European Heart Journal (2016) 37, 2294–2299 doi:10.1093/eurheartj/ehw296
New joint European cardiovascular prevention guidelines Population approaches are emphasized for the first time The highly anticipated document gives the latest advice on prevention of cardiovascular disease (CVD) in individuals and populations. It was published in European Heart Journal,1 the European Journal of Preventive Cardiology, and other specialty journals, and presented in a dedicated session at Heart Failure 2016 and the 3rd World Congress on Acute Heart Failure in Florence, Italy.2 ‘The last 30 years have witnessed a decrease in deaths from CVD, mainly due to improved treatment of heart disease, and falls in cholesterol, blood pressure and smoking,’ said Professor Massimo F. Piepoli, Chairperson of the guidelines Task Force. ‘This trend is partly offset by rising obesity and type 2 diabetes, and poor adherence to lifestyle changes.’ The document was written by the sixth joint Task Force of the European Society of Cardiology and nine other societies chaired by Professor Massimo F. Piepoli. It argues that CVD mortality rates could be halved by modest risk factor reduction. New scientific evidence has led to adapted target levels for important risk factors, such as blood pressure and lipids. Special attention has been dedicated to younger adults and to the elderly. Reducing population risk by 1% would prevent 25 000 CVD cases and save E40 million per year in a single European country. Stronger laws and policies on food, physical activity, and smoking are needed, as follows:
Food † Legislate food composition to reduce calories, salt, saturated fat, sugar, and limit portion sizes † Eliminate industrially produced trans fats † Legislate to restrict marketing foods high in fat, sugar, and salt to children † Tax foods rich in sugar and saturated fat, and alcoholic drinks † Make water and healthy food available in schools and workplaces † Regulate location and density of fast food outlets
Physical activity † Consider physical activity when planning new landscaping, buildings, or towns † Post signs to encourage use of stairs † Increase fuel taxes
† Provide tax incentives to buy exercise equipment or gym membership † Give financial incentives to lose weight and increase fitness
Smoking † Restrict advertising, marketing, and sale of smokeless tobacco † Ban smoking in school, pre-school, and child care to protect from passive smoking † Advise parents to be tobacco-free when children are present and never smoke in cars or at home † Give electronic cigarettes the same marketing restrictions as cigarettes The detrimental impact of air pollution on heart health is highlighted, and the authors say that the media can inform the public about air quality (e.g. by using apps) and provide smog alerts. Air quality can be improved by reducing taxes on electrical and hybrid cars. New houses and schools should be built away from highways and polluting industries. Professor Piepoli said: ‘A healthy environment is essential for preventing CVD. Lawmakers need to take more responsibility for their nation’s wellbeing by taxing unhealthy choices and giving incentives to healthy ones.’ Novel recommendations are given for patients with rheumatoid arthritis, erectile dysfunction, and patients receiving treatment for cancer. Women with a history of pre-eclampsia, premature birth, polycystic ovary syndrome, or gestational diabetes should be screened for diabetes and hypertension. Cardiovascular disease risk varies considerably between immigrant groups and ethnicity should be considered in CVD risk assessment. Professor Arno W. Hoes, Task Force Cochairperson, said: ‘The recommendations cover the entire spectrum of CVD prevention in individuals and populations. We all have a role to play to stop heart disease.’
A. Tofield ESC Press Office [email protected]
References References are available as supplementary material at European Heart Journal online.
Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2016. For permissions please email: [email protected].
