Abstract
Dr William R Hiatt, a past president of the Society for Vascular Medicine (SVM), died on December 8, 2020 at the age of 70 (Figure 1). He was a Professor of Medicine at the University of Colorado School of Medicine, Division of Cardiology, and the past president of CPC Clinical Research (CPC). Dr Hiatt (or Will to his friends) was a pillar in the vascular medicine community, a compassionate and valued physician, a pioneer in vascular clinical research, and an internationally renowned clinical trialist. He served as a teacher and mentor for numerous physicians and PhD scientists and cared for many patients with complex cardiovascular disease. Beyond this, he was a beloved colleague and friend to many members of the SVM.
William R Hiatt, MD, MSVM (1950–2020).
He entered the field of medicine at the University of Colorado School of Medicine, where he received his medical degree in 1976. His internship and junior year of medical residency took place at University Hospital in Boston, where he was inspired by Dr Jay Coffman (1928–2006), a pioneer in vascular medicine, and trained alongside lifelong colleagues Drs Mark Creager and Jonathan Halperin. He returned to the University of Colorado, Denver, for his senior residency, and there he completed his fellowship in general internal medicine and vascular medicine. He then joined the faculty of the University of Colorado and rose quickly through its academic ranks to become Chief of the Section of Vascular Medicine and Professor of Medicine with tenure and was bestowed the Novartis Foundation Endowed Chair in Cardiovascular Research. In 1996, he was appointed President of the Colorado Prevention Center (CPC Clinical Research), a non-profit academic research organization affiliated with the University of Colorado, through which he led groundbreaking research in peripheral artery disease (PAD) and impactful community health programs focused on populations with disparities. He also served as the Chairman of the Scientific Advisory Committee of the General Clinical Research Center and the Chair of the Clinical and Translational Research Advisory Committee at the University of Colorado School of Medicine. During his career he received numerous awards and recognitions for his work, including designation as a Master of the Society of Vascular Medicine (MSVM), a Distinguished Scientist by the American Heart Association (AHA), and the Clinical Research Prize from the AHA. He served as Chair of the AHA’s Council on Peripheral Vascular Disease and was chair of the US Food and Drug Administration Cardiovascular and Renal Division. He also led the international Trans-Atlantic Inter-Society Consensus (TASC) on the Management of PAD. 1 This work, in particular, underscored Will’s gifts for bringing parties across disciplines together and fostering collaborative work.
A pioneering investigator
Dr Hiatt’s scientific investigation of vascular disease spanned approximately 30 years. He published over 280 manuscripts and 60 book chapters, reviews, and editorials. He established himself as a scientific leader in vascular medicine, with a special focus on PAD. In the 1990s, he conducted some of the very first randomized clinical trials (RCTs) of treadmill exercise in patients with PAD through CPC, laying the groundwork for a therapy that is now considered the most effective noninvasive intervention to improve their functional performance. 2 Will also was among the first investigators to describe skeletal muscle damage in patients with PAD and directly link this with lower extremity ischemia. He and co-investigators demonstrated that patients with PAD randomized to treadmill exercise developed histologic findings of denervation in calf skeletal muscle, while patients with PAD randomized to resistance training did not develop skeletal muscle abnormalities.3,4 Later, working with Dr Alan Hirsch (1954–2017), Will was a lead investigator in the PARTNERS program, a groundbreaking initiative that documented the high prevalence of unrecognized PAD in the United States. 5 Enrolling nearly 7000 patients from general medical practices across the United States who were age 70 years and older or between ages 50 and 69 with history of diabetes or smoking, the PARTNERS trial used ankle–brachial index testing to demonstrate a 29% prevalence of PAD. Nearly half of the patients with newly identified PAD were previously unaware of this diagnosis.
