The future of coronary heart disease
Heart disease should be treated just like cancer, says guest Mike McConnell, an author and expert in preventive cardiology at Stanford: Detect and stage early, then treat aggressively.
In his practice, McConnell focuses on using low-dose CT imaging for detecting early coronary artery disease. He also helped pioneer the use of AI to infer cardiovascular risk from retinal scans. Such non-invasive, consumer-friendly tools could expand prevention, personalize therapy, and cut heart attacks and strokes across the board, he says. “Everybody also deserves a proactive preventive cardiologist in their phone,” McConnell tells host Russ Altman of the latest approaches to heart disease on this episode of Stanford Engineering’s The Future of Everything podcast.
Transcript
[00:00:00] Russ Altman: This is Stanford Engineering's The Future of Everything, and I'm your host Russ Altman. I thought it would be good to revisit the original intent of this show. In 2017 when we started, we wanted to create a forum to dive into and discuss the motivations and the research that my colleagues do across the campus in science, technology, engineering, medicine, and other topics. Stanford University and all universities, for the most part, have a long history of doing important work that impacts the world, and it's a joy to share with you how this work is motivated by humans who are working hard to create a better future for everybody. In that spirit, I hope you will walk away from every episode with a deeper understanding of the work that's in progress here, and that you'll share it with your friends, family, neighbors, coworkers as well.
[00:00:48] Michael McConnell: The cancer world has really pushed the idea that if we can detect things early, treat it aggressively, we can cure cancer. And I want people to think about heart disease the same way.
[00:01:05] Russ Altman: This is Stanford engineering's The Future of Everything, and I'm your host, Russ Altman. If this podcast brings you some value, please rate and review it. That's a great way to spread news about the podcast and grow our listenership, and also improve the show through your comments in the reviews. Your input is extremely valuable, so thanks for doing that. Today, Mike McConnell will tell us that you wanna learn about your heart disease as soon as possible so you can make changes, get medications, and live a long, healthy life. It's the future of coronary heart disease. Today we're gonna continue our feature called the Future In a Minute, I will ask Mike a few rapid-fire questions. He'll give me his best rapid-fire answers and it will be fun. Before we get started, don't forget to rate and review. We love those.
[00:01:54] So heart disease. It causes heart attacks. You don't want to get a heart attack. Many people, it's the number one killer in the world, get heart attacks. So we know that there are great treatments. We know we can take statin medications to reduce cholesterol and there are some amazing other new medications. We know that you can exercise, you can make changes in your lifestyle to prolong your life. But what about finding out that you even have heart disease? You don't wanna wait until you're having chest pain whenever you exert yourself. That means it's far advanced. So there is a new sense among cardiologists that we have to do early detection of heart disease. And in fact new technologies, including AI, have enabled amazing new ways to detect the very start of heart disease so you can intervene quickly. Well, Mike McConnell is a professor of cardiology at Stanford University and an expert on early detection and prevention of heart disease. He's gonna tell us that these new methods of detection really are mandatory so people can find out if they have a disease and intervene. His hope for the future, way less heart attacks and longer lives.
[00:03:02] Mike, you wrote a book called Fight Heart Disease Like Cancer. Can you explain that analogy and why it's so important?
[00:03:10] Michael McConnell: Thanks, Russ. Yeah, I, it'd be great if there was a really short answer to that, but, uh, uh,
[00:03:16] Russ Altman: We got 25 minutes.
[00:03:17] Michael McConnell: Okay. We've got a good opportunity to talk about it. Um, really it came from, uh, a lot of experience working with patients and also in, in circumstances around my family, realizing that as much as we recognize heart disease is leading cause of, you know, death and disability around the world, um, we still view as it thinking, you know, we can just sort of do lots of prevention. Don't really need to think of it around the way we do cancer, where we really need to do early detection and thinking about treating it early so we never have to get to a point where people are having heart attacks and strokes. So it's really many aspects, right? One, it's, it is like cancer, a biologic disease with these small growths that start in our blood vessels.
