Heart health isn’t just about one organ. Cardiologist Dr. Anand Prasad works with high-risk patients in the catheterization lab at UT Health San Antonio while researching connections between diabetes and cardiorenal disease
By Ivy Ashe
Population Health Scholar
University of Texas System
PhD Student in Journalism
UT Austin Moody College of Communication
When he was a medical student at Louisiana State University, Anand Prasad set his sights on becoming a cancer surgeon. His mother and other family members had had cancer, and the path seemed to make the most sense.
“It’s visceral; you can take out a tumor and help the patient,” said Prasad, now an Associate Professor of Medicine in the Division of Cardiology at UT Health San Antonio.
A medical elective class in rural Louisiana changed his mind. It was a cardiology elective. Nothing fancy, Prasad said--just bread-and-butter work like basic EKGs and stress tests. But bread and butter are staples for good reason, and Prasad found that he liked the balance of diagnostics and doing medical procedures. When it came time for his fellowship, he went to UT Southwestern to focus on cardiology, where he worked with Dr. Benjamin Levine and Dr. Ellen Keeley (Keeley now works at the University of Florida).
Under Levine, Prasad honed his research and writing skills. And in large part thanks to Keeley’s influence, he decided to pursue interventional cardiology.
“I was a new cardiology fellow, and I didn’t know anything, and she got me involved in an acute myocardial infarction procedure,” Prasad said. The patient required an arterial stent; a small metal tube would be placed in the narrowed artery and expanded to clear up a blockage.
“We were in the cath lab and we opened up the artery,” Prasad recalled. “I thought it was so cool that you could do a procedure in ten minutes that saves someone’s life.”
Today, Prasad is the Director of the Cardiac Catheterization Laboratory at University Health System at UT Health San Antonio, stepping into the role after a year of directing the center’s Cardiology fellowship program. The aim of saving lives is the same as when Prasad was a fellow himself, but there is now far more emphasis on being multidisciplinary and multi-procedural. A catheterization lab can now handle many procedures that once required open-heart surgery.
One of Prasad’s primary research areas is how to best help the patients who are at risk for complications from a relatively straightforward procedure like a stent placement. These patients may have high blood pressure, or they have already suffered one heart attack. They may be on a ventilator.
“You can imagine their reserve for tolerating any kind of complication or a temporary loss of blood flow in the artery is very minimal,” Prasad said.
Prasad was one of the first people to work with Impella pumps, a family of devices that can be placed into the heart’s chambers via non-surgical means (typically through the arm or leg) and augment weak blood flow mechanically. That enables cardiologists to continue inserting the stent with less fear of losing blood flow temporarily.
“It’s really drawn me to better understand hemodynamics,” Prasad said. “Changes in blood pressure, volume within the heart and the body, and how those measures are disturbed during times of stress and shock--and how these pumps can help that.”
He’s currently editing a handbook on how to use Impella pumps, working with authors around the world who’ve seen the devices in action. Impella devices are not cheap--about $25,000 per pump--and having a guide for proper use is important to best determine how they can be used within a healthcare system.
The catheterization lab also focuses its efforts on reducing amputations in diabetic patients, specifically through opening arterial blockages and improving circulation in the lower limbs.
“Texas is known for diabetes; we’re in the diabetes belt,” Prasad said, referring to a swath of the Southern United States where residents are more likely to develop Type 2 diabetes. A great deal of Prasad’s research efforts involves the study of diabetes and the intersection of kidney disease and vascular disease. He’s worked in these areas for more than ten years.
Within Texas there is a gradient of diabetes rates, with prevalence increasing from north to south. In San Antonio, for example, about 13 percent of the population has diabetes. In the lower Rio Grande Valley, Prasad said, the rate approaches 30 percent.
“We’re going to see a lot more cardiovascular and renal disease because of rising diabetes rates,” he said.
To best address these issues, there’s a great deal of collaboration not only between departments at UT Health San Antonio, but between institutions. Dr. Ralph DeFronzo of UT Health San Antonio and the Texas Diabetes Institute, who helped describe the phenomenon of insulin resistance, works closely with Prasad and his team. The third annual Cardio Renal Connections conference , organized by Prasad and UT Health San Antonio nephrologist Dr. Shweta Bansal, took place last month. An ongoing diabetes study in Cameron County partners with the UT School of Public Health in Brownsville, and an initiative with Rice University develops educational 3D models of a diabetic foot.
It’s all, says Prasad, part of the overall effort to combat vascular disease holistically and address heart conditions in the context of the biggest picture.
“If you just attack one area -- ‘Oh, you have to have better circulation’ -- but you’re not addressing lipids or diet or diabetes, you’re not going to be successful.”