photograph by trey clark / stern cardiovascular center
Dr. Steven Gubin monitors a patient at Stern Cardiovascular Center, where high-tech diagnostics are a time-honored tradition.
Being a cardiologist is serious work anywhere, but in the Mid-South, given the particularly high rates of heart conditions here, mending hearts can be especially daunting. That challenge only fuels Dr. Steven Gubin’s commitment to his work as president of the Stern Cardiovascular Center in Germantown.
“Heart disease is the number-one cause of death, in both men and women,” he says, “and it’s a lot more prevalent here. Mississippi, Tennessee, and Arkansas are hotbeds for heart disease, probably because of people in this area being more overweight, more sedentary, and more inclined to smoke.” (These tendencies are often rooted in socioeconomic challenges, but Gubin’s task is addressing the physical manifestations, and that is our subject here.)
Gubin says, “We do a pretty good job of taking care of patients once they have a problem,” but his real passion is taking a more proactive approach. The problem with that, however, is knowing who might need preventative care before any symptoms become apparent. Assessing a patient’s risk factors is key, to ensure doctors and patients understand who might need preventative care in the first place — before any symptoms arise.
photograph by trey clark / stern cardiovascular center
Dr. Steven Gubin
Some of those risk factors are simply things you’re stuck with. “There are what we call non-modifiable risk factors,” he says. “That’s like your age and your family history. If you’re a man, your risk of heart disease is a little higher than women, at least until women go into menopause. So it’s really important to know your family history, because that’s one of the biggest risk factors.”
Then there are the risk factors based on how people live. “It’s the modifiable risk factors that we really try to emphasize — things like high blood pressure, diabetes, smoking, high cholesterol, sedentary lifestyle, obesity, stress, or lack of sleep. Those are factors that you can do something about.”
Those with lifestyle choices that can lead to heart disease can, of course, be exhorted to change their behavior, but as Gubin points out, true change must come from within. “We really try to educate our patients about these modifiable risk factors, and we have a great person that runs our weight-loss program. She really helps motivate patients, and she’s always available, even if they’re in a restaurant and they just can’t figure out what to order.”
He believes that’s one reason that Stern’s weight-loss program has been successful. “We really try to work with them and motivate them. It’s important to emphasize that you have to be an advocate for yourself. You have to be proactive. People need to know their numbers and understand what those numbers mean, like their ideal weight, their ideal blood pressure, and what their cholesterol numbers mean. And if they have any issues, they need to go to their doctor and not ignore it.”
Even then, some patients may have no clue that they are at risk. Indeed, as Stern website notes, about a third of all heart attacks — approximately 300,000 a year — occur with sudden death and no previous symptoms. One may be oblivious to one’s risk factors until it’s too late. That’s why, as Gubin puts it, “I started this thing called vascular screening.”
Gubin recommends such screening for anyone older than 21 years of age who smokes, has a family history of heart attack, stroke, or coronary artery disease, or currently has diabetes mellitus, high blood pressure, abnormal cholesterol panels, or atherosclerosis. He also says, “I recommend it for anybody over 50 for sure.”
photograph by trey clark / stern cardiovascular center
Stern Cardiovascular Center’s main offices in Germantown. Other facilities are located in Memphis, Southaven, and Oxford, Mississippi.
Once a month, for $250, anyone can be tested. “We make sure there’s no plaque in your carotid arteries,” Gubin explains. “We check for an aneurysm. We check circulation in your legs, and we do a calcium score, which is a test to see if you have any calcified plaque in your coronary arteries.” The screening includes an electrocardiogram, an abdominal ultrasound, blood pressure, blood tests, and an ankle brachial index, which “compares ankle and arm blood pressure to find blocked arteries due to peripheral artery disease.”
It’s incredibly comprehensive, and the thoroughness of such screenings has paid off many times over. “That’s been such a rewarding test for us,” says Gubin, “because we’ve had people come in who are usually trying to be proactive. Just through that screening, we picked up a number of patients who had lung cancer but didn’t have a clue, and I think we saved their lives. And we’ve had a lot of patients come in and to get their calcium score, which turned out to have been significantly elevated, and by doing that screening, we’ve been able to prevent them from having a cardiac event.”
“What I like about our group is, if I have a patient that comes in with something that I don’t specialize in, I have partners that do, So we help each other.” — Dr. Steven Gubin
The value of the vascular screening is that it can reveal things even a checkup at the doctor’s office can miss. “Usually you don’t have symptoms until you have a 70 percent blockage or greater,” says Gubin. “So if you do a stress test and you have a 50 percent blockage, the doctors say, ‘Mr. Smith, you did great on your stress test!’ The patient walks away and thinks it’s okay, right? But if you do the vascular screening, we check and we say, ‘I know you’re not having symptoms, but you do have plaque, so we need to be very aggressive.’”
Many patients don’t want to be on cholesterol medicine, fearing possible side effects. “But if they find out they have plaque, they say, ‘Okay, now I guess I need to be on medicine.’ If you do the screening and you see they do have plaque, then it makes people more willing to be proactive.”
The diagnostic power of such screening may be one reason that Gubin is especially enthusiastic about testing methods. “I do a lot of ultrasounds and nuclear studies,” he says. It turns out, such high-tech diagnostics are a time-honored tradition at Stern. “When we started in 1920,” says Gubin, “our founding member was Dr. Neuton S. Stern, who brought the first EKG machine to Memphis.” From there, Gubin traces a direct line to the present. “His son, Tom Stern, was the next president. Then there was Dr. David Holloway, who just passed away, and he was the third president. And now I’m the fourth president in 104 years.”
Gubin emphasizes that it’s the whole team at Stern that makes the center so effective. “I’m really proud that we have all these doctors that specialize in different areas,” he says. “In our group, we have 46 cardiologists, with offices in Oxford, DeSoto County, and Memphis, and we have doctors in the group that specialize in different areas. So if you have electrical problems with your pacemaker, we have six electrophysiologists that specialize in that area. If you need a coronary intervention, we have a subset of doctors that do the stents. If you have vascular disease, we have doctors that specialize in peripheral vascular disease or venous disease. And then we have doctors that specialize in heart failure. So if you have advanced heart failure, or you might need a heart transplant, we have doctors that do that.”
The way Gubin sees it, excellence in healthcare takes a village … of specialists. “What I like about the group is, if I have a patient that comes in with something that I don’t specialize in, I have partners that do,” he says. “So we help each other.”
