Dr. Lang is a Professor of Cardiology and the Deputy Dean of Research at the University of Malaysia, as well as the director of Clinical Investigation at the University of Malaysia Medical Center. He is the winner of numerous prestigious awards, including a Fulbright Scholarship, two Pfizer Academic Awards, and fellowships from the American College of Cardiology, the Royal College of Physicians of Edinburgh, and the Royal College of Physicians of London. Dr. Lang currently researches and practices in his native Malaysia. He is Heart1's first international Hero.Heart1: Much of your research has involved patients with chronic heart failure. What can you tell us about the significance of this disease?
Dr. Lang: Heart failure is a public health problem worldwide. Here in Malaysia, it accounts for 9% of all hospital medical admissions. Statistics from the United States in 1991 established that heart failure was the primary diagnosis in approximately 790,000 hospitalizations.
Heart1: How is this disease normally treated?
Dr. Lang: Drug treatment remains the mainstay. The hemodynamic model, which served our needs well from the 1950s through the early 1980s, has now been largely abandoned, except for the management of decompensated patients in the hospital. [Heart1: "Decompensation" refers to the inability of the heart to maintain adequate circulation, particularly when a heart failure patient is overloaded with fluid.] Now, to define appropriate treatment strategies, we need to define a pathophysiological model of heart failure.
Heart1: A "pathophysiological model" is a way of understanding an illness based on how it changes the body’s functioning (the "physiology" of the diseased body). What can you tell us about the modern pathophysiology of heart failure?
Dr. Lang: The contemporary working hypothesis is that heart failure is a progressive disorder of the left ventricle which results in impaired cardiac function and circulatory congestion. This changed understanding of the pathophysiology of heart failure is predicated on numerous clinical trials conducted over the past 20 years. The evolution of treatment for chronic heart failure as a result of these clinical trials has provided us with an understanding of the fundamental biology of the disorder. This is a reversal of the usual flow of information (from basic science to clinical investigation).
Heart1: How might your research impact the future treatment of heart failure?
Dr. Lang: The treatment of chronic heart failure is now largely based on the "neurohormonal hypothesis": that neuroendocrine activation is important to the progression of heart failure, and that the inhibition of neurohormones is likely to lower morbidity and mortality rates over the long term. My research goal has been to evaluate the role of neurohormonal activation in the pathophysiology of exercise intolerance.
Heart1: You’re a pharmacologist as well as a clinician. What can you tell us about the use of pharmaceuticals to address this disease?
Dr. Lang: Drugs specifically designed to heighten cardiac contractility and "unload" the left ventricle have proven unhelpful in the long-term management of patients with chronic heart failure. I am interested in the renal effects of low-dose prazosin.
Heart1: For our readers, prazosin is a drug which dilates the blood vessels in order to reduce blood pressure. Dr. Lang, what else can you tell us about your pharmacological interests?
Dr. Lang: Clinical pharmacology has its roots in measuring the effects of drugs on human beings, and identifying the factors responsible for the variation among individual responses. Accordingly, I am interested in ethnic differences among drug responses. These phenomena have important consequences--from rational drug use for the individual patient, to the drugs’ development, evaluation, and licensing/distribution worldwide.
