Boris I. Medarov1, Jin Ye Yeo2
1Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, USA; 2JPHE Editorial Office, AME Publishing Company
Correspondence to: Jin Ye Yeo. JPHE Editorial Office, AME Publishing Company. Email: jphe@amegroups.com
This interview can be cited as: Medarov BI, Yeo JY. Readers’ Choice: Author Interview with Dr. Boris I. Medarov. J Public Health Emerg. 2024. Available from: https://jphe.amegroups.org/post/view/readers-rsquo-choice-author-interview-with-dr-boris-i-medarov.
Expert introduction
Dr. Boris I. Medarov (Figure 1) is the medical director of Albany Medical Center’s Pulmonary Hypertension Program and Sleep Clinic. He specializes in diagnosing and treating pulmonary hypertension, or abnormally high blood pressure in the arteries of the lungs. He applies the latest diagnostic techniques and provides patients with a comprehensive approach to treatment of all forms and stages of this chronic, life-threatening disease. In addition, as a recognized leader in pulmonary hypertension research, Dr. Medarov can offer patients access to the latest medical advances in the treatment and management of the disease.
Recognizing the inherently complex problems associated with pulmonary hypertension, Dr. Medarov offers patients intensive ongoing care from a multidisciplinary team that also addresses disorders that cause pulmonary hypertension such as obstructive sleep apnea and heart valve problems.
Dr. Medarov’s article titled Current strategies in chronic obstructive pulmonary disease management published in our journal has received outstanding readership and entered the journal’s Most Read Article List.
Figure 1 Dr. Boris I. Medarov
Interview
JPHE: What drew you into the field of pulmonary hypertension (PH)?
Dr. Medarov: PH is a misunderstood disease state. It is challenging to diagnose, and delays are common. At the same time, it can be a fatal disease, which, left untreated, can result in significant morbidity and death. The most dreaded form of PH—pulmonary arterial hypertension or group I PH—rivals aggressive cancers in its prognosis. Historically, survival was less than 3 years if untreated. A very high level of awareness is needed among healthcare professionals to ensure timely diagnosis.
JPHE: Could you provide an overview of the recent publications in PH? What are some findings that stood out to you?
Dr. Medarov: Pulmonary arterial hypertension is a vasculopathy—a condition involving pulmonary vessels, mostly smaller-sized arteries. It results in the narrowing of the lumen and increased vascular resistance. Therefore, the focus over the past decades has been to promote pulmonary vasodilatation. There are therapeutic agents designed to accomplish that work on three major pathways—endothelin receptor blockade, nitric oxide, and prostacyclin pathways. It became apparent, however, that vasodilation alone is not sufficient to prevent the remodeling of the vessel, a process resulting in irreversible changes and, ultimately, right heart failure. Most recently, more efforts have been invested in tackling the proliferative component of pulmonary arterial hypertension, and new nonvasodilatory agents have been under development. A new drug “sotatercept” cleared the regulatory approvals by national regulators and became the first antiproliferative agent approved in the therapy of group I pulmonary hypertension. A groundbreaking phase 3 study was published in the NEJM in March 2023, paving the way for its clinical use (1). This new development is probably the most significant achievement in the field of PH in decades. Both patients and providers look at these developments with a great deal of new hope.
JPHE: What do you think are the most critical areas in PH research that need more focus?
Dr. Medarov: We still need to find the exact mechanism or a group of mechanisms that unlock the pathophysiology of pulmonary hypertension. We still do not have a modality that completely halts its progression, let alone “cures” it.
The invention of sotatercept is hopefully the first step in addressing this challenging problem. We need more bench and translational research to shed more light on the pathology of the disease and develop more tools to treat it.
JPHE: In the article entitled “Current strategies in chronic obstructive pulmonary disease management”, you discussed the strategies for COPD management (2). What would you say are the key takeaways from your article for clinicians and researchers in the field?
Dr. Medarov: COPD is a preventable disease. In modern 21st-century society, it is virtually always caused by smoking. As much of a cliché it is, the notion “one ounce of prevention is worth more than a pound of treatment” is very appropriate here. We can scrutinize painstakingly the relatively modest benefits of the various inhaled treatment options for COPD and look for the optimal algorithm to manage COPD but the fact that there is virtually no COPD without smoking should be front and center.
JPHE: In the article, you also mentioned that very few treatment options have an impact on mortality and lung function decline. From then till now, are there any new treatment options or approaches that have emerged that you find particularly promising for improving COPD outcomes?
Dr. Medarov: We certainly know more now than we did 10 years ago. The benefits of combination therapy, such as triple therapy, are better understood today. However, COPD is an irreversible disease state. It is similar to pulmonary arterial hypertension in that sense. There will never be a therapy that cures it or drastically changes its impact on mortality and quality of life unless we have an easy and safe way to fully replace one’s lungs. If we ever accomplish that, there is a long way in front of us.
JPHE: What do you think is the current biggest challenge in reducing the global burden of COPD, and how can healthcare systems adapt to meet this new challenge?
Dr. Medarov: The most challenging task is convincing billions of people that smoking is not worth it. Public health efforts have made strides in reducing the prevalence of smoking but more needs to be done. There are still more than one billion smokers across the globe, according to WHO. For as long as smoking remains prevalent, COPD will be prevalent. When we have hundreds of millions of people with COPD, there will be a tremendous cost to society, both financial and human costs.
Reference
- Hoeper MM, Badesch DB, Ghofrani HA, et al. Phase 3 Trial of Sotatercept for Treatment of Pulmonary Arterial Hypertension. N Engl J Med 2023;388(16):1478-1490.
- Keen C, Medarov BI. Current strategies in chronic obstructive pulmonary disease management. J Public Health Emerg 2017;1:26.