Jim Walker, a third-year student in Feinberg’s MD/MBA program, was the lead author of a recent study published in JAMA Cardiology, which found that using the American Heart Association’s “Life’s Essential 8” cardiovascular health paradigm to measure cumulative cardiovascular health may be an effective strategy for identifying young adults at higher risk of cardiovascular disease.
Learn more about Walker’s findings and his medical school experience below.
Why did you choose Feinberg for medical school?
Choosing Feinberg is one of the best decisions I have ever made. Before arriving, I had heard about its great people, culture and location; what I didn’t know was that Feinberg would feel like home. Within a couple of weeks of being here, I had found many lifelong friends. From the beginning, I was amazed by the warm and welcoming nature of the whole class. I never imagined that I could feel this confident that I am exactly where I am supposed to be.
What are your current research and clinical interests?
My research focuses on preventive cardiology at the population level. Cardiovascular disease has remained the leading cause of death for generations. By focusing on primary and even primordial prevention (i.e., preventing the development of risk factors for cardiovascular disease), we can improve our population’s lifespan and healthspan. I am also interested in cost-effective and efficient care. Access to healthcare in the U.S. still has a long way to go, and improving efficiency can help ensure more patients receive the care they need.
On the clinical side, my favorite third-year rotation was internal medicine. I enjoyed the complex medical management of our patients and the teamwork with residents and attendings. I have also loved all the time I have spent around the heart. Whether it was preventive cardiology clinic with my mentor, Dr. Donald Lloyd-Jones, electrophysiology clinic and lab with Dr. Rod Passman and Dr. Susan Kim, or valvular surgery with Dr. Chris Mehta, the heart and its pathologies continue to fascinate me. Although I cannot say with certainty what I will be doing in 10 years, I imagine it will involve the heart.
Tell me about your recent JAMA Cardiology paper. What was the motivation for this work and how can your findings help improve patient care and cardiovascular outcomes?
Cumulative health measurements (e.g., cigarette pack years, accumulated radiation exposure from CT scans, etc.) are valuable for gauging disease risk. However, most cardiovascular health research has relied on point-in-time measurements rather than cumulative measurements. Created in 2022, the American Heart Association’s “Life’s Essential 8” (LE8) allowed us to quantify participants’ cumulative cardiovascular health. LE8 is an eight‑metric index of diet, physical activity, sleep, nicotine exposure, BMI, blood pressure, lipids and glucose.
In our paper, we created the LE8 “point years” construct — effectively the area under the curve of cardiovascular health over time. Among 4,832 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort study, those in the top cumulative LE8 score quartile experienced an 88 percent lower cardiovascular health risk and 71 percent lower all‑cause mortality compared to the bottom quartile. These findings held even after adjusting for LE8 score at age 45. Additionally, a positive LE8 score slope (termed “points up”) — reflecting improvement in CVH over time — was associated with decreased cardiovascular health risk, independent of cumulative LE8 score.
These “point years” and “points up” metrics provide a concrete tool for clinicians and public health practitioners to monitor and promote lifelong cardiovascular health. Most 18- to 45-year-olds I know rarely think about their cardiovascular health. I hope this study helps show young adults the power they have to prevent cardiovascular disease before it ever starts.
What advice would you give to prospective medical students?
Reach out to current medical students at the schools you are interested in attending. Ask how they got there and what helped them stand out in the admissions process. There is no one path into medical school, but hearing many stories from many different applicants will help identify themes and show that there is no such thing as a perfect application.
Second, figure out what helps you handle stress. Everyone handles stress differently, and throughout the process of becoming a physician, life provides plenty of stress. The people who do the best are the ones who know themselves well and can find peace no matter the turmoil around them. Personally, I have found that being purposeful with my downtime allows me to decompress and perform my best in the hospital. Find what works best for you.
