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L. Kristin Newby, MD, MHS, ponders path from lab to clinic
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In this issue, L. Kristin Newby, MD, MHS, FACC, FAHA, professor of medicine, co-director of the cardiac care unit and leader of the primary and acute care cardiology practice group at Duke University Medical Center, tells Cardiology Today of her career path that took her from researcher in a basic lab to one of cardiology’s most prominent figures in biomarker and translational population health research.
Newby, a member of the Cardiology Today Editorial Board, got her medical degree from Indiana University in 1987 and then headed to Duke, where she has remained ever since, completing her residency in 1990 and her fellowship in 1993, after which she joined the faculty. She received an MHS from Duke in 2002.
During her career at Duke, she has contributed to groundbreaking research in four areas. No. 1, she has steered and participated in numerous clinical trials for new therapies or approaches for treatment of acute and chronic CHD. No. 2, she has developed risk models that have influenced cardiology practice guidelines. No. 3, she has led the evaluation and development of novel biomarkers and helped define their roles in clinical practice. No. 4, she has conducted longitudinal health studies and established biorepositories to support the goals of precision medicine and disease reclassification.
Newby is deputy editor of JACC: Basic to Translational Science and has served as senior associate editor of the Journal of the American Heart Association, president of the Society of Cardiovascular Patient Care and chair of the AHA’s Council on Clinical Cardiology. She was elected to the Association of University Cardiologists in 2014 and has published more than 300 articles in peer-reviewed journals.
Who has had the greatest influence on your career?
Dr. Newby: There are four people that come to mind. My father, Eugene Newby, MD, was a third-generation general practitioner and my mother, Charlotte Newby, was a nurse. I obviously had medical exposure at home and was fascinated by what medicine could and couldn’t do for people. They encouraged me in my decision to go to medical school at a time when that wasn’t necessarily an accepted career for women. Women were very underrepresented in the field at that time. They were incredibly supportive. I chose cardiology not only because I was interested in the physiology and impact of heart disease, but also because my father passed away of an unexplained cardiomyopathy during my first year in medical school.
I had an amazing advisor in medical school at Indiana University, the late John (Chris) Bailey, MD, who was my attending in cardiology, recognized my potential and interest in cardiology, and also encouraged me to look beyond my comfort zone and consider Duke University for my medical training, which then gave me the exposure to cardiology that sealed the deal for me to choose my path. He took the time to know me and help guide me to places he thought would be ideal.
Then there is Robert M. Califf, MD, MACC, who is one of the giants of cardiology and clinical research. It was an incredible opportunity to work with and be mentored by him at Duke. He gave me the support and freedom to move my clinical research career forward. Everyone who has had a chance to work with him in that capacity reveres him.
What has been the greatest challenge in your professional career thus far?
Dr. Newby: I was not in the pioneer generation of women, but going into medical school in the early 1980s wasn’t really what women did commonly back then. Being a woman in a very male-dominated profession and navigating my way through that has been an interesting challenge, but I’ve been fortunate to have wonderful senior women role models in cardiology and supportive colleagues. The transition from basic science research to clinical research while a clinically busy junior faculty, learning the discipline and developing the confidence and the realization that I was capable and had good ideas; just trusting my instincts, moving forward, and not letting distractions take me away from making progress as a clinical researcher was also a challenge, but sticking with it has made a difference in my career.
What areas of research in cardiology interest you most right now?
Dr. Newby: My research interest right now is precision medicine. How can we integrate different types of information from our fundamental biology, the molecular side of things — which harkens back to my days in a basic molecular lab — with clinical data, environmental data and sociocultural information to help us understand health and disease and response to therapy? I frame it as translational population health research, but it’s really a matter of questions fundamental to precision medicine: How do we understand people better so we can better tailor therapy to them? What evidence do we need to base practice on these integrated signatures? How do we implement and measure the effects of precision medicine approaches?
Have you ever been fortunate enough to witness or to have been a part of medical history in the making?
Dr. Newby: I think the things I’ve been fortunate enough to be a part of qualify — working with E. Magnus Ohman, MB, and others on the evolution of troponin as a diagnostic and prognostic biomarker, and particularly under Dr. Califf in my early career during a transformation in clinical research and the practice of cardiology: Increasingly demanding evidence to support the things we do in clinical practice. What we take for granted today as evidence-based medicine has been part of what I’ve seen firsthand grow and evolve.
I have participated in clinical trials that change how we practice and what drugs we use. The first one that left a lasting impression on me and cemented in my mind that we have to demand evidence of benefit before we deploy a therapy broadly in a population was the HERS trial, the first randomized clinical trial of hormone replacement therapy for preventing CVD events in postmenopausal women. Up until that time, it was held as common knowledge that women got coronary disease 10 years later than men, and it was because of the protective effect of estrogen, and if we gave women back hormones after menopause, we would prevent CV events. This was the first randomized clinical trial I participated in as a faculty member after I came out of the basic lab, and I will never forget it. We randomly assigned 2,763 postmenopausal women to hormone replacement therapy or placebo, and found no preventive benefit of hormone replacement therapy for the primary outcome of MI/CHD death, or secondary outcomes such as stroke, in women. The trend was actually toward harm. That was one of the biggest developments that changed the guidelines for how we treat women. Subsequent studies confirmed those findings.
What are your hobbies outside of practicing medicine?
Dr. Newby: I love to play golf. I could do it all the time, if I had all the time to do it. I like being outdoors, and I like the peace and tranquility golf brings. To play a round of golf, it takes 4 hours. You have to commit that you’re turning everything else off. You may be hitting good shots or bad shots, but you’re out there in nature, disconnected during that time. You can enjoy the game and your playing partners. Golf teaches you patience. The worst shot you ever hit can be followed by the best one, and vice versa. You appreciate that success and failure are temporary. And that’s kind of true in life too. I enjoy having that time and being away from the pressures of work and everyday life. – by Erik Swain