[00:04:11] You know, the original term, you know, for these growths was atheroma, which is similar to, you know, the oma that we think of carcinoma. And so it was really getting people to reframe how they think about it. You know, especially around the early detection. And then when you find it, you know, we now have lots of therapies that we can really stop it in its tracks. And, you know, whether you want to get into the words of eradicate or ultimately cure the disease, you know, the cancer world has really pushed the idea that if we can detect things early, treat it aggressively, we can cure cancer. And I want people to think about heart disease the same way.
[00:04:56] Russ Altman: Great. Great. So, yeah, so that, that's really helpful. And it, and one of the themes you just kind of, um, alluded to is that the, there should be a sense of urgency and that sense of urgency needs to be early, not when the disease is advanced. So just for people who don't think about heart attacks or coronary artery disease very much, um, you already mentioned that it, it's related to the buildup of what we call plaques or cholesterol, uh, glops that are blocking the blood flow in your heart. Um, could you quickly review the risk factors that people should worry about, that you as a cardiologist are, are always asking about? Um, and also how is the diagnosis made? Because I, I just wanna set that up as a background, um, and maybe the traditional ways for risk factors and the traditional ways for diagnosis. 'Cause I know that you've been involved in a lot of really new ways to do that, which we can get to in a minute.
[00:05:44] Michael McConnell: Yeah. Probably the most important thing to start is heart disease actually starts in our blood vessels, not in the heart muscle itself. And we have these, what are actually quite small coronary arteries. That, you know, feed the heart muscle, uh, and they're only about a 10th of an inch in size, and that's why a little bit of this plaque buildup, these atheroma growths inside the heart arteries, you know, if they cause a severe blockage, or the most common situation with heart attacks is a blood clot forms on one of these plaques, blocks blood flow, and that's, you can have a heart attack or sometimes your heart stops.
[00:06:24] And, you know, a lot of people, their first symptom can be that they have what we call sudden death or cardiac arrest. Um, and so, right, the, the risk factors people probably are aware of, I call some of them sort of the big three growth factors. So high blood pressure, high cholesterol, uh, and high blood sugar or diabetes. Um, but the Heart Association is also, uh, promoted the concept of life's essential eight. Um, so the other things beyond those big three are, you know, physical activity, uh, healthy diet, not smoking, um, getting good sleep, and maintaining a good body weight. So the, those are the sort of essential eight to prevention. Uh, and then you asked about diagnosis. So,
[00:07:18] Russ Altman: Yeah. And maybe the traditional ways, because I, I know you're doing a lot of really new stuff that's exciting.
[00:07:22] Michael McConnell: Yeah. Well, the, the, there has been a technique that's been around actually for quite a while that obviously AI and other tools are empowering even more. Um, but the most simple and what's in the guidelines is when, uh, these plaques form in your heart arteries, they can calcify as they age. And X-rays are very sensitive to calcium deposits. Just like a mammogram can pick up calcium deposits in a breast tumor, calcium deposits form in these plaques that form in our blood vessels. So a, a simple low radiation dose CT scan that takes, you know, 30 seconds, um, can pick up these early deposits and so that this coronary artery calcium scan is, uh, the one that's been around the longest in the guidelines.
[00:08:18] Um, and we can start getting into how, you know, AI is sort of em empowering that even more. Um, but basically you're looking, you know, the, the older way to do it was you were looking if you had a, a blockage that was really narrowing the blood vessels substantially. But, you know, part of this discussion is we wanna reframe, that's really late, that's like looking for an end stage tumor that's already causing lots of problems that's hard to, harder to treat. We wanna catch that early, just like a mammogram catches breast cancer early when it's most treatable, uh, and curable.
[00:08:57] Russ Altman: Yeah. So a lot of people have, are aware of these things that they call, like the treadmill test, where, you know, you put somebody on a treadmill, you work 'em out, and you're, you're checking their EKG and of course asking them if they're having any chest pain. I take it that that is, um, that's late in the game. Um, uh, and does that still have a role?
