The concept of prevention enticed David Goff, M.D., Ph.D., early in his medical career.
“When I was in my first couple years of medical school, I learned a lot about the causes of heart disease,” said Goff, director of the Division of Cardiovascular Sciences at the National Heart, Lung, and Blood Institute. “Then in the hospital, seeing patients face to face made me realize we should be doing more to prevent it.”
Goff, a longtime volunteer who’s known as the American Heart Association’s “cholesterol go-to guy,” received the organization’s Meritorious Achievement award last month in Dallas. He has made major contributions to understanding the epidemiology of cardiovascular disease, and to developing and implementing AHA guidelines for managing patients at risk for heart disease.
Goff grew up in the small, one-high-school town of Rocky Mount, North Carolina. His family ran a mom-and-pop restaurant where he worked as a teenager. He got his first taste for medicine through a high school club that met at a county hospital to hear presentations from medical professionals. A book about early drug development further intrigued him.
At the University of North Carolina School of Medicine in Chapel Hill, where Goff received his M.D., his interests eventually turned to interventional medicine and cardiology. He went on to earn his Ph.D. in epidemiology from the University of Texas Health Science Center at Houston and completed his clinical training in internal medicine at Baylor College of Medicine-affiliated hospitals.
“Seeing patients with severe, advanced heart failure — the number of people and the extent of the disease — made me realize we weren’t doing a good job with prevention,” Goff said. It also sealed his professional fate: preventive cardiology.
The mid- to late 1980s was a time when ideas about prevention were limited, and game-changing drugs were still in development.
“The thoughts about prevention were that we needed to help people quit smoking, achieve a healthier diet and be more active, and we needed to control blood pressure better,” he said. “That’s about as far it went because we didn’t have good cholesterol-lowering drugs yet.”
The tides started to change when lovastatin, the first cholesterol-lowering statin, came on the market in 1987 , and a new class of high blood pressure and heart failure drugs called ACE inhibitors was giving hope on the prevention front.
“It was an exciting time to think about prevention,” Goff said.
In the late ’80s and early ’90s, Goff worked on the Corpus Christi Heart Project, which helped shed light on disparities in health outcomes by race. About the same time, he began volunteering for the AHA. He has gone on to direct more than 50 research projects for the nonprofit. As director of the AHA’s 10-day seminar on the epidemiology and prevention of cardiovascular disease, he trained hundreds of early career cardiovascular scientists.
He also led the development of an AHA guideline that spurred big changes in how many doctors help patients lower their risk for heart disease. Then he steered efforts to have the guideline incorporated into the U.S. Department of Health and Human Services Million Hearts program.
Over time, Goff said he’s developed a greater appreciation for social determinants of health such as such as poverty, lack of affordable housing and education, and inadequate access to health care and healthy food.
“I’ve come to appreciate that it’s really hard to talk to someone about changing their diet if the reality of the world is that cheap food is crap, and healthy food is expensive and you don’t have access to it,” he said.
Goff is interested in learning people’s motivations for making health changes. He wants to help them understand how, for example, smoking is stopping them from going on a hike or attending a wedding.
“We still need to learn more about behavioral science,” he said. “We lag behind Madison Avenue and marketers in understanding choices and how to change behavior.”