How preventive cardiology can reshape healthcare: A conversation with Dr Lourdes Ella Gonzalez–Santos

^{Screenshot of the cover of the 2nd Littman special issue of MIMS Doctor magazine (2026)}

Mel M. Beluan

The field of preventive cardiology is rarely integrated into routine practice in the Philippines, because doctors are not familiar with it, and our healthcare system favors disease treatment, hardly reimbursing long-term wellness.

We recently sat down with Dr Lourdes Ella Gonzalez–Santos, the head of both Section of Preventive Cardiology of Cardinal Santos Medical Center’s (CSMC) Cardiovascular Institute, and Section of Preventive Cardiology, Hypertension and Lipidology of UP-Philippine General Hospital’s Division of Cardiovascular Medicine, to talk about preventive cardiology, clinical research, leadership roles, and how she balances them with being a mother to two sons.

A graduate of the University of the Philippines College of Medicine (UPCM), she has been assigned to several academic and administrative roles,* the most recent being the treasurer of the Philippine Heart Association (PHA). She is the principal investigator of several ongoing cardiovascular (CV) outcome clinical trials. This interview excerpt has been edited for length and clarity. Find out which among her roles is her favorite.

On education

Why did you pursue medicine?

As the eldest granddaughter, I took up the responsibility of looking after my cousins when we lived together in a residential compound. From my experience of being the ate who was always called up to take care of their scrapes and burns, I already knew early on that taking care of people was something I wanted to continue to do.

What and who drew you to the crossroads of preventive cardiology, lipidology, and hypertension?

I was a cardiology fellow at Cardinal Santos Medical Center when Dr Rody Sy, a pioneering researcher in CV health, inspired me to pursue lipidology. He recognized the country needs experts in this field. While looking at New York University’s (NYU) new combined training program in three disciplines—preventive cardiology, hypertension, and clinical lipidology, I felt that if I were to subspecialize, it would be great to pursue preventive cardiology and hypertension as well.

I was fortunate to be choosing between the fellowship programs of Baylor College of Medicine and NYU’s Langone Medical Center. My husband jokingly remarked that New York might give him more excuses to visit me during my training because of endless sightseeing opportunities. In the end, I chose NYU where I had the privilege of becoming their first fellow in preventive cardiology.



On preventive cardiology

How does preventing cardiovascular disease differ from traditional cardiovascular care? When does a doctor refer to a preventative cardiologist?

 In our country, the practice of medicine is mostly reactive. Preventive cardiology is taking a step before diagnosis to prevent events from happening. There are two types of patients in this field: the patient in primary prevention—no stroke, no heart attack yet—and the patient in secondary prevention, i.e., the patient who already had a medical event. We identify and treat patients early in primary prevention to make sure that they don’t cross over to secondary prevention. Thus, we make a bigger impact in primary prevention.

Our goal eventually is for every Filipino physician to be more aware of preventive cardiology and preventive medicine in general, especially now that many patients are asking doctors questions from what they learn from the internet, e.g., “What’s my 10-year risk for developing a heart attack?”. To answer such a question, one of the roles of preventive cardiologists is to properly stratify patients into low, moderate, and high risks. Helping patients identify their risks empowers them with the ability to treat their condition with urgency.

What are the challenges and misconceptions about preventive cardiology?

One of the focuses of primordial prevention is education at all stages of life, which demands a lot of effort and global expenses. It’s one reason healthcare concentrates more on treatment rather than prevention. For doctors, institutions, and the society at large, the challenge is how to shift to a prevention-focused model and mindset of healthcare. The PHA and the Philippine Lipid and Atherosclerosis Society (PLAS) have been in constant talk with the Department of Health regarding this issue.

Another challenge in this field is that most patients wait for symptoms to occur before they see a cardiologist, not realizing that they can have a heart ailment without being sick or presenting symptoms. The greatest fallacy is if you don’t have symptoms, you are not at risk—you don’t need to have chest pain to have coronary artery disease. Families now wonder why a loved one suddenly dies of a heart attack or stroke despite appearing seemingly healthy.

We have the Asian paradox—Asians can have a thin build, thinking they’re healthy. They can have coronary artery disease that they don’t know yet until careful risk assessment reveals a strong family and smoking history, and a sedentary lifestyle. Inadequate restful sleep is already a risk for developing a medical event. Sedentary lifestyle, including not walking for 30 to 45 minutes a day, five to seven days a week, not only increases one’s risk for stroke but also for cognitive decline and Alzheimer’s disease. So, it’s not just the usual suspects anymore, like obesity or hypertension.

What’s the best type of exercise?

The most accessible form of exercise is walking. PHA and PLAS particularly advocate this type of exercise. Take the time to walk while scrolling on your phone early in the morning or while waiting for your kids to come out of the school gate. It doesn’t entail coaching, gym membership, or special equipment.

