Chief’s message: Happy Fathers Day and Events of the Past week
Hope you all are enjoying this weekend with thoughts and celebrations of the fathers in your life. Many in our community support and recognize the impact of families and fathers — so hopefully for the kids, dads, and granddads – there is time to spend with family.
You will find this week again some updates around our graduating fellows and the amazing work that our faculty continue to do with patient care, education, and research with some key publications and findings highlighted.
Highlights of the week:
CD Fellows Celebrated at Annual Dinner
Our annual dinner to celebrate our graduating Cardiovascular Disease Fellows, Cardiovascular Disease Research Pathway fellows, and Adult Congenital Heart Disease Fellows was held at Parizade on Saturday, June 13, 2026.
Congratulations to the following:
- Michael Cosiano, MD, will join the Duke Critical Care Medicine Fellowship.
- David Elliott, MD, PhD, will join the Duke cardiology faculty later this summer.
- Jonathan Hanna, MD, will join the Duke Interventional Cardiology Fellowship.
- Seamus Hughes, MD, will join the Duke Advanced Heart Failure and Transplant Cardiology Fellowship.
- DaMarcus Ingram, MD, will join the Duke Clinical Cardiac Electrophysiology Fellowship.
- Ivan Nenadic Wood, MD, PhD, will join the Northwestern University Clinical Cardiac Electrophysiology Fellowship.
- Joshua Rushakoff, MD, MPP, will join the Duke Advanced Heart Failure and Transplant Cardiology Fellowship.
- Husam Salah, MD, will join the Duke Interventional Cardiology Fellowship.
- Aarti Thakkar, MD, will join the Duke cardiology faculty later this summer.
- Eric Xie, MD, will join the Duke Clinical Cardiac Electrophysiology Fellowship.
- Anthony Lin, MD, will enter the Duke Clinical Cardiac Electrophysiology Fellowship to finish his 2nd Year.
- Belal Suleiman, MD, will enter the Duke Clinical Cardiac Electrophysiology Fellowship to finish his 2nd Year.
- Paula Rambarat, MD, will join the Duke Advanced Heart Failure and Transplant Cardiology Fellowship.
- Allison Levin, MD, MSc, will join the Columbia University Advanced Heart Failure and Transplant Cardiology Fellowship.
- Nina Morgan, MD, our finishing ACHD fellow, will enter private practice with Advent Health Pediatrics and Adult Congenital Cardiology.
Each year, we recognize outstanding team members during this annual celebration. This year, those award recipients are:
- Michael Cosiano, MD, was presented with the Walter L. Floyd, MD Excellence in Clinical Cardiovascular Medicine
- Bharathi Upadhya, MD, received the Thomas Bashore Teaching Award.
- Willard Applefeld, MD, received the award for Outstanding Mentorship.
- Emily Towery and Clarence Cumming were each presented with a staff award for Outstanding Service.
- Husam Salah, MD, was presented with the Joseph Greenfield Award.
- Joshua Rushakoff, MD, MPP, was presented with the Brandt and Belinda Louie Award.
- DaMarcus Ingram, MD, was presented with the Cassell-Saperstein Award.
Congratulations to all our fellows and award winners!
Closing the Cholesterol Gap
One in four Americans has elevated cholesterol — but with better treatment and system-wide action, millions of heart attacks, strokes, and even dementia could be avoided
What keeps Nishant Shah, MD, up at night? Thinking about all the missed opportunities to prevent heart attacks. “Heart disease remains the number one killer across the globe and many of the risk factors, like high cholesterol, are preventable,” said the Duke Health cardiologist.
Cholesterol-lowering drugs can reduce a person’s chances of developing heart attacks and strokes, and vascular dementia, by preventing plaque from building up on the walls of blood vessels.
But too many patients who could benefit aren’t being treated. Shah, an associate professor of medicine at Duke University School of Medicine, recently led a study following almost 2 million patients at 16 academic health centers and found that less than half of patients with known heart disease and high cholesterol were taking medications to lower their cholesterol.
“The study shows a problem across multiple health systems,” he said. “We aren’t controlling cholesterol the way we need to.”
Shah hopes to develop interventions that will help health systems be more effective at controlling cholesterol levels among patients, with the goal of reducing heart attacks across the country.
New Cholesterol Guidelines
The topic is especially timely because new cholesterol guidelines have just been released by the American College of Cardiology and the American Heart Association. The new guidelines recommend aiming for lower levels of LDL, commonly known as “bad” cholesterol. “There is more and more evidence that the lower your cholesterol is, the better it is for you,” Shah said.
Under the new guidelines, patients at very high risk for heart disease — those with a history of cardiac events and multiple risk factors — should aim for an LDL cholesterol level below 55 mg/dL. High risk patients, including those who’ve had a previous cardiac event, should target less than 70 mg/dL. For everyone else, the goal is below 100 mg/dL.
