Saving Hearts
From launching Singapore’s first women’s heart health clinic to co‑founding a medtech start‑ up that harnesses artificial intelligence to automate the fight against heart disease, cardiologist Carolyn Lam’s passion for heart health has led her to trailblaze a path in her profession
Fresh from an invigorating 12 km run in sunny Hawaii, where she is enjoying a long-awaited family vacation, Dr Carolyn Lam is glowing with vitality. The acclaimed Singaporean cardiologist, who is world-renowned for her expertise in heart failure, in particular a type that affects mostly elderly women, knows better than most why it is essential to care for the state of her heart. After all, she has spent her career investigating sex differences in cardiovascular disease and advocating for greater awareness about heart disease among women.
“This is an area that women don’t pay enough attention to. Women need to know that we are just as at risk of heart disease as men,” says Dr Lam, a senior consultant cardiologist at the National Heart Centre Singapore, over Zoom.
“Yes, you heard that right,” she tells me as I gasp in surprise. Despite a common misconception that men are more susceptible to heart disease, it is in fact the leading cause of death for both men and women and represents about one in three deaths globally, including in Singapore. This is why it is essential to get women to focus on more than “bikini medicine” for their breasts and reproductive organs, she emphasises.
“A lot of heart disease is actually lifestyle disease and could actually be prevented if we had just taken better care of ourselves,” says Dr Lam. She established the first Women’s Heart Health Clinic at the National University Heart Centre Singapore in 2011—the first of its kind in Singapore and Asia—and now serves as director of the Women’s Heart Clinic at National Heart Centre Singapore. Additionally, she is the only
commissioner from Asia appointed in an international team for The Lancet’s Commission for Women and Cardiovascular Disease.
Articulate and friendly in demeanour, she has a knack for sharing vivid anecdotes that are easily understood by laymen. “We chase our husbands, boyfriends and brothers to check their cholesterol, but we don’t. Even in my own home, it used to be that my dad can’t eat the egg yolk, but my mum can eat it for him. That’s not true,” says Dr Lam, who is also a tenured full professor of the DUKE-NUS Cardiovascular Academic Clinical Program.
To get the ball rolling on changing these misconceptions and to encourage more women to lead heart-healthy lifestyles, she walks the talk herself. For example, at the hospital, she takes the stairs to fit in some movement between clinic sessions. “Don’t think of exercise as something very prescriptive that you have to buy a gym membership for,” she says. “Instead, think of it as simply being active.”
Trim and fit, she stays motivated to exercise by regarding it as a holistic respite that impacts her mental health too. “Frankly, I do it more for my mind and emotions than just physical health,” she shares. “I treat it as moving meditation. I find that when I go for a run, it clears my mind.”
And on occasion, when she is bored, she and her husband, James Hare, will follow an app-based high-intensity interval training (HIIT) workout together. HIIT, by the way, has been shown to positively impact heart health.
The dynamic duo are not just keeping their own hearts in tip-top condition, but have also teamed up to enhance the fight against heart disease. In 2017, they co-founded medtech company, Us2.ai, which uses artificial intelligence (AI) to analyse echocardiograms, ultrasound images of the heart.
Calling herself an “accidental entrepreneur”, Dr Lam shares that the idea for this was sparked when Hare’s own echocardiogram resulted in two readings—one stated that it was normal and the other, that it wasn’t—from two different doctors. A “retired” entrepreneur who had grown his last founded company, edreams, to the IPO stage, Hare realised that it would be possible to harness machine learning to speed up the analysis of echocardiograms, which typically requires doctors to manually measure every image they receive to detect heart disease.
“Ultrasound screening of the hebaurlgta(roi echocardiography) is the safest anddimamonsdtscaonmdemeoranldlsy, used tool to image the heart. And using AI to automate the reading of the echocanrddsiaopgprhairme enables
“We chase our husbands to check their cholesterol, but we don’t. It used to be that my dad can’t eat the egg yolk, but my mum can eat it for him. That’s not true”
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doctors to generate reports faster, with precision and with full control—so patients can get an immediate answer instead of waiting,” says Dr Lam. “How the AI algorithms work to read the ultrasound is analogous to the way other AI software reads an ECG (electrocardiogram), say, on the Apple watch. This is the step needed to democratise this very safe tool in the fight against heart disease.”
She admits that as a practising doctor, she initially had misgivings about the technology too. “I understand how doctors feel when I show them the software because they feel exactly how I felt—which is that there is no way to automate what I do. But when you break it down, you actually realise that it can be done,” she says with a laugh. “And instead of spending so much time doing manual measurements for a job that can be automated, I could have more time to spend with patients or do more complex tasks that cannot be automated.”
Last September, following multiple trials with global pharmaceutical partners and a validation study at the Brigham & Women’s Hospital of Harvard Medical School, the software received US Food and Drug Administration approval for clinical use in the US. She attributes this success to the “powerful combination” of herself, an academic and a doctor, and her husband, an entrepreneur.
“I’m strongly defensive of the hospital system and I understand what doctors need, but I’m not necessarily a good business person. As an innovator, James opened my eyes to the inefficiencies in the way we doctors were doing things, which led to the development of a product that would enhance the work that doctors do—by cutting down the manual, error-prone, repetitive work and leaving us with more time to spend with patients,” she says.
And while the couple are excited about the potential of their medtech innovation, they are also careful to set boundaries so that they keep work and family life separate. “Very early on, we agreed that the business is only here because we’re in a marriage, so we have to set priorities,” she says. “We wrote a manifesto and locked it in that it is us first, then family, then company. That’s how we make it work.”
“How the AI algorithms work to read the ultrasound is analogous to the way other AI software reads an ECG, say, on the Apple watch. This is the step needed to democratise this very safe tool in the fight against heart disease”