Later in his scientific career, Dr Hiatt led work demonstrating the limitations of aspirin as a secondary preventive therapy for patients with PAD in contrast to observations in patients with coronary artery disease (CAD). While clinical practice guidelines recommended aspirin as a first-line therapy to prevent cardiovascular events, Will collaborated with Dr Jeffrey Berger to lead a meta-analysis of RCTs, which demonstrated that aspirin therapy significantly reduced rates of ischemic stroke but did not significantly reduce rates of myocardial infarction, cardiovascular mortality, or all-cause mortality among patients with PAD. 6 This work was largely responsible for a subsequent change in the level of evidence used to support aspirin therapy for PAD in clinical practice guidelines. 7 He later published an algorithm to help clinicians select optimal antiplatelet therapy for patients with PAD, based on the presence or absence of CAD and ischemic leg symptoms. 8
Will led the multinational EUCLID and the VOYAGER trials, which were among the first large multicentered RCTs designed specifically to study therapies to prevent cardiovascular and limb events among patients with PAD.9,10 The EUCLID trial found comparable efficacy of ticagrelor and clopidogrel for reducing cardiovascular event rates in patients with established PAD, while the VOYAGER trial demonstrated that rivaroxaban 2.5 mg plus aspirin significantly reduced the rate of adverse limb and cardiovascular events versus aspirin alone in patients following peripheral revascularization. These landmark trials helped to characterize the risk profile of patients with PAD, including limb and cardiovascular events in patients with PAD. They also helped to further elucidate the heterogeneity of response to therapies in PAD versus CAD and the unmet need for dedicated trials with specific endpoints in this relatively understudied and high-risk population.
Realizing his vision at the Colorado Prevention Center (CPC)
The CPC was founded in 1989 by Dr Robert Schrier, Chairman of the Department of Medicine at the University of Colorado. Will joined Dr Schrier, Dr Raymond Estacio, and others at CPC in 1996. The organization was born from the Appropriate Blood Pressure Control in Diabetes (ABCD) Trial, 11 which sought to understand the role of optimal blood pressure control in improving outcomes in patients with diabetes, including those with concomitant PAD. From there, CPC continued work to better understand therapies to prevent adverse outcomes in at-risk populations, where Will brought in a particular focus on PAD and aligned it with CPC’s mission to improve outcomes for patients. Dr Hiatt served as President of CPC for over two decades. He dedicated extensive effort to physiologic studies of PAD and became a master of measuring functional outcomes in a precise and reproducible fashion. His work transformed the use of functional outcomes in studies and led to the development of CPC’s functional core lab and EQuIP® program. He drove these initiatives to address variability in outcomes, a key issue in conducting informative research using functional endpoints. During his years at CPC, his mission to improve outcomes in PAD spanned early and late phase trials, small and big studies, population studies, and registration pathway trials. He led trials with a culture of collaboration and inclusivity manifested by multi-institution, international, and multidisciplinary leadership. His legacy of dedication to the care of patients with PAD helped to transform research in this area and holds promise to improve outcomes in this high-risk patient population.
Along with excellence in research, he made a commitment to reduce cardiovascular risk in Colorado by supporting CPC’s community health programs led by Dr Estacio. He challenged the CPC Community Health team to continuously improve their service to the underserved in Colorado. These include the Community Heart Health Actions for Latinos at Risk (CHARLAR) and Colorado Heart Healthy Solutions (CHHS) programs. Both programs have been recognized by the Centers for Disease Control and Prevention (CDC) as community health models to reduce CVD risk.
Through his leadership of CPC and as a clinician, Will interacted regularly with University of Colorado leadership and worked tirelessly to further the vision of creating an outstanding academic environment. Chancellor Donald Elliman Jr, who worked closely with Will and serves on the CPC board, stated: Every institution has a few people who constitute its soul. People who embody all the highest ideals we all aspire to. Will was one of those very few. His spirit will continue to guide us in the days ahead.
Similarly, University of Colorado School of Medicine Dean, John Reilly, noted: I first met him in 2015 and, like many, was impressed by his thoughtfulness, kindness, and his ability to provide very direct advice in a respectful and disarming way. He was obviously very knowledgeable about clinical research, regulatory approval processes and coordination, and oversight of large multisite trials. He cared deeply about both the School of Medicine and CPC and was very deliberate and thoughtful in succession planning for the latter . . . Will’s approach to his illness was in line with how he approached life: clear-eyed recognition of reality, unambiguous decision-making, and a determination to make the best of his time, regardless of how long he had. I watched him deal with his disease with admiration at the courage and dignity he mustered when dealt a very bad hand.
