Curious, Enthusiastic, Optimistic, Collaborative, Grounded
These are the words that Michael Shapiro, DO, MCR, the Fred M. Parrish professor of cardiology and molecular medicine at Wake Forest University School of Medicine and director of the Center for Prevention of Cardiovascular Disease at Atrium Health Wake Forest Baptist uses to describe himself. Shapiro’s research and clinical work are focused on the prevention of cardiovascular disease, specifically heart attack and stroke.
Shapiro – who brings a unique training and perspective that is focused on atherosclerosis imaging and preventive cardiology – often uses his direct patient encounters to inspire what he researches. He leads a team that conducts a large number of clinical trials that examine new therapies for heart disease prevention. Throughout his career, he has received funding from the National Institutes of Health, the American Heart Association and various other foundations.
Shapiro serves as the associate program director of the T32 Cardiovascular Disease Epidemiology Program at Wake Forest Baptist and is the president-elect of the American Society for Preventive Cardiology. He has published extensively in the areas of atherosclerosis imaging, lipid disorders and preventive cardiology. Get to know him in his own words.
Tell us about your background. What’s your experience and how did you get into the field?
I have had a somewhat indirect route to my current position. Prior to my arrival at Wake Forest, I did all of my training in New York City and Boston. During my internal medicine residency, I became quite interested in cardiovascular medicine and pursued a clinical cardiology fellowship. At that time, novel non-invasive cardiovascular imaging techniques leveraging MRI and CT were just in their infancy. I recall going to the Society of Cardiovascular Magnetic Resonance annual meeting in my last year of cardiology fellowship and falling for these new modalities: hook, line and sinker. I immediately started to investigate fellowship training opportunities in MRI and CT.
Fortunately, I was awarded an NIH T32 training grant to pursue a clinical and research fellowship at Massachusetts General Hospital in advanced cardiovascular imaging, specifically with these two (MRI and CT) modalities. It was an interesting experience for a number of reasons, not the least of which was the fact that I was a cardiology fellow in a department of radiology. Beyond getting formal clinical training, I had ample opportunity to pursue research in imaging and this prepared me well for transitioning to my first faculty position. I was recruited to Oregon Health & Science University in Portland, Oregon to start and direct an advanced cardiac imaging program.
Now, much of what we do with those imaging techniques is called ‘atherosclerosis imaging’. That means we can non-invasively look inside the heart (coronary) arteries and evaluate the amount and specific characteristics of cholesterol plaque – the harbinger of heart attack – within the coronary arteries. Gradually, I got more and more interested in understanding the underpinnings of atherosclerosis and preventing its progression and complications. This is really the heart (no pun intended) of preventive cardiology. As my clinical and research interests were evolving in that direction, I coincidentally got connected with the most important mentor of my career. He was instrumental in providing guidance as I applied for my first research grants. This connection catalyzed my evolution from cardiovascular imager to preventive cardiologist.
What’s your current research focus?
I am involved with both translational and clinical research. Most of what I study has its origin from direct patient encounters. In other words, questions that come up in my day-to-day clinical practice inform the questions that I ultimately try to answer with research studies. At the highest level, most of my research focuses on either refining cardiovascular risk assessment or improving risk reduction strategies.
I also lead a team that conducts a large number of clinical trials examining new therapies for heart disease prevention, particularly novel lipid-modulating therapies.
What made you want to get into research?
Since the earliest days of my clinical training, I recognized that there was much more that we did not know as compared to what we actually did know about human health and disease. I admired numerous mentors who used research as a means to gain new insights into pathophysiology of disease, refine diagnostic strategies, and improve therapies. As much as I enjoy the clinical interaction with patients, I find focusing on research just as fulfilling. And the two endeavors complement each other beautifully.
What makes opportunities at Wake Forest University School of Medicine unique?
I started my career on the west coast. After about a decade there, I had the opportunity to build a preventive cardiology program at Wake Forest Baptist from the ground up. The move was a bit risky as I was happy and productive at my former institution. However, my instincts in taking the position at Wake Forest Baptist were spot on. It has been wonderful making the transition here and this institution benefits from an incredible spirit of collaboration, collegiality, as well as clinical and academic expertise. I have benefited from the breadth and depth of experience and know-how amongst the numerous faculty collaborators across the campus.
What attributes should someone have that’s pursuing a career in research or healthcare?
I personally believe that the most important attribute for success in research is resilience. Scientific research is full of highs and lows. Years of attention and energy devoted to a study may not yield fruit. Trials and tests fail. As new data enters the medical community, it can invalidate an entire body of work. Successful researchers are able to face disappointment and rejection without throwing them off course. Of course, there is a spectrum of resilience, and some individuals are born with higher levels and some with lower levels. The good news is that there are effective strategies that one can learn to boost your baseline level of resilience, no matter where you are starting from.
What’s the most exciting research you’ve worked on?
I have been fortunate to have participated in a number of really interesting projects over the years. One that I look back with special fondness relates to a clinical observation that we took to the basic science lab. We were able to identify the mechanism underlying the counterintuitive finding that a circulating protein intimately related to circulating cholesterol levels goes up by an order of magnitude despite an effective treatment that is used to antagonize its action. Ultimately, we were able to identify the previously unknown feedback loop in hepatic sensing and secretion of this protein.
What advice would you give someone who is just starting their research or medical career?
For those who are getting started in clinical research, seeking formal training in research methods and trial design is invaluable. Although I received this advice myself, I waited until I was a faculty member before pursuing my Masters of Science in Clinical Research. Once I started my formal coursework, particularly biostatistics, I realized how much I was missing prior to that training. Based on my own personal experience, I always encourage trainees who are interested in pursuing research to obtain this formal training sooner rather than later.
How can students and researchers find mentors?
It is pretty straightforward. I would recommend choosing an area that you are interested in pursuing research in and then contacting faculty who are doing work in that field. Fortunately, Wake Forest is replete with enthusiastic and energetic faculty who are happy to take on trainees.
What are some of your hobbies or interests outside of work?
Too many. A quick top five list would look like this (in no particular order):
- I am a coffee fanatic. If you have any questions regarding the best roasters, brewing methods, or equipment, I am your guy.
- I have had a long-term meditation practice. Without question, this is the most important endeavor I have pursued in my lifetime. It ultimately makes you better in all endeavors.
- Love reading non-fiction, particularly as it relates to the study of consciousness, comparative religion and ancient history.
- Very much enjoy exercise, which typically includes riding my Peloton, running, or hiking.
- Most importantly, I love spending as much time as possible with my family.