr Nijjer guides us through a broad selection of clinical trials spanning post-MI management, heart failure therapeutics, atrial fibrillation strategies, and interventional innovations. The discussion challenges established practice, from questioning routine beta blocker use after MI in patients with preserved ejection fraction, to examining the controversial findings from the CLOSURE AF and OCEAN studies. The episode highlights encouraging advancements including the POLY-HF study's success with fixed-dose polypills for heart failure, promising data on bioadaptor stents and drug-coated balloons in interventional cardiology, and the robust cardiovascular benefits of GLP-1 agonists demonstrated in the SOUL and SURPASS studies. Dr Kalra and Dr Nijjer conclude with an optimistic look at cardiology's future, exploring how targeted therapies could transform the landscape from polypharmacy to precision medicine. Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

In this landmark 150th episode of Parallax marking the start of Season 8, Dr Ankur Kalra welcomes Professor Robert Bonow, Professor of Medicine and Cardiology at Northwestern University and Editor-in-Chief of JAMA Cardiology. This milestone conversation explores the career of one of cardiology's most influential academic leaders and examines how strategic vision, mentorship, and institutional leadership have shaped modern cardiovascular medicine. The discussion reveals the practical realities of building academic excellence through Dr Bonow's 33-year tenure at Northwestern University. He details the strategic approach to growing a cardiology division from 25 faculty members to over 70, emphasizing that success hinges on recruiting exceptional talent, providing institutional support, and granting faculty freedom to pursue their visions. Dr Bonow offers candid perspectives on academic leadership challenges and creating environments where innovation flourishes. Dr Bonow reflects on his influence through editorial and professional society leadership. As co-editor of seven editions of Braunwald's Heart Disease, he shares lessons from Dr Eugene Braunwald and discusses the evolution toward a digital "living textbook" responding in real-time to clinical evidence. His role founding JAMA Cardiology reveals strategic decisions required to establish a premier journal, while his progression through the American Heart Association - culminating in the presidency - demonstrates how sustained professional engagement amplifies individual impact. He closes with actionable guidance for early career cardiologists on recognizing opportunities, developing writing skills, and embracing the non-linear nature of successful careers. Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

In this week's episode of Parallax, Dr Ankur Kalra welcomes Prof Rasha Al-Lamee, interventional cardiology consultant and professor of medicine/cardiology at Imperial College London, and deputy editor of JACC. Prof Al-Lamee has transformed interventional cardiology through her pioneering work on the ORBITA trial series and coronary sinus reducer device studies, introducing the paradigm-shifting concept of sham-controlled device trials to the field. What makes a clinical assumption worth questioning? How do we design trials that reveal truth rather than confirm bias? When does revascularization truly benefit patients with stable angina? Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Guest: @RashaAlLameeMD Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

In this episode of Parallax, Dr Ankur Kalra welcomes Dr Sarah Matt, Associate Clinical Professor at Upstate Medical University, health tech strategist, and author of the newly released The Borderless Healthcare Revolution. Dr Matt brings a unique perspective shaped by her experience both in academic medicine and as a former Oracle employee, positioning her at the intersection of clinical care and healthcare technology innovation. https://www.drsarahmatt.com/ This conversation explores the inflection point facing today's generation of physicians—a cohort that has navigated the evolution from paper charts to sophisticated EMRs, and now stands at the threshold of AI-driven healthcare transformation. Dr Matt offers actionable guidance for both healthcare delivery leaders and "builders" creating new technologies, emphasizing that improving access must be integrated from inception rather than retrofitted. She shares her vision for removing financial barriers entirely and provides practical checklists from her book to help clinicians make meaningful impact while combating burnout. Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

In this week's episode of Parallax, Dr Ankur Kalra welcomes Dr Courtney Maxey-Jones, Director of the Coronary Care Unit at Upstate University Hospital and a cardiac anesthesiologist intensivist by training. Dr Maxey-Jones co-founded and serves as Chief Operations Officer of GOMED, a not-for-profit organization transforming how we think about medical device waste and global healthcare equity. Dr Maxey-Jones shares the origin story of GOMED - born from witnessing the staggering waste generated in cardiac operating rooms, where expensive single-use devices are discarded due to expiration dates or changing surgeon preferences. Together with her partners, cardiac surgeon Dr Farhan Nadeem and physician assistant Connor Wasilnak, they recognized an extraordinary opportunity to make use of these waste items. Dr Kalra and Dr Maxey-Jones examine the ethical complexities of equipment reuse, the critical unmet needs for EP devices and cath lab equipment internationally, and GOMED's innovative partnership with Syracuse University biomedical engineering students to develop low-resource autoclaves. This episode reveals how observation of systemic waste evolved into a sustainable model for global cardiovascular care equity. Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.