In 2019, after recruiting Dr Marc Bonaca to be Executive Director of CPC, Will transitioned from CPC President to Chief Science Officer. Will had been a scientific mentor to Dr Bonaca for years, but with the latter’s move to the University of Colorado in 2018, their relationship became much closer. Dr Bonaca noted: Will was an incredible mentor. It was more than a job. He was supportive and generous. Most of all, he was a good person and led by example. On a hike one day, Will told me, ‘If you have integrity, nothing else matters. If you don’t have integrity, nothing else matters.’ Will had integrity . . . and it all mattered. He taught not just in the clinic or at CPC but brought me on climbs and to the rodeo, and used opportunities to teach about life, values, mission, and character. The day after he passed away, I went to his office and found a message on his white board which said: ‘Life and having a purpose is a total blessing and thank you CPC’. His grace and gratitude in the face of a terrible illness was yet another profound lesson.
A mentor and role model
Throughout his career, mentorship was a priority for Dr Hiatt. He was highly regarded by his trainees as an outstanding mentor because he had the key attributes of altruism, generosity of spirit, and patience. He taught skills requisite to studying vascular pathophysiology, met frequently with his mentees, constructively reviewed their grants and papers, provided networking opportunities in national and international arenas, and instilled leadership. He taught his trainees about the importance of scientific collaboration, that there was no such thing as a zero-sum game in research, and not to be worried about being scooped, noting that everyone can be successful within a field. His joy of teaching and sharing knowledge was clear, and he brought a spirit of collaboration and openness in his interaction with his mentees.
Dr Judith Regensteiner, Professor of Medicine and Director of the Center for Women’s Health Research at the University of Colorado School of Medicine, was one of Dr Hiatt’s first mentees. She reflected on the important contribution Will made to her professional development: I met Will in the late spring of 1986. I was just finishing my postdoc at the University of Colorado School of Medicine and he had just gotten his first big grant and was looking for someone knowledgeable about exercise research to work on it with him. His grant was focused on supervised exercise training for people with PAD. I really enjoyed and appreciated working with Will because he was a great teacher, helping me learn the skills needed to study exercise and PAD. From Will, I also learned how to work effectively with study participants. His respect, unfailing patience, and obvious care for his patients and research subjects were admirable qualities. Will also taught me about the importance of teamwork. I joined him as a junior faculty member of the University of Colorado School of Medicine and worked closely with him for more than 10 years.
Drs Hiatt and Regensteiner were co-authors on 53 papers between 1986 and 2019.
Dr Hiatt’s list of mentees includes many other accomplished clinical investigators at the University of Colorado and beyond. Dr Mark Nehler, Professor of Surgery and Vice Chair of Education at the University of Colorado, CPC Clinician Scientist, and a mentee and collaborator, remarked: Will had an amazing energy and combined the persona of a frontier cowboy and a world-renowned clinical trial researcher. Over the years together, I learned to be a trialist and, as such, experienced the world from him; however, the most important thing he taught me was how to live life, how to enjoy every minute of it, and how precious it is. He loved his career, his family, and his home state in an awe-inspiring way. He poured his heart and soul into mentoring, just like he did everything else.
Dr Cecilia Low Wang, Professor of Medicine at the University of Colorado and CPC Clinician Scientist, said: My first impression of Will was that of a kind, energetic, and centered person. Will supported and guided me in the latter part of my professional journey in academic medicine, and I would not be doing what I am now doing without him. He was a role model, living his life with authenticity, balancing his love of the outdoors and devoting time to his family and friends with his passion to improve the lives of patients through careful attention in (and out) of clinic, the research he led, the teaching he did, and his mentorship of faculty like me. Will was a generous and selfless mentor who took time for me and connected me with people whose collaborations and relationships I cherish. I am forever indebted to Will for his transformational mentorship.
Dr Connie Hess, Associate Professor of Medicine at the University of Colorado School of Medicine and CPC Clinician Scientist, stated: Will was a mentor, friend, and father figure. He was a role model in all aspects: a generous, compassionate, and kind person; a wonderful physician whose wisdom improved the lives of countless patients; a giant in clinical research whose achievements have inspired many of us to (try to) follow in his footsteps. Above all, he was a family man with a carpe diem approach to life who taught each of us lucky enough to have known him by example.
Dr Warren Capell, Associate Professor of Medicine at the University of Colorado, shared that: Will had a rare and overt mix of talent, knowledge, humility, and caring. As a mentor, Will always made time to meet, strategize, and work through obstacles. He had an infectious positivity that left even the most ardent worrier with the impression that things could possibly work out alright. To me, he embodied the true spirit of a mentor: patience, sage advice, and genuine caring.