For CV health, consistency and duration matter more than intensity. You don’t have to start with a brisk pace. If you begin slow-paced walking and sustain it for 30 to 45 minutes daily, you can cover more ground over time because your body is adapting and getting used to it. Of course, for people who have certain limitations, they can opt for other types of exercise that are friendlier to the knees and spine like swimming.

What can you say about fad diets like the ketogenic diet?

We have a lot of fad diets in the country. Ketogenic diet has a lot of evidence but mostly in children with epilepsy, with the number of seizure episodes decreasing after they’re started on this diet.
 
In our consensus statement published in December2020, a proper ketogenic diet must be physician-guided, requiring that most of the calories are coming from good fat. But many people may misinterpret this high-fat diet as indulging in lechon de leche (incidentally, it has the same acronym as low-density lipoprotein). Of course, if you eat lechon without rice every day, eventually you will lose weight. But what you don’t see is the bad cholesterol buildup in the arteries of your neck and your heart. The diet’s bad effects are not immediately seen. Dieters won’t even realize that the stroke or heart attack that will happen five years down the line may have been contributed by the ketogenic diet. The diet’s benefit is only for short-term weight loss in the severely obese, but it doesn’t translate into a reduction of CV events.

Fake news and unfiltered evidence are among the greatest challenges that doctors face in the clinics. I always try to explain with evidence, telling patients the reason I’m a clinical trialist is that when I prescribe a medicine, I can show them which clinical trial showed a benefit and in which Asian population this benefit is showing. 



Are there tools and lab tests that are underutilized by Filipino doctors? Is the risk stratification abroad applicable in the country?

American Heart Association’s PREVENT and Europe’s SCORE2 are CV risk calculators based on American and European populations. We are hoping that by next year, we can come up with a version tailored to our local setting. In the meantime, all local doctors should routinely do risk factor‒counting as it’s more accessible.

The value of PREVENT and SCORE2 in local practice is knowing what the guidelines show, recognizing the calculators’ peculiarities and the dataset studies that they are based on, and choosing which one is most convenient in your practice. An example of PREVENT’s peculiarity is it predicts 10- and 30-year risks even for younger patients, starting at age 30. So, one can be young and have a low 10-year ASCVD risk but have a high long-term, 30-year ASCVD risk. As for SCORE2, it stratifies risk by also regionalizing it, e.g., people living in Spain and France have the lowest background rates of cardiovascular disease.

As a preventive cardiologist, I routinely perform the carotid artery duplex scan and the coronary artery calcium score (CAC score), which makes the deposited cholesterol problem more tangible for patients even when one is asymptomatic, thus, encouraging the patient to adhere to their medication.

We now also have the advanced biomarkers. An example is Lp(a) (lipoprotein a), whose serum levels are genetically determined. Tested only once in one’s lifetime, it’s especially useful when family history is unreliable. If you have high serum Lp(a), each one of your children has approximately a 50 percent chance of inheriting this trait. Your children then need to be tested while they’re still young to give them a headstart in primary prevention against a surprise heart attack at, say, age 20.

Preventive cardiology is often a long game. How do you motivate patients to stick to the treatment plan?

The goal is to frame consults as a partnership and to empower patients to take responsibility of their health. Because internet-savvy patients nowadays want to know their risks, they tend to be receptive to explanations of their treatment plan and targets in terms of pathophysiology, which ultimately connects to the importance of a firm commitment to the treatment on their part. Such commitment would result in a better quality of life in the long term.

Can you tell us about a specific patient whose transformation inspired you?

The most impactful ones are those who were resistant to the advice of previous doctors, but had a light bulb moment after they began to understand their risk, CAC score result, etc. When they realize their targets, we get on the same wavelength, and the commitment to the long-term treatment plan is achieved.

“[THE WHO-ORGANIZED SOLIDARITY CLINICAL TRIALS WERE] THE MOST MEMORABLE [STUDY THAT I WAS INVOLVED IN] AS WE DIDN’T KNOW MUCH ABOUT COVID-19, AND, HENCE, THE RULES CHANGED EVERY DAY. ALSO, WE WERE STRUGGLING TO KEEP OUR PATIENTS ALIVE.”

On research

What is the focus of your research? What was the most challenging study you did?

The trials I’m overseeing right now are on hypertension, lipidology, heart failure, and things that can impact reduction in CV events. They all connect to preventive cardiology. For example, what I’m seeing right now is that patients who have preserved ejection fraction (EF) are already at risk. There are newer agents that can prevent progression to even mildly reduced EF. When we treat diabetes now, we are also preventing and treating heart failure and chronic kidney disease. The newer agents are not treating disease but modifying it to prevent disease progression.

The several clinical trials that we are handling now involve new molecules that were proven to reduce blood pressure, but can they reduce the risk of heart attack or stroke? We are trialing the antidyslipidemic PSK9 inhibitors to see if they can prevent the risk for the same. 