[00:09:15] Michael McConnell: Uh, so, uh, for evaluating patients who have chest pain, you know, stress testing as you've describing, um, is still used. Uh, I do highlight in the book that the idea of using it as a screening test to sort of make sure everything's okay, I think is very misguided because one is, it's only gonna detect late stage disease. And two, people walk away if their stress test is normal, they could actually have a lot of plaque buildup in their heart arteries, um, that just hasn't caused enough narrowing for the abnormal stress test. And so they think everything's fine. And you hear about people that had a stress test one day and heart attack the next, then ,that's because you don't, you don't actually need a severe narrowing to have a heart attack. And so you know, that's why going directly more to the source of looking at the blood vessels, picking up those earlier changes is, is critical.
[00:10:18] Russ Altman: Great. So now let's get into all the new stuff. And you mentioned you, you said the word AI or the, the letters AI at least two or three times already. So why don't we go right to AI? How is that, uh, revolutionizing or is it revolutionizing these kinds of diagnostic, uh, tests and the, and the ways that you can then approach the disease?
[00:10:37] Michael McConnell: Yeah, so I, one of the most recent examples, which actually, you know, happened sort of after the book, uh, is some other colleagues at Stanford have used AI when people had a chest CT scan for another reason. Um, you know, they found that, uh, an AI developed at Stanford could analyze that chest CT, see if they had that, those calcium deposits. And then when patients and their doctors were notified that these prior CT scans had the evidence of early heart disease, you know, over 50% of them got on good preventive therapy within six months and you know, over 90% stayed on it.
[00:11:21] Russ Altman: Yes. I think you've called this. Sorry to interrupt. I think you've called this opportunistic because they got the chest X, the chest X, the chest CT maybe for a pneumonia or whatever.
[00:11:30] Michael McConnell: Right.
[00:11:30] Russ Altman: But then they're getting this bonus finding, which actually might be more important than the reason they check the CT in the first place.
[00:11:37] Michael McConnell: Yeah. So this concept, yeah, there's opportunistic imaging that many pictures that we get of different parts of our body have a lot of health information beyond whatever the doctor ordered it for, right? So the, the other one where I've, you know, I've been working with a startup company is doing AI retinal imaging. Something actually, we first published back when I was at Google, now it's, uh, almost eight years ago. Uh, it shows you can take a long time to get from a publication into a product. Uh, but similarly, when someone gets a routine photo of the back of their eye, it has a lot of blood vessels there. And so, you know, we can run AI to detect that you're at increased risk and really need, you know, a more thorough evaluation for early disease and, and likely need for preventive therapy.
[00:12:32] Russ Altman: Okay. So that's, I'm gonna stop there and I, I want to dive a little bit into that. Because I think people will be thinking, wait a minute, my eyeball is telling you about my heart. So can you go through the kinds of changes? Um, I know you wrote a paper about, um, I think detecting hypertension by looking at the retina. I don't know if that was before or after heart disease, but you obviously have a great interest in using the eye as a proxy for the heart. So can you tell us what, what does the AI actually see that allows it to make these inferences?
[00:13:01] Michael McConnell: Um, well, you probably know that some of the things that AI sees we understand and some of the things AI sees, we don't understand. Actually, the, the original publication when I was working at Google, um, it really blew away the ophthalmology world because the AI, you know, they basically trained it against all these different risk factors, which include age and sex. And um, and the AI was, you know, over 90% accurate at telling men from women, just from, you know, being trained on images of thousands of men versus thousands of women.
[00:13:43] And ophthalmologists who've been looking at retinal images their whole career couldn't, you know, didn't really, you know, this is sort of, there's a black box element and then there's some more explainable elements. Certainly when we did these, what they call these attention maps, you highlight the pixels in the image where the AI is basing a lot of its, uh, prediction and certainly when it's trained on blood pressure, the pixels all light up along the blood vessels.