To determine risk, the guidelines recommend using PREVENT-ASCVD, a calculator that considers factors such as age, blood pressure, blood sugar and body mass index. When a patient’s risk remains unclear, a coronary artery calcium scan can help guide treatment decisions.
The guidelines also recommend screening and treating earlier, because the negative effects of high LDL cholesterol accumulate over time — the more plaque builds up, the narrower arteries become.
Identifying System Level Barriers
Shah is working with Duke Health preventative cardiologist Neha Pagidipati, MD, MPH, to try to understand why so few people with heart disease are taking cholesterol-lowering drugs that could help them.
The investigators are working with six different health systems to identify barriers that prevent more patients with heart disease from having their LDL tested, receiving a prescription, filling the prescription, or taking the medicine. The researchers are also developing strategies to overcome those barriers.
To generate the maximum benefit, the strategies have to be system-wide, scalable, and financially feasible, Shah said. “We’re trying to figure out how to make a health system-wide impact to really move the needle at a population level,” he said.
At Duke, Shah and Pagidipati, an associate professor of medicine, are leading a clinical trial to evaluate the strategy of using a “care champion” to meet with patients while they are hospitalized and stay in touch after discharge. The care champion is responsible for nudging the patient or providers or both in the service of meeting the LDL goal.
To help educate patients and providers at Duke, Shah said, cholesterol reporting has changed in patients’ electronic health records. In the past, LDL was flagged as abnormal only above 190. That’s been changed to 100. There is also guidance at the bottom of the test result about desirable LDL levels, which will be updated according to the new guidelines.
“We’re trying to find ways to maximize awareness at the provider side and the patient side so we get to the common goal of improving everyone’s cardiovascular risk,” he said.
If so few patients with known heart disease are taking cholesterol-lowering drugs, one can imagine uptake is even lower among those who have high cholesterol but haven’t had a heart attack or stroke — yet.
“The problem with high cholesterol is that you don’t feel it,” Shah said. “It’s just circulating in your body until something happens. You want to prevent that something from happening.”
This article, published June 10, 2026, appears in Magnify magazine.
New study reveals ‘droplet’ mechanism behind key drug targets
A new study in Nature reveals that one of the body’s most important receptor families signals through liquid-like protein clusters — an unexpected mechanism that could open new avenues for drug development.
Researchers at Duke University School of Medicine found that G protein-coupled receptors (GPCRs) — targets of roughly one-third of FDA-approved drugs — signal through dew-like droplets called biomolecular condensates, formed by β‑arrestin proteins.
“Our work shows that these receptors that essentially regulate every aspect of physiology signal using a way that we didn’t appreciate before,” said Sudarshan Rajagopal, MD, PhD, associate professor of medicine and senior author of the study. “That’s important because it’s potentially druggable; it suggests that there might be different ways to target GPCR signaling that take advantage of their use of these condensates.”
β‑arrestins have long been known to regulate GPCR activity and are best known for their role in stopping their signaling. But a longstanding puzzle in the field has been how just two β‑arrestin proteins regulate nearly 700 GPCRs in the human body.
For decades, GPCR signaling has largely been understood as a one-to-one interaction: a receptor activates a single β‑arrestin, which then passes the signal along to the next molecule in a linear chain.
But that tidy model didn’t match what MD‑PhD student Preston Anderson had been seeing under the microscope. At levels normally found inside cells, β‑arrestins are known to form clusters inside cells. During a beach vacation to Kure Beach, as he watched clouds drift and merge across the sky, he began to wonder if β‑arrestins might do the same. What if they weren’t just clustering, but assembling in a way that allowed them to communicate?
That night, he drew a sketch proposing an experiment to test his idea. “When I sent it to Sudar, he basically said it wasn’t going to work. But Sudar is such a great mentor; he never says no. He’ll always let you do the experiment,” Anderson said.
Back in the lab, Anderson attached two halves of a glowing protein to the tail ends of β‑arrestins to see whether they would light up when the proteins come together. When he ran the experiment, they did.
“When I saw it glowing, I thought, ‘We’re onto something,’” he said.
The work began to shift the view of β‑arrestins from individual actors to components of a larger, coordinated system.
“One part of our study shows that the way β-arrestins align and orient with one another influences how effectively they regulate receptor signaling,” Anderson said.
In addition to the split-protein test, over three years of work the team tested the idea with multiple approaches, including:
- Imaging to visualize β‑arrestin droplets both at baseline and near receptors in cells
- Using chemical and genetic tools to promote and disrupt clustering
- Functional assays which showed how those changes affect receptor signaling and internalization.
Together, these experiments showed that β‑arrestin clustering is not incidental — it directly influences how GPCRs function. When the scientists disrupted the condensates, GPCR signaling was disrupted.