The most challenging clinical trial we are involved in right now is the one on heart failure, as it has been challenging to enroll patients with decompensated heart failure.

What overall purpose do your studies serve?

The end goal is ensuring that published results are disseminated, understood, and used by physicians in their clinics. The bottom line is patient care. Can the results spell a difference in the quality of life of a patient with heart failure? Can this new agent assure a patient that he can walk her daughter down the aisle when she gets married, without using a wheelchair? Published research hasn’t really changed anything if it hasn’t provided answers for our patients, improved clinical practice, and ultimately changed lives.

What was the most memorable research you’ve ever done?

During the recent pandemic, we were part of the global WHO-organized Solidarity clinical trials, which aimed to evaluate the possibility of repurposing old antivirals, antimalarials, and anti-inflammatory agents for COVID-19 treatment. It was the most memorable as we didn’t know much about COVID-19, and, hence, the rules of the trials changed every day. Also, we were struggling to keep our patients alive.

The trials proved that the said drugs were not effective, changing the nature of practice everywhere. It allowed me to view how research can make a difference—it showed that we could get answers if we, physicians and patients, worked together.

Closing insights

How can health institutions incentivize preventive cardiology?

Healthcare right now is oriented to treatment as the latter pays the most. It’s hard to show to people preventive cardiology’s benefit in a well person, because we are not treating anything but risks. It’s our duty to show that wellness is nuanced by stratifying a patient’s risk. Patients may feel well but they have underlying risks.

We incentivize preventive cardiology by raising awareness among doctors through the implementation of guidelines. There are efforts right now to come up with guidelines on primary prevention. In addition, we can also make use of electronic medical records by modifying them to issue alert prompts to doctors whenever their patients’ lab tests and other metrics are not at goal.

How do you balance your life among different roles? Do you have a favorite?

Yes, balancing it while being a mother to two sons. Since we can only fit so many things in a day, it’s prioritizing what you value the most, and knowing what you need to accomplish for the day, which is to improve patients’ lives and make patient care better. I move through the day—do the rounds, see the clinical trial patients, hold clinics, then head back home to check with my boys—knowing I’m doing God’s work, and I’m making a difference in someone’s life. I believe being true to this mission in life has given me all these opportunities—the clinical trials and the leadership roles.

Among the different roles that I play in my life, it’s being a mother to my children, being a sister, and being a daughter to my mom and in-laws that I cherish the most. Having close bonds with my family provides me with moral support, solid grounding, and guidance. 

Do you have non-medical interests? What are your hobbies?

My dad, whose work required him to be in different parts of the world and who passed away while I was still a cardiology fellow, instilled in me a love for travel. I also developed a passion for speaking, as my mom, being a professor of literature, was a stickler for language. I do lectures at UPCM and CSMC. Being frequently invited to speak abroad gives me an opportunity to both travel and do speaking engagements at the same time.

What advice do you have for doctors who want to build a career balancing clinical practice and research?

When we practice medicine, we have to wear different hats—we can be a clinician, a researcher, a teacher, and an advocate. All of these should complement one another. The best research questions come from the patients you see in the clinics. We do research, asking how we can make my patients’ lives better, knowing that the patients we see in the clinic will benefit from the research that we do. So, being in the clinics makes the research better, and researching makes the clinician better. Teaching also complements these by allowing me to continue to learn, as information-savvy students nowadays are always keeping me on my toes.

In addition, you need to seek mentorship. No one will succeed if they do it on their own. You have to know when to ask for help. I’m lucky enough to be guided by Dr Rody Sy, letting me make an impact in a small field, and by Dr Carlos Lu, who has generously invited me to practice in his clinic.

Choosing a field requires being focused on a passion. Carve out your niche. Be amazing and spectacular in it. Create waves. Be true to what centers you and to what your goal in life is.

^{*Selected appointments: President, Asian Pacific Society of Atherosclerosis and Vascular Diseases (Sept. 2025 ) ● Director I, Board of Directors, PHA (May 2025) ● Research Head, Internal Medicine Residency Training Program, Cardinal Santos Medical Center (Jan. 2023) ● President, Philippine Lipid and Atherosclerosis Society (Feb. 20222) ● Member, Technical Research Committee, Clinical Practice Guidelines for the Management of Hypertension in the Philippines 2020 (Feb. 2020) ● Chair, Scientific Committee, 25th Joint Philippine Lipid and Atherosclerosis Society and Philippine Society of Hypertension Annual Convention (Nov. 2019) ● Head, Technical Research Committee, Clinical Practice Guidelines for the Management of Dyslipidemia in the Philippines 2020 (Mar. 2019) ● Chair, Scientific Committee, 11th APSAVD Congress “Addressing Regional Diversity in Atherosclerosis and Vascular Disease In the Asia-Pacific Region” (Feb. 2018)}