Preventive Cardiology vs. Preventive Medicine

[Sensation]

Hi.

I've been interested in Cardiovascular Disease since 9th grade and after my two years in Medical School, I'm pretty sure that's the subspecialty for me... but lately I've been feeling the desire to practice Preventive Cardiology, and I'm excited to see that it does exist.

But how does one decide whether to do Internal Medicine/Cardiology then 2 years of Preventive Medicine Residency vs. Internal Medicine/Cardiology then 1 year of Preventive Cardiology?

Does it only depend on whether I want to focus on prevention one patient at a time vs. groups of individuals at a time? Thanks!

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[grendelsdragon]

Hi.

I've been interested in Cardiovascular Disease since 9th grade and after my two years in Medical School, I'm pretty sure that's the subspecialty for me... but lately I've been feeling the desire to practice Preventive Cardiology, and I'm excited to see that it does exist.

But how does one decide whether to do Internal Medicine/Cardiology then 2 years of Preventive Medicine Residency vs. Internal Medicine/Cardiology then 1 year of Preventive Cardiology?

Does it only depend on whether I want to focus on prevention one patient at a time vs. groups of individuals at a time? Thanks!

Preventative medicine is primarily a fellowship out of general internal medicine residency. There are 2 types of prevention: primary and secondary. Primary refers to preventing an initial event (the best kind of prevention), and secondary refers to preventing further/subsequent events after the initial presenting event (what most cardiologists deal with).

For cardiovascular disease, primary prevention is usually in the practicing realm of the general practitioner (for example, regular exercise, lipid control, target weight, lifestyle/dietary choices, etc.). Most cardiologists intervene at the level of secondary prevention (for example, treatment of patients with aspirin, beta-blockers, statins, and ACE inhibitors after initial management of acute myocardial infarction to prevent subsequent MIs). Generally, primary preventative measures are best implemented for practice in the general practitioner arena to intervene in the largest populations. Many cardiologists practice in a referral or tertiary level practicing environment.

Preventative cardiology is more an area of public policy and research in academic medicine. Rather than a formal "preventative cardiology" fellowship, most people get further training in the form of graduate education in public health (MPH at minimum or masters/doctorate in epidemiology or biostatistics) and then pursue specific research in the area of interest (like risk stratification, pharmacoepidemiology, novel biomarkers, epigenetics, to name a few). Cardiologists are also big on vascular diseases and metabolic disorders, but this tend to be more of a focus of research and advanced secondary prevention.