[00:14:18] And we've actually known for 60 years that cardiovascular disease causes, you know, narrowing of the arteries and widening of the veins, uh, which you can see in the microvessels of your retina. So there, there are explainable aspects, um, you know, sort of the damage that comes from hypertension, diabetes, uh, cholesterol. Um, but there's also some things that we still haven't fully been able to explain of how the AI can pick up often a lot of early features that humans can't easily see.
[00:14:55] Russ Altman: That's, that's really just amazing. One quick question as a follow up is, um, are the people who are having high scores for coronary artery disease risk from their retinal scan, do, are they having visual problems or is this all below the level of detection of visual issues?
[00:15:12] Michael McConnell: Yeah, so this is all below the level of detection of visual issues. So, and that's why on the other hand, there, it's estimated there are about a hundred million people who go for eye exams because they do, you know, need glasses and other things, um, actually more than get sort of a regular, uh, primary care, uh, annual exam. And so that becomes this huge opportunity, um, when they're going for their regular eye exam to, you know, sort of get flagged that you, you're likely at increased risk for heart disease. And it's good to know early and talk to your doctor about getting further checked and on preventive therapy.
[00:15:58] Russ Altman: So, so now we've talked about two kind of amazing new ways. You, you talked about the, the calcium and the coronary, uh, from a CT. You also talked about the retina. Are, uh, you implied that the, um, the coronary calcium is gonna show up early, and so it could be an early, is the retinal changes also showing up earlier than other traditional markers of disease, or, or is the jury still out on that?
[00:16:21] Michael McConnell: That's a good question. There are, um, there are publications and other efforts that actually compare the retinal changes and they train those against calcium scores.
[00:16:35] Russ Altman: Oh, good.
[00:16:36] Michael McConnell: So in some ways, those two worlds may ultimately come together. Um, you know, I think a lot of what I've been interested in is how do we better identify when somebody needs a calcium scan? And so, you know, the retina potentially becomes a, a way to identify that. We have a number of risk scores. But if you just look, I mean, when I worked on the book, one of the things that sort of blew me away was, even though I've been doing this for a long time, you know, when a man hits 50, about one in three already will have, you know, calcium deposits in their heart arteries. And a woman when hits 60, same thing, one in three. So, you know, this notion that you can just sort of look at somebody and say they look healthy and, you know, um, you don't have to worry about heart disease, you know, I, I sort of jokingly say, you know, I've been doing this for over 20 years, but I don't have X-ray vision.
[00:17:41] And, you know, so, um, people that I think are at increased risk, some percentage will still have a zero score and some will have a score off the charts. So we can much more personalize, and again, some other colleagues had published, which was a nice link to sort of this cancer approach, is they took, you know, your calcium score could then stage your heart disease. So the, so the same concept of, of cancer diagnosis and treatment. And so they, you know, stage zero through four and, and then the intensity of the therapy matches the stage of your disease. So part of what I think is a good paradigm shift that's starting to happen, uh, in how we approach heart disease.
[00:18:33] Russ Altman: This is The Future of Everything with Russ Altman. We'll have more with Mike McConnell next. Welcome to The Future of Everything. I'm Russ Altman and I'm speaking with Mike McConnell from Stanford University. In the first segment, Mike told us about the amazing new ways that we can detect coronary artery disease very early to maximize the chance of intervening and living a long life without heart attacks. In this segment, Mike's gonna tell us about his excitement about direct to consumer technologies, wearables, AI, on your medical record that can also help with this task of early detection. The direct to consumer is tricky though because it means that you're taking some of the influence away from the clinician and putting it in the hands of the patient. That might not be a bad thing. Don't forget, at the end of the episode, we'll have our Future In a Minute segment where I'll ask Mike some questions and he'll gimme some answers.
[00:19:36] Mike, you've been very involved in thinking about how we can empower a patient to kind of take control of their heart disease because their doctors may or may not have a sense of urgency that you think should be had. So tell me about why you're thinking about direct to consumer and how it's manifesting itself in the diagnosis of heart disease?
