Salim Yusuf, Executive Director of the Population Health Research Institute and Professor of Medicine at McMaster University, does not have to worry about being low profile, as any search of Medline reveals hundreds of results. But this one-time doyen of clinical trials in cardiology has broadened his perspective in more recent times towards global epidemiological research, partly shaped by his curiosity about the high burden of cardiovascular disease (CVD) in his native India, which was a trigger for the seminal INTERHEART study, undertaken in 52 countries, and published in The Lancet in 2004. “In INTERHEART and subsequent studies, such as the Prospective Urban Rural Epidemiological (PURE) study, we explored why people get the risk factors, the causes of the causes”, he says.” This means looking at the social determinants of health and environmental factors and their influence on health behaviours, risk factors, and disease.”
This global outlook contrasts with the cardiology research that made his name from the 1990’s onwards: SOLVD, Yusuf’s first large clinical trial, highlighted the effect of angiotensin-converting enzyme (ACE) inhibitors in heart failure and left-ventricular dysfunction; his work in the ISIS programme, especially ISIS-1 showing the efficacy of atenolol after myocardial infarction; and the HOPE study, which showed the efficacy of ACE inhibitors to treat atherosclerotic disease, to name just a few. “The problem we face today is that the results from these and other major trials that identified life-saving therapies are not widely used, especially in low and middle-income settings”, he says. “All drugs from those trials are now off-patent, yet their use is extremely low. We need to understand the reasons for this and how to rectify this huge gap in implementing evidence-based strategies.”
Born in 1952 in Kerala, India, Yusuf was brought up in a middle-class family and was “instructed by my father to go into medicine”, he says. After some failed applications to medical school, he studied at St. John’s Medical College in Bangalore. “I was very aware that I was not the brightest student”, he recalls, “so I just had to work as hard as possible to keep up to my peers”. This eventually paid dividends, as Yusuf flourished in his medical degree, and gained a Rhodes Scholarship to research cardiology at the University of Oxford in the UK. “Cardiology interested me as an undergraduate, and even more so after my father had a heart attack”, he says. Under the paternal eye of Peter Sleight, and some robust mentoring from Richard Peto, Yusuf has happy memories of his time in Oxford from 1976 to 1982, where he researched the effect of β blockers on acute myocardial infarction, a firm foundation for his later career in clinical research.
In 1984, Yusuf was offered a position at the US National Institutes of Health (NIH), a turning point in his career. “I was extremely flattered, as a Registrar, to be offered a wonderful research opportunity at the National Heart, Lung, and Blood Institute”, he says. “It was an incredible 8 years there, with seemingly endless resources and a feeling that, as young researchers, we could change the world, which we discussed every day over lively lunches”. One of the main achievements at NIH was the establishment of the SOLVD trial.
McMaster University in Hamilton, ON, Canada, recruited Yusuf in 1992 as its head of cardiology, where his first job was to set up a stellar research group for CVD research. Within 2 years, he was running five large research programmes, which enabled him to grow McMaster’s research programme into what became the Population Health Research Institute a decade after his arrival. “I had always been interested in population health, especially at a global level, and in research that could extend beyond cardiology” he says. “Through a combination of hard work, good luck, and the ability to attract excellent collaborators and seize opportunities, we were fortunate to make some important discoveries that had direct application to improving health.”
Yusuf, who is Chief Scientist at Canada’s Hamilton Health Sciences, is still very much engaged in new research programmes. His institute is investigating the safety and tolerability of a polypill for primary prevention of CVD, and is currently recruiting participants into two trials. “A polypill to deliver four life-saving therapies globally could reduce CVD by two-thirds to three-quarters and could be a transformative leap in disease prevention worldwide. It is a key priority for our team over the next few years”, he says. As the current President of the World Heart Federation, Yusuf is leading an effort to develop practical strategies that can be implemented at a low cost and can potentially reduce premature CVD by a quarter in the next decade.
Martin McKee, professor of European Public health at the London School of Hygiene & Tropical Medicine, has worked with Yusuf on the PURE study for the past 7 years, and says: “Salim is the 21st-century incarnation of Rudolf Virchow, an outstanding scientist committed to making the world a better place. Although best known as a trialist, his contribution to understanding the global burden of CVD is immense. His leadership is inspirational, his support for colleagues unsurpassed, but working with him is exhausting!”
Conventional retirement is not something Yusuf gives much thought to, although the imminent arrival of his first grandchild might see him ease back after three decades at the top of his profession. “I heard that you become a better parent, once you become a grandparent”, he says. “I am very much looking forward to this new phase in my life.”
This article has been copied in its entirety from www.thelancet.com Vol 386 August 15, 2015
Author: Richard Lane