Dr Jennifer Armstrong, Associate Professor of Pediatrics, Neurology, and OB/GYN at the University of Colorado, said: Will created a mentorship dynasty, of which I was privileged to be part. One can trace the myriad career paths he helped forge from junior to senior, established faculty. He was a particular champion of equity for female faculty. Will recognized the synergy of bringing folks together from all levels and diverse fields. This legacy is a lasting foundation that helped build and remains integral and sustaining within the University of Colorado.
Dr Diane Treat-Jacobson, Professor and Associate Dean for Research for the School of Nursing at University of Minnesota, shared the following: I had the privilege of knowing Will for almost 25 years, first as a respected leader of SVM(B) and researcher and then later as a valued colleague and friend. He was a great mentor, generous with his time and support, but with a humility not often seen in one as successful as he. I value the time I had with him and will miss him.
Dr Ryan Mays, Assistant Professor, University of Minnesota, Minneapolis, shared his thoughts: Will was a beacon of light, guiding and inspiring so many. Those who knew him became better people professionally and personally. Will was a giver, not a taker. He was the voice of reason in vascular medicine, and in all things really. Will embodied honesty and truth, and he led by example. A saying he once told me, and which will stay with me forever was: ‘Don’t let the sun set without a sweat!’. So many of us lost a mentor, a friend; however, his remarkable influence has forever shaped the field of vascular medicine and the lives of so many of us.
Dr Tim Bauer, Executive Vice President of Everlywell, Inc. in Austin, TX, noted: Will was an indelible mentor providing perspectives and insight both professionally and personally. Will had many admirable characteristics; however, the one I most fondly recall was his sense of adventure and exploration – traits he masterfully deployed across his personal and academic life. As a mentor, Will was a rigorous scientist combining his clinical skill and measured judgment with his warmth and openness – and modesty – a charisma that drew people in and rewarded them with his knowledge and friendship.
Dr Jeffrey Berger, Associate Professor of Medicine and Surgery and Director of the Center for the Prevention of Cardiovascular Disease at New York University School of Medicine, noted: Everything he did (which was a lot), he did in an incredibly respectful and humble manner. As a trainee when I was thinking about a career in vascular medicine, I turned to Will for guidance. He spent countless hours on the phone with me talking about the pros and cons of different career options. When I spoke to Will I felt like I was talking to someone who genuinely cared about my personal and professional well-being. He treated me like I was part of his family. When he became ill, we would talk about life and he would constantly remind me about the value of a life well led. Will Hiatt led an outstanding life, and I will miss him very much!
A leader of SVM and Vascular Medicine journal
The contributions of Dr Hiatt to the SVM and this journal, Vascular Medicine, cannot be understated. Will was one of the earliest members to join SVM after its initial founding and was highly active in SVM activities throughout its first 30 years. He served as a Trustee of the then Society for Vascular Medicine and Biology (SVMB) and as President (1995–1997). In recognition of his extraordinary contributions as a scholar, educator, mentor, and champion of vascular medicine, Dr Hiatt received the SVM Jess R Young Vascular Medicine Educator Award in 2012.
Will represented SVM in several national and international organizations and activities, including the Vascular Disease Foundation, TASC (in collaboration with his friend and mentor Dr Robert Rutherford, among others), and the Vascular Clinical Trialists (a consortium of SVMB members focused on clinical trials). Indeed, a common and important theme of his leadership contributions to our Society was reaching out across disciplines and working together to advance our field.
In his reflection on the first 25 years of SVM and his leadership of our organization, Dr Hiatt wrote: . . . these were exciting times as vascular medicine was growing and differentiating. We were targeting not just our unique clinical practice and expertise, but also trying to create an international environment to foster clinical research activities, to further define new therapeutics, and move the scientific basis for clinical care forward.
12
Recently, he lamented the loss of some of these important intersocietal collaborations and a fracture of our field across interspecialty lines.
13
He advocated for a reinvestment in interspecialty/intersocietal collaboration. Just last April, he issued an impassioned call to action, published in this journal, which implored: For vascular physicians, what does the future hold? Have we regressed back to what appears to be tribal behavior, or does the opportunity exist for ‘a sea-change into something rich and strange’? [. . .] Although this is an exciting time for vascular physicians, the benefits of a comprehensive and multidisciplinary approach will only be realized if integrated vascular programs are developed that once again bring us back together. I very much look forward to seeing that happen – which will be consistent with the vision that Dr Rutherford articulated for me back in the 1970s.