[00:19:56] Michael McConnell: Yeah. I, you know, a lot of what I've been trying to do over the last 10 years is how do we do this prevention at scale? Um, and we recognize our healthcare system is super busy taking care of all of the acute active problems we had. And it's, you know, it's hard to spend a lot of time on the prevention side. Obviously as a preventive cardiologist, that's the primary thing I do, but, and, you know, most people don't have easy access to preventive cardiologists all the time. Um, and you know, I've been excited over the last few years how prevention has really come into growing importance, right?
[00:20:35] Our, our current spending on healthcare is skyrocketing. I think there's broad interest in how do we do more prevention, and I think in particular patients or consumers, as part of the reason I worked in consumer companies like, like Google is, you know, how do you reach many more people um, and make them aware of this? And you know, obviously it's in, we're often the most interested person in our own health. Uh, and I think we see this in a lot of the emergence of what are now called sort of longevity companies, which, uh, it's, you know, it's exciting, you know, the, it's a new buzzword.
[00:21:17] It's ultimately how do we do better prevention? How would we have a better, you know, health span, right? How do we stay healthy, active, vigorous for longer? And everybody wants that. And now with, you know, we can have health records on our phones, we can, you know, there are multiple companies now offering to connect their AI agent to your phone health records to say we can help you analyze it. We can find evidence of early detection. We can connect your mobile wearable data to your health record data, potentially to your genomic data.
[00:21:56] Um, so, you know, the power of this mobile ecosystem, that pretty much everyone has a phone, and, you know, the power of, of AI on top of it, I think we have a lot more opportunities to help people be more, uh, aware of and get more help. You know, sort of the thing I put in the book is, you know, everybody deserves to have a little preventative cardiologist sitting in their phone monitoring their wearable data and their health records and, you know, trying to help keep you healthy.
[00:22:33] Russ Altman: So it is remarkable that you say all this because really you're a cardiologist. You've been trained in the traditional way, right? And, and so you could have come on here and you could have said, I'm very worried about all of these pseudo cardiologists, that, well, forget about taking away your business. I'm sure you're very busy anyway, but like maybe they're not doing a good job. So implicit in your comments is that you must think that these really have promise not to mislead patients, but to actually lead the patients to kind of better outcomes. So where are we and like what are the technologies that you think are the most like, mature in the direct to consumer space where you would tell a loved one or a friend, yeah. Doing that is not crazy. There's actually some science behind that.
[00:23:18] Michael McConnell: Yeah. I think, right, you're, you heard sort of the optimist side of me. Um, there, there's clearly the challenge of many businesses. You know, they focus on how to make money and, and to, you know, often promise things that sort of go beyond the science or the guidelines. And so that is the worrisome part, right? And many of the programs can be quite expensive so they can actually, you know, make disparities in healthcare in many ways worse. Um, I mean, right, so there's a company that I help that's very focused on South Asian heart health because, uh, as a group that have a number of risk factors and increased rates of heart attacks. Um, and we intentionally work with the heart association and their, what they call their cardio kidney metabolic health paradigm.
[00:24:18] So what has me optimistic is, you know, many of the medical societies and the healthcare system, you know, is trying to still contribute to this space so that we try to make it as guideline based, uh, as possible. Um, you know, that life's essential eight that we talked about at the beginning, you know, blood pressure, blood sugar, blood cholesterol, you don't need a battery of a hundred tests, you really, you know, if you can focus on the fundamentals that covers 90% of it. Um, so there are, there are risks, uh, in sort of overtreatment, over testing, over promising. But I think the part that makes me optimistic is it's putting sort of prevention and health span, you know, much more into the public realm. And hopefully help many more people with early recognition of health conditions and engage them in all the things that they can do for prevention.
