Clinical History

Practice-Based Research and Epigenetic Insights

The early science of Cardiometabolic Care grew out of a small clinical practice established by William H. Bestermann, Jr., MD, in the late 1970s, in Beaufort, South Carolina. A self-made researcher, Bestermann believed his pioneering rural clinic had the makings of a first-rate, cardiometabolic translational research center—and that any clinic with the right protocols and toolkits could generate world-class outcomes. In noticing the lag between medical science and community practice, Bestermann became increasingly passionate about closing the 17-year gap in medical research translation—even before the gap was widely recognized—and he regularly participated in groundbreaking pharmaceutical trials focused on cardiometabolic drugs and biologics.


An internist, Bestermann co-developed an innovative intensive care unit (ICU) in a local hospital. In this role, he became increasingly sensitive to the limitations of interventional cardiovascular medicine in preventing cardiovascular disease (CVD) complications and death. Faced with the disturbing need to give bad news to half a dozen families each week, Bestermann became highly frustrated with so-called best practices. He took it upon himself to create and refine therapeutic protocols and toolkits to improve care coordination and patient outcomes. For example, when captopril was first launched with limited availability in rural settings, Bestermann enlisted the local Highway Patrol to make a midnight run to Savannah, Georgia, to pick up the lifesaving pills and deliver them to the ICU. He then split a pill in fourths, ground it up, dissolved it in water, and administered it through a nasogastric tube. The patient’s blood pressure (BP) dropped dramatically, and Bestermann infused saline to maintain safe BP levels. This transformed the patient’s clinical course, so she was discharged from the hospital in less than half the normal time. This and other outlier experiences at the frontlines of care—combined with rigorous practice-based research—led to enhancements in the hospital’s ICU protocols and toolkits.


Convinced that the national strategy around cardiovascular disease could be improved, Bestermann became one of the few internist-presidents of the American Heart Association (AHA) affiliate in South Carolina and began building influential relationships with AHA and other thought- and practice-leaders. This resulted in Bestermann’s establishing the first clinical practice in the Hypertension Initiative of South Carolina, where his commitment to both evidence-driven practice and practice-based research intensified.


After evaluating clinical outcomes from a pioneering protocol with Daniel T. Lackland, PhD, and Brent M. Egan, MD, Bestermann served as lead author on “A systematic approach to managing hypertension and the metabolic syndrome in primary care.” This peer-reviewed publication and a subsequent article highlighting a unique approach to cardiometabolic risk management were groundbreaking in their (1) call for a coordinated, unified approach to the treatment of cardiometabolic disease in patients with complex chronic conditions, and (2) demonstration of differentially favorable outcomes in diabetes and cardiovascular disease—what Bestermann now calls new science, new systems, and new outcomes™.


Committed to moving South Carolina hypertension control “from worst to first,” Bestermann next prototyped early population health management functionality within an off-the-shelf electronic medical record (EMR) and worked to prepare Beaufort for the forthcoming era of value-based contracting.  Over time, Bestermann assumed the role of President of the Cardiovascular Center of Excellence (COE) program within the Consortium for Southeastern Hypertension Control, in collaboration with Carlos M. Ferrario, MD, and Michael A. Moore, MD.


Continuing this line of work alongside Jerry Miller, MD, and the Holston Medical Group—an advanced Patient-Centered Medical Home (PCMH) near the Eastman Chemical Company and other self-insured employers (SIEs)—Bestermann reviewed economic, clinical, and humanistic outcomes (ECHOs) to build evidence-based CMD case management algorithms, culminating in a proprietary practice-validated, integrated protocol with precision medicine derivatives.


With this base of experience, Bestermann co-founded Epigenex Health and—working closely with co-founders Eric Kruep, PharmD, MSc, and Synthia Laura Molina, BSc, MBA—helped further refine the protocols and toolkits essential to preventing, mitigating, and managing more than two dozen cardiometabolic diseases (CMDs).


Today, Bestermann serves as the Chief Medical Officer for Epigenex Health and helps primary care practices (PCPs) understand the science behind Cardiometabolic Care. The groundbreaking Epigenex Health solution he helped pioneer prevents and mitigates the effects of more than two dozen cardiometabolic diseases.


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