Clin-STAR Journey Story

A Whole Body Approach to the Care of Older Adults: The Marriage of Cardiovascular Disease and Frailty

Ariela Orkaby, MD, MPH, is an Assistant Professor of Medicine at Harvard Medical School and a geriatrician at the New England GRECC at VA Boston and in the Division on Aging at Brigham & Women’s Hospital in Boston. She began her career thinking that she would become a neurologist. But it didn’t take her long to discover that she preferred taking care of the whole person rather than just a part. “I was drawn more and more to Geriatrics through the influence of incredible teachers during medical school and my residency. They sparked a deeper reflection on the future of my career trajectory.”

During Dr. Orkaby’s additional training in Preventive Cardiology, a number of trials on atrial fibrillation and other common cardiovascular conditions all had upper limits for age. As a clinician, she recognized that these studies didn’t apply to her patients. Likewise, during her Geriatrics fellowship, she noted that cholesterol guidelines did not include patients older than 75. Dr. Orkaby stated, “Not knowing what to do for patients in the aging population was a tremendous blind spot. Cardiovascular disease is the leading cause of morbidity and mortality in older adults, as well as functional impairment—and it’s a treatable condition with modifiable risk factors. We can do better. We need to do better for our patients.”

These experiences were the impetus for Dr. Orkaby to move from being solely a practicing clinician to becoming a clinician-scientist. She recognized she needed to gain skills in epidemiology and statistics to move her career into a research direction. And that’s exactly what she did, along the way receiving both a Pepper Pilot Award and a GEMSSTAR award.

Dr. Orkaby first heard about Clin-STAR at a GEMSSTAR meeting before the pandemic. Clin-STAR started special interest groups (SIGs), and she is currently Co-Chair of the Clin-STAR Frailty Research SIG, which includes members from many disciplines and specialty areas. She comments, “It is encouraging to see how many nongeriatricians are getting involved in frailty. Regardless of our specialty area, we all see older patients, and we can all rally around this. Frailty is the lens through which we can measure vulnerability.” Several members of the group are collaborating on a paper about the state of frailty, including our current understanding and knowledge gaps, across medical subspecialties.

Dr. Orkaby’s research interests focus on identifying pharmacologic preventive strategies for cardiovascular disease and frailty in older adults, specifically looking into the role of commonly used drugs, particularly statins. The PREVENTABLE trial, one of the largest research studies ever conducted in older adults, has the objective of determining if taking a statin can help older adults live well for a longer time by preventing heart disease, disability, and dementia. Dr. Orkaby is excited to be involved in a leadership role as a principal investigator for one of the PREVENTABLE sites. This has also afforded her the opportunity to collaborate, including on publications, with those from other disciplines.

Dr. Orkaby is also funded by a VA Career Development Award and has also led work on the Veterans Affairs Frailty Index and studies evaluating the relationship between frailty and cardiovascular disease. She stresses the need to disseminate what geriatricians do so that all health care professionals can incorporate these assessments into their patient care. For example, anyone can take a few minutes to observe the patient walking. She adds, “Much work has been done on defining frailty. We now need to move on to the implementation and treatment phase for the benefit of our patients. Cardiovascular disease and frailty are so closely interrelated, they need to be considered together. Treatments that are good for the heart, are likely to be good for the body, and may help to mitigate or prevent frailty!”