[00:25:26] Russ Altman: When you look at the DTC world, um, you, there's gonna be, um, some stuff in the area of early detection, and then as you know, there's a ton of stuff on like wellness and exercise support and kind of prevention. Um, which of those are you more bullish about? Are you equally bullish? Is it like all good or would you recommend that somebody who's listening to this would maybe say, um, for your first thing, like get an app that helps you do X or is it not that simple? So what are you thinking? Where are you most excited about the current capabilities of cell phones, AI, and, and all the technology, and the wearable technologies, the rings, the watches, all that stuff.
[00:26:07] Michael McConnell: Yeah. I, um, I'm honestly probably because it's been underemphasized is I'm most excited about this idea that it's actually become very easy to pull your health records into your phone, and then get help analyzing those for early evidence of, you know, there's pre-diabetes. So you don't have frank diabetes, but pre-diabetes is reversible. Um, you can pick up, you know, earlier levels of underlying kidney disease and other risk factors that often don't, you know, while they're living in your health records, often you as a patient, and then it, you know, it doesn't sort of rise to the level that your doctor raises it.
[00:27:00] Um, so to me it's more around that early detection. There's a lot of information and, and the AI could also tell you, yes, you've had these two tests, but you, you don't have a blood sugar in there or you don't have a recent blood pressure. And so, um, it can tell you sort of the gaps in any testing. It can tell you what it finds and then even better, it then links in, here's what the guidelines say, or the best treatments either to, you know, prevent progression or if you have early disease, you know, then how do, how do we stop it or, or reverse it?
[00:27:41] Russ Altman: So I'm assuming that if, uh, so good. So that, that is a really good answer, is that you really are very excited about the, um, mostly because it's emerging and it hasn't become standard, that using these AI systems, which can help detect early disease is, is an area that you're excited about, which totally makes sense. Um, when they do this, if, if the patients do this on their own, direct to consumer, they have an app, I'm presuming that you're encouraging them to eventually go tell their doctor about it. So how are doctors, uh, how are your colleagues in cardiology receiving this? You're an, you're a futurist, and you've always been at the, uh, at the, at the, uh, frontier. Tell me how the cardiology community is responding to these, um, apps. Are, are they as bullish and excited as you or is there some friction?
[00:28:28] Michael McConnell: I think there is friction. I think I'll also be very straight up that you've highlighted sort of the big challenge in this, in that you can empower a person, a consumer, around their information and, and what health issues they may have. But then there's still many things that do require a medication or a prescription or a diagnostic test that does rely on a physician. Now that has changed a lot in the direct to consumer world, right? There are many tests and drugs that you can get by answering questions, you know, online that don't necessarily involve. Now, you know, there again becomes, is that the best answer? It does break down some barriers, which I think in the long run is a positive thing.
[00:29:23] But really how to connect, make sure people are, have access to and, and get, you know, good guideline based care. I think that that is a big part in the system that we haven't figured out. And yes, some of the friction, I, I think, you know, one of the times we pitched at a cardiology conference about, you know, early detection of people at risks, you know, uh, from their eye and they're like, well wait, we're too busy for that, you know? You're just gonna send all these people and there aren't enough doctors to take care of them. And I recognize that, but it doesn't mean we shouldn't tell people that they're at risk and they're not on a guideline recommended therapy. So, um, this is why I think,
[00:30:12] Russ Altman: And I, I can imagine a company like Costco with this, when this is all validated and everything, um, I've been so impressed with their ability to scale. Uh, and, uh, and I, I should say I have no financial relationship with Costco, but I can imagine places like that really jumping on this when it's shown to be effective. Um, so that's pretty exciting. Now we, we're, we're not gonna have time actually to talk about treatment, but I do wanna touch upon, um, I think implicit in a lot of what you've said is that once we have these early diagnosis, um, physicians do have an arsenal of medications that they can use to not only stop progression, but my understanding is that with sufficiently aggressive treatments, you can actually reverse some of that disease. And so I wanted to just ask you briefly about that, because underlying this whole conversation is that the early detection, there's things you can do about it once you get the diagnosis. 'Cause, so could you just give us half a minute on the, the treatment, um, landscape?
