From the heart
Heart researcher has much to smile about
By Peggy Peck
Editor's note: CNN.com has a business partnership with MedPageToday.com, which provides custom health content.
Cannon and his father, Dr. Paul Cannon, on the day that he won his first research award.
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BOSTON, Massachusetts (MedPage Today) -- Dr. Christopher P. Cannon is not your father's cardiologist, but he was, in an unexpected way, his father's cardiologist.
In the high-pressure, publish-or-perish world of academic medicine, physicians who devote their careers to heart research often come across as somber intimidating figures. It comes with the territory. The heart is serious business.
By contrast, Cannon always has a smile playing around the corners of his mouth. He is lively and friendly, even as he gives major lectures at big-time cardiology meetings.
He bounces on the balls of his feet as he flicks a laser pointer across a screen displaying the latest results from yet another heart study he and his colleagues conducted at Brigham and Women's Hospital here.
This is the legendary Harvard hospital known as "the Brigham" that is home to many of the medical faculty's best and brightest physicians.
When Cannon took time to talk about his research, he turned serious only once. This was when he recounted the story of how his research led to better treatment of his own father's heart attack.
"That was my most poignant moment as a researcher," he recalled.
Skier, DJ, doctor
At 44, Cannon could easily pass for a decade younger, and those who run into him on snowy slopes are likely to mistake him for a ski instructor, a job that would suit him since he served as captain of the Yale University alpine ski team during his undergraduate years.
Likewise, those who meet Cannon at a party where he is entertaining guests with his latest music mixes might mistake him for a DJ, which he said is an avocation that he pursues by issuing "new CDs for every time we have the results of a trial."
For example, when he finished a study called CLARITY that investigated an anti-clotting drug called Plavix, "Madonna's song 'Open Your Heart' came to mind," he said. The Madonna song is the first track on the celebratory CLARITY trial CD that Cannon sent to friends and family.
Even though he wanted to be doctor when he was growing up in Ridgewood, New Jersey, by the time he finished medical school at Columbia University and was starting a three-year general internal medicine residency there, "I knew I didn't want to be a cardiologist, because I heard that cardiologists came in the earliest and stayed the latest, and I thought that would be too hard on my wife."
He knew this because he is the eldest son of Dr. Paul Cannon, who headed the Department of Cardiology at Columbia in New York for 13 years.
The younger Cannon was married after his first year of residency and "working 100 hours a week as a resident was already hard on my wife, so I didn't want to continue that pattern."
All thumbs in the lab
But he was interested in research, and started to build his reputation by winning an award as a third-year medical student for a paper he published in the top-rung scientific journal Nature.
He pursed his research interest during his residency by working in a laboratory devoted to basic research in kidney disease.
"We were supposed to be cloning genes and I had no idea what I was doing," he said. Finally, a "light bulb went off and I realized I was not meant for basic research."
He started considering clinical research and "another light bulb went off" when he realized that most of the journal articles he was keeping in his locker were from cardiology journals.
So he applied for a fellowship in cardiology and "my paper in Nature got me into the Brigham," in a program headed by legendary heart specialist Dr. Eugene Braunwald.
Cannon arrived at the Brigham in the late-1980s just a month after Braunwald published his new classification system for the chest pain called unstable angina pectoris.
"The paper concluded that the system needed to be validated in a prospective study," Cannon said. "I decided to start using the classification system for my own records of unstable angina patients that I was treating."
By Christmas, Cannon had a journal with data from 93 patients and he decided to plot the patients' classifications and actual clinical outcomes to see whether the patients he had classified as Class III angina, which Braunwald said were the sickest patients, also had the worst outcomes.
Lo and behold, they did.
Pleased with his results, Cannon recalled that he "wrote a letter to Braunwald explaining my findings."
Boldness brings job offer
"Sending that letter was rather bold for a first-year fellow," Cannon laughed.
But the next day he was paged to the office of Braunwald, whom had not met at that point. Once there, Cannon received Braunwald's praise and the offer of a job. He was asked to join Braunwald's fledgling team of cardiologists studying ways to restore blood flow to blocked arteries in the heart.
If a blood clot becomes lodged in a vein or artery that is narrowed by the buildup of plaque, it can stop or greatly diminish blood flow to the heart, which causes a heart attack. The longer the blood is cut off, the greater the damage to the heart, so restoring blood flow is major challenge for cardiologists. It's known as reperfusion.
When Cannon joined Braunwald's project, called the Thrombolysis In Myocardial Infarction (TIMI) group, it was just beginning its third study, TIMI-3.
Time flies. "We are just starting TIMI-40," Cannon said.
Survival is a matter of time
Over the years, the TIMI group has provided evidence for the efficacy, or lack of efficacy, for virtually every nonsurgical treatment of coronary artery disease.
The TIMI researchers were among the first to report that minutes mattered when delivering clot-busting drugs, so the faster the "door-to-needle" time the better the outcome.
But it was another TIMI study, one that looked at door-to-balloon time, meaning the time between heart attack symptoms and balloon angioplasty to force open blocked arteries, that would have a personal impact on Cannon's life.
"We had just published the TIMI study that demonstrated rapid door-to-balloon time improved outcomes when my dad had a heart attack," he said.
"He felt a little arm pain and decided to act on it right away and within 10 minutes he was in the cath lab," Cannon said. "It was incredibly terrific to see my own work, something that I had researched, translate into the care of my own father."
Cannon's dominance of the TIMI work has led many observers to speculate that he is the heir apparent to Braunwald's cardiology throne at the Brigham. Cannon, however, said he is not comfortable with that speculation.
"I could never be one-tenth what Braunwald has been in cardiology and medicine, but I am a testimony to his mentoring," he said.
He is, he said, more comfortable in the day-to-day world of clinical research, where his immediate goal is to help practicing cardiologists put the TIMI research into practice so that hundreds of thousands of heart patients can be assured of the same benefit that his father received.
"I landed in this field at a wonderful time when there is a lot going on," he said. "When I was an intern, heart attack patients got nitroglycerine and morphine for the pain. That was it. We didn't even give them an aspirin. Today we have real treatments that really work. So, I guess that's why I'm smiling."
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