13
The very success of this journal owes a tremendous debt of gratitude to Dr Hiatt. Will served as an Editorial Board member since the beginning of what is now known as Vascular Medicine. For nearly 20 years, he served as an Associate Editor, a role that requires hours of weekly dedication to reading manuscripts and shepherding them through peer review, amounting to thousands of hours given generously on a volunteer basis during his career. When the Editorial leadership of Vascular Medicine transitioned from Dr Mark Creager to Dr Heather Gornik in 2014, Dr Hiatt volunteered to continue as an Associate Editor to assure a seamless transition (and to provide further mentorship to a young Editor-in-Chief). Dr Gornik shared: During the past 6 years, Will was a critical member of the editorial leadership team; he actively participated in our bimonthly Associate Editor calls and was always willing to share his clinical trial/research perspectives on all the papers we discussed. He made time for calling in, even when getting ready to speak at an FDA panel or present at important clinical trial investigators’ meetings. He served as a role model and gifted our current generation of Associate Editors with so many pearls of wisdom on the approach to evaluating manuscripts and how to best help authors improve their work. He genuinely enjoyed connecting with and meeting the younger members of our Editor panel. As final testimony to his true commitment to this journal, Will’s final editorial decision was an enthusiastic acceptance of a revised manuscript just 2 days prior to his death.
Dr Hiatt was also a high-volume contributor to our journal, with a recent query identifying approximately 45 research articles, reviews, and editorial or scientific statements of which he was an author. Beyond this, he was a tremendous advocate and cheerleader for Vascular Medicine and rallied others to prioritize support of this journal as the voice of our specialty and society.
Hiatt the athlete
All who knew Will recognized him as a gifted and enthusiastic athlete. The passion and intensity that he brought to his professional life was mirrored in his passion and intensity for engaging in physical activity and, in particular, outdoor activities. This was a passion he shared with his father who was an avid climber and athlete. He was a Masters swimmer and enjoyed weekly swim practice even through his diagnosis and treatment for lung cancer. Swim practice was an activity he participated in with his daughter, Kelsey Wasylenky, a collegiate swimmer and athlete like her father. Will was also an avid runner and biker and would routinely jog or bike to work and would be seen in the office in his bike shoes and clothes. He took great joy in his time at his Rocky Mountain cabin, which is at 10,000 feet and only accessible in the winter through a miles-long hike or snowshoe. He was an avid climber and conquered all the Colorado ‘14ers’, including climbing some of them multiple times (Figure 2). His passion for climbing brought him on international expeditions, including Aconcagua of the Andes mountain range in Argentina, at over 22,000 feet. He served on the board of Outward Bound and felt passionate about the importance of sport, athletics, and experiencing the wilderness.
Dr Hiatt on a mountain climbing expedition in Argentina at Aconagua in 2000.
A life of purpose and an enduring legacy
Dr Hiatt led his life focused on a mission, to reduce the burden of cardiovascular diseases, particularly in those communities that experience social, economic, and healthcare disparities. He had a clear focus on serving this mission, while also training the next generation of clinician-scientists and leaders. He had vision, and his values guided every interaction. He was uncommonly grounded, humble, and generous. He was loved by his co-workers and peers, as his sincerity and generosity shone through in areas where competition and ambition are generally drivers of success. His passion for this mission was only outweighed by his passion for family (Figure 3). He leaves behind his loving wife Susan, daughter and son-in-law, Kelsey and Mike Wasylenky, and grandchildren Sydney, Maelle, and Sloan. Many of his happiest moments were spent with his family at their cabin in the mountains – a place with profound meaning for Will and his family.
Dr William Hiatt and his family in Fall 2020.
Will leaves a professional legacy of groundbreaking science, impactful clinical research, accomplished mentees, and grateful collaborators and colleagues. His impact on the field of vascular medicine has been profound, and countless patients around the world have benefited from his life’s work. We greatly miss the profound vascular knowledge, methodological expertise, commitment, and heart that Dr Will Hiatt brought to our vascular community and Vascular Medicine. We will remember him always in the years of work that lie ahead.