[00:31:08] Michael McConnell: Sure. Yeah. I think probably the, the core that is around preventing heart attacks is when you know our most effective therapy is to get your cholesterol, particularly your bad cholesterol, what we call the LDL, or sort of a better marker now is called ApoB, that's sort of the part on the cholesterol that's sort of most, uh, most prone to promote plaques growing. Um, that, uh, yeah, we, you know, statins have been around for a long time. They're very inexpensive, very safe, but we have this whole new world of cholesterol lowering medications, things like PCSK9 inhibitors, very long name. But, you know, they found that they were people walking around with very low cholesterols. They figured out the gene and showed that those people live very healthy lives without heart attacks. And so then they made antibodies, you know, to this PCSK9 protein, and, um, it can get people very low.
[00:32:17] There are people working on a single shot gene therapy so that you have the effect of a, a good PCSK9 gene for the rest of your life. Um, so there are lots of opportunities and the guidelines keep saying, you know, the lower, the better, uh, um, but that's one of the things that we personalize based on risk factors and other things. But yeah, we have this sort of growing list of very safe and effective cholesterol learning medicines that do, in lots of studies, show that they can shrink, you know, the, the plaque, particularly the noncalcified plaque. There's a whole emerging part of CT scans to quantify with AI the noncalcified plaque, and show that that can improve. Stanford's doing a big trial in that area. Um, so, yeah, that's, you know, if you can pick it up early, the calcium part doesn't go away. But sort of what we think is the more dangerous noncalcified plaque that's more prone to have heart attacks that that can reverse with, with these new therapies.
[00:33:31] Russ Altman: Great. So that's great. So we, we've gotten a, a great overview and thanks very much for the new dimensions in detection, including direct to consumer and we know that we can treat this. Well, but before we finish up, I just wanna move to our, our new, our relatively new segment called the Future In a Minute, uh, where I ask you five kind of rapid-fire questions and you give me the shortest answers that you can while, uh, being true to yourself. Uh, so are you ready for that, Mike?
[00:33:58] Michael McConnell: I'm ready, Russ.
[00:34:00] Russ Altman: Okay, great. First question, what is one thing that gives you the most hope about the future?
[00:34:05] Michael McConnell: So it's really that the culture has shifted towards prevention and, you know, as part of that, that early detection for heart disease in particular is now gaining a lot more attraction.
[00:34:19] Russ Altman: What's one thing you want people to walk away from this episode remembering?
[00:34:24] Michael McConnell: Prevention alone is helpful, but early detection, you know, just like you wouldn't do prevention just for alone for cancer. Uh, you know, you need that screening along the way.
[00:34:38] Russ Altman: Aside from money, what is the one thing you need to succeed in your research?
[00:34:42] Michael McConnell: Um, we always need more data, given the AI training and, you know, a faster path to get in, you know, into a product through the FDA and get paid for it. Those are very long things that make it hard to bring a technology all the way to, to people.
[00:35:05] Russ Altman: If all goes well, what does the future look like?
[00:35:08] Michael McConnell: No more heart attacks and strokes.
[00:35:11] Russ Altman: Whoa. If you were starting over again and you needed to get your degree or your certification in a different discipline, what would that be?
[00:35:19] Michael McConnell: I really think now about implementation science. They, we come up with great new science and inventions, but then it doesn't get that last mile because we haven't figured out the best way to implement it. So that, that's the thing I think about most these days.
[00:35:38] Russ Altman: Thanks to Mike McConnell, that was the future of coronary artery disease. Thank you for listening. If you're enjoying the show, please tell a friend or family member who you think would love it about it. We would love to have them as a listener. Don't forget, we have nearly 300, more than 300, episodes in our back catalog, so you can spend hours listening to The Future of Everything. We would love that. Please take advantage of that catalog. You can connect with me on many social media platforms like LinkedIn, Bluesky, Mastodon, and Threads. I'm @RBAltman or @RussBAltman. You can follow Stanford Engineering a@StanfordSchoolOfEngineering, or more simply @StanfordENG.
