Creativity, inspiration drive Jagat Narula’s, MD, life and work

A dedication to medicine, tireless work ethic and desire to shape the lives of young researchers have all been part of Narula’s professional and personal life.

Jagat Narula, MD, is dedicated to the field of cardiology, but purposeful filmmaking may occupy the next stage of his career.

Narula is the director of the Cardiovascular Center, UC Irvine Douglas Hospital, and a professor of medicine at the University of California, Irvine School of Medicine. Currently the editor-in-chief of the Journal of the American College of Cardiology: Cardiovascular Imaging, he has written more than 700 research publications or presentations and edited more than 25 books or special journal supplements. His research has contributed to the development of novel noninvasive imaging techniques in the areas of describing the phenomenon of apoptosis and the vulnerability of atherosclerotic plaques.

In an interview with Cardiology Today, Narula explained how his professional journey beginning as a student in India has shaped his life and how he has used these experiences to shape the lives of others.

Jagat Narula, MD Director of the Cardiovascular Center, UC Irvine Douglas Hospital. Professor of Medicine at the University of California, Irvine School of Medicine. Editor-in-chief of the Journal of the American College of Cardiology: Cardiovascular Imaging Member, Imaging section of Cardiology Today’s Editorial Board.

What do you enjoy doing when you’re not practicing medicine?

When am I not practicing medicine? There is hardly any time. If not practicing medicine, I’m in my lab doing research or editing, writing or reading. But, more importantly, I’m working with fellows, specifically the people who are doing research with me. Some people have come to me from Japan, Netherlands or other countries and have spent 2 or 3 years of their time doing their PhD or completing their research projects in my lab. As a ritual, every Saturday from 5 am to 1 pm, I work with them, help them finalize their manuscripts, and develop research protocols, which they will continue to pursue after they have completed their research assignments in my lab and returned home. Working closely with fellows has allowed for intellectual stimulation and dynamic interaction and exchange.

If you hadn’t gone into cardiology or medicine, what would you have done?

Creativity is a passion, so something I would like to engage in is work in the creative arts. If I have to choose one particular arena, I would say cinema, specifically directing films. I would have gone for projects that promote societal education or reform. In the next 5 to 7 years of my life, I will end up doing that. I’ll be looking to see how I can use cinema to improve CV health in developing countries and, from that perspective, improve overall health. That is going to come sooner than later. It will be a challenge, as it’ll require an entertaining script and an appealing fictional storyline, with my message embedded throughout.

What would you consider one of your biggest successes in your specialty?

From the research perspective, my work in apoptosis is the most fulfilling project I have been involved in. It has largely explained the basis of inexorable decline in myocardial function in heart failure even after the inciting insult has abated. While I’ve worked in other areas, including the pathology of atherosclerosis and the detection of high-risk plaques, what fascinates me about apoptosis is the realization that this process starts in heart muscle cells but does not go to completion and remains interrupted. After all, the cells that are not able to reproduce may similarly not have the capacity to kill themselves. And, since the apoptotic process is not completed, the process of HF seems reversible. This revelation has significant therapeutic and prognostic implications.

What is the last art collection you saw? Why, and what did you think of it?

Not long ago, I was in Paris for a meeting, and there was a Claude Monet exhibit with 200 of his paintings. I’ve always admired his work, the reason being that when you look at it very closely, you feel that the brush strokes don’t make sense. But as you start stepping back, you see the amount of inspiration and imagination involved.

Although, what impresses me the most about Monet’s art is what he started doing when his eyesight was failing. You see that the brush strokes are becoming coarser and less tangible, since he couldn’t see, but when you stand back, you see that his imagination persists. This is personally very inspirational, as persistent imagination, creativity, and passion is what keeps me going.

Whom do you most admire, and what would you ask that person if you had 5 minutes with him/her?

Eugene Braunwald, MD. I worship him. I’d ask how he balances creativity with humility. The man continues to be creative at his age, and there is no one who is more humble. It’s inspiring. Modern cardiology is what it is because of him, and yet, he is still so humble and continues to contribute.

What is the best advice you’ve ever received?

My father has been my best friend, philosopher and guide. One thing he always used to tell me was at the end of your day, you should be able to say that you did what you were expected to do, and you did not do anything that does not let you sleep well at night. He followed this principle throughout his life and wanted me to follow it, as I want my children to follow it.

Whom do you consider your mentor?

I am indebted to many of my teachers, who have been very influential in my life. First of all, I started my cardiology career in India. One person who I would list at the top during that time is Raj Tandon, MD, who taught me to practice medicine with humanity, which is the basic essence of what medicine is. Also, M.L. Bhatia, MD and K.S. Reddy, MD, contributed tremendously to my growth as a cardiologist.

When I came to Massachusetts General Hospital from India, Edgar Haber, MD, and William Strauss, MD, taught me the principles of scientific inquiry. If I write well today, it is because of Bill Dec, MD, the chief of cardiology of Mass General. I also must thank Barry Zaret, MD, and Tony DeMaria, MD, who have helped me grow as a keen editor and have been mentors from a distance.

Most recently, I have been working with Narain Naidu, MD, a microbiologist who has a unique perspective of life and science, and has truly helped me think differently about the high-risk atherosclerotic plaques. And, as I am now set to move to East Coast to Mount Sinai, I look forward to the mentorship of Valentin Fuster, MD, PhD, whom I have always admired.

In addition, I must acknowledge my primary school homeroom teacher, Mr. K.S. Katiyar. When I was in sixth-grade, he singled me out as the student he thought was going to do very well in the statewide secondary school examination. He would come to my home at 3 o’clock every morning, 365 days a year, on his bicycle, to wake me up so that I could study. If I was in town, he was in town. He followed this routine for 4 years, without missing a single day and he was even more excited than I was when I topped the list of successful examinees.

I’ve often told him that I owe all my achievements to him, to which he has always responded, “You don’t owe me anything. I started with a passion that my students would make it to the top. And you fulfilled my dream.” To this day, I wake up at 3 a.m. every single day and I often think of him. His influence on my career is indelible.

What kind of diet and exercise regimen do you have?

My diet has been experimental. I was overweight and tried multiple diets, and had the most success with Atkins, losing 40 pounds and bringing my weight to a normal level.

Since meeting one of the saints in India, I’ve become totally vegetarian, which I’ve been for almost 4 years now. For the rest of my life, there won’t be any more experiments with my diet.

Regarding exercise, we have a gym at home, and every single machine has a television. There has been a rule for children at home, which my wife and I have strictly followed, that you cannot watch TV unless you are watching it in the gym as you exercise. That has kept us all exercising. Even if I get home at 10 p.m., my wife is waiting for me to get on a machine so we can watch our recorded programs together.

What do you think will have the biggest influence on cardiology in the next 10 years?

Prevention through personalized medicine: identifying and refining genes that underlie the disease, widening the epigenetic factors that would convert it to a full-blown disease and monitoring the phenotype with the help of innovations in biomarkers and noninvasive imaging.

What is your favorite travel destination?

I travel a lot and love seeing places and admiring nature and art. But the travel destination where I get the maximum inspiration and where my creativity is at its best is in my lab. I feel the happiest when I’m there.

What is your favorite restaurant?

My wife’s kitchen. She always makes sure that I have freshly cooked food every single evening I’m in town. There is no better pleasure for me than eating with my family at the dinner table. It’s the best part of my day. – by Brian Ellis