Because condensates organize signaling in specific locations, they may offer new ways to more precisely control GPCR activity. That could ultimately allow drugs to target certain signaling pathways while avoiding others.
“It’s a new model for understanding how this system works,” Rajagopal said. “It suggests we should start thinking about how to selectively target these condensates in the context of specific receptors.”
GPCRs are found throughout the body, and drugs that act on them are used to treat conditions ranging from shock to heart disease and asthma. Anderson said his interest in GPCR biology was shaped by his clinical training during the COVID‑19 pandemic, when he saw patients in shock treated with the same set of GPCR-targeting drugs — such as norepinephrine and vasopressin — that have changed little in decades.
The work builds on Duke’s long legacy in GPCR research, including the discoveries of Robert Lefkowitz, MD, which helped define how these receptors function and earned the 2012 Nobel Prize in Chemistry. The new findings point to a next chapter — one in which the spatial organization of signaling, becomes central to how scientists understand and target these critical systems.
Funding: The American Heart Association, the Mandel Foundation, and the National Institutes of Health.
Other Duke Authors: Adam Kaakati, Juliana Alfonso-DeSouza, Alejandra Patino, Andrew Ahn, Chanpreet Jassal, Samuel Liu, Biswaranjan Pani, Athmika Krishnan, Oscar Chen, Joseph Strawn, and Joshua C. Snyder.
Drs. Rajagopal and Lefkowitz are both principal investigators with the Duke Cardiovascular Research Center.
This article, published online June 1, 2026, was written for Duke University School of Medicine.
Shout-out to DeVore
We received a note of praise for Adam DeVore, MD, this week from neurosurgeon Jordan Komisarow. The note reads:
“I am writing to highlight the fantastic care Adam provided on one of my patients. He is a wonderful partner and am grateful to get to work with him.” — Jordan M. Komisarow, MD, vice chair of clinical operations, Department of Neurosurgery.
Way to go, Adam!
Upcoming CME Events & Opportunities
June is Pride Month. At Duke Health, we believe everyone deserves to feel safe, seen, and supported, especially when it comes to their health.
Cardiology Grand Rounds
June 23: Advancing Contemporary Cardiac Electrophysiology: Innovations in Ablation, Rhythm Control, and Anticoagulation with Belal Suleiman, MD. 5 p.m. DN 2002 and via Zoom.
All Duke CGR Recordings (except for those containing PHI) can be found on Duke Warpwire by year: 2026, 2025, 2024. Questions about recordings? Contact Tracey Koepke.
Cardiology Grand Rounds: June 29
2026 Dyslipidemia Guidelines: Practical Implementation with Nishant Shah, MD, and Manesh Patel, MD as moderator
JB Duke Hotel, 230 Science Drive, Durham, NC 27708
6-7 p.m.
The in-person event at JB Duke is free (as is parking) but limited to 60 people. Live streaming will be available on the NACE virtual online platform. Creating a NACE account is quick and easy.
Registration is required for both the in-person and the live-stream. NACE will offer CME credit. In-person registration link.
Virtual event registration link.
CD Fellows Core Curriculum Conference
June 24: HF/Tx Case Conference with Jonathan Kusner. Noon, DMP 7E39 and via Zoom.
June 26: HF/Tx Case Conference with Harriet Akunor. Noon, Zoom only.
MMCVI Grand Rounds
Multi-Modality Cardiovascular Imaging Grand Rounds: A multi-imaging approach to cardiovascular disease cases. Thursdays, Noon to 1 p.m., via Zoom.
June 25: Systemic and Pulmonary Hypertensive Heart Disease with Fawaz Alenezi
2026 Symposia
The dates for the following 2026 Duke Heart symposia have been set. We will announce others as they are added.
- September 26: Duke Case-Based Multimodality Imaging Symposium – Course directors are Sreekanth Vemulapalli and Anita Kelsey. Location: Trent Semans Center, Great Hall.
- October 30: 18th Annual NC Research Triangle Pulmonary Vascular Symposium – Course directors are Terry Fortin, Sudar Rajagopal, and Jimmy Ford. Location: Durham Convention Center, Durham, NC.
Please save the dates!
Hitting with Heart Softball Tournament
The 10th Annual Hitting with Heart Softball tournament will be held on Saturday, August 22 at Valley Springs Park, 3805 Valley Springs Road, in Durham. The tournament raises funds that will, in part, support the American Heart Association’s 2026 Triangle Heart Walk.
Have news to share?
If you have news to share with the Pulse readership, please contact Tracey Koepke, director of communications for Duke Heart & Vascular at tracey.koepke@duke.edu. We would love to hear about your latest accomplishments, professional news, cool happenings, and any events or opportunities that may be of interest to our team. Please call me with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged. Submissions by Noon on Wednesdays will be considered for weekend inclusion.