CardioPulse
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doi:10.1093/eurheartj/ehw297
Leaders in cardiovascular medicine
Lionel H. Opie MD DPhil DSc FRCP to London to become a consultant in Medicine at the Hammersmith Professor Lionel Opie is one of the most respected international Hospital and Imperial College where he continued as a Research cardiovascular scientists of our generation who has contributed sigFellow under another Nobel Laureate, Sir Ernst Chain. nificantly to both basic and clinical cardiovascular research for the This very productive period covered the 1960s and in the early past five decades. His contribution to cardiovascular research has 1970s he returned to his country of birth, namely South Africa, to been immense and it has been my privilege to be associated with take up the position as Director, of the MRC Research Unit for him for so many years. Ischaemic Heart Disease, UCT. As one of the world leaders in the pathophysiology of myocardial It was around that time that I, as a young graduate, was leaving ischaemia and reperfusion, his research over the decades have inSouth Africa to undertake a PhD in the UK so our paths just failed volved an understanding of the metabolic imbalances of carbohyto cross. In fact, the first time I was privileged to meet Lionel was drate and fatty acid metabolism of the ischaemic heart. Here he when I was a PhD student and he was already a house-hold name. was able to demonstrate how myocardial ischaemia affects the This was at a British Society for Cardiovascular Research meeting in ability of the heart to induce adrenergic stimulation which increased Scotland in the late 1970s. He was invited to give one of the importcirculating fatty acids which then proceeded to harm cardiac conant presentations and I was one of those ‘academic groupies’ who traction, with subsequent inhibition of glucose uptake triggering sat in the front row listening to the great man. I refurther ischaemia. These ideas were the forerunner member going up to him at the dinner afterwards of one of the mainstay treatments in the setting of and introducing myself, naively thinking that he would acute coronary syndromes, namely the use of talk to me as I was originally from Cape Town—my b-blockers. thinking at the time being that—if we did not have inHis glucose hypothesis published in 1970 has proved tellectual similarities (my being a mere student) we durable and his discovery of the role of excess cyclic would have at least had cultural similarities—but if I AMP in sudden myocardial infarction has made world remember correctly I was dismissed, although in a ponews. lite manner. In the setting of myocardial reperfusion his research The following two decades the name of Lionel demonstrated that insulin can directly protect the Opie was synonymous with three items—an excelmyocardium from ischaemia-reperfusion injury, exlent research output, international travel and tending his studies to the concept of preconditioning Lionel H Opie awards—too many to mention—and what many of where he observed that tumour necrosis factor alpha us agree on as arguably his greatest asset, and that is his ability to discan prevent myocardial damage following myocardial reperfusion. seminate knowledge—by this I mean in both his own scientific writStudies of this type helped to understand the mechanism of the pheings (he has published in excess of 500 manuscripts) in addition to nomenon of preconditioning, which is known to be the most his now legendary books including Drugs for the Heart (now in its powerful form of protection to date. 8th edition) and Heart Physiology, From Cell to Circulation (now in Professor Opie will always be known as creative investigator who its 4th edition) to name just two. Two of his books have also been undertook original studies in a precise, visionary, and meticulous translated into Chinese and one is the standard reference on the manner. He combined his unique basic science knowledge with treatment of heart disease. In short, Lionel Opie’s research has his clinical acumen—creating an unbeatable combination. benefitted millions of people across the world. Lionel was born in South Africa in 1933 and after attending It is difficult to pick out the highlights of his career, as there are so school in Cape Town he went on to undertake his medical degree many, but one of them must surely be his instigation in forming at the University of Cape Town (UCT) where he obtained a 1st what was initially called the Study Group for Research in Heart MeClass honours as well as the gold medal in his final year. Therefore, tabolism, and which became the International Society for Heart Refrom the beginning it was possible to see his academic credentials search. Concurrently with this, he become the founding editor of evolving. the Journal of Molecular and Cellular Cardiology (‘the yellow journal’) After his internship at the famous Groote Schuur Hospital, he which is the scientific journal of the ISHR. This contribution alone went to Oxford University, in 1957, as a Rhodes Scholar where has solidified cardiovascular science in a major way. he continued his medical training undertaking house jobs at the RadTo end on a more personal note. As we all know events changed cliffe Infirmary in addition to obtaining a Wellcome Trust Fellowship politically within SA and in the mid-1990s I was honoured to be to undertake research under the Nobel Laureate, Sir Hans Krebs approached by the Medical School of the UCT to help them plan where he earned his DPhil investigating myocardial metabolism. for the future in the new South Africa. Lionel and I decided to create Further clinical positions followed at Harvard Medical School in links between the UCT and my University, that is University College Boston and the Toronto General Hospital in Toronto, and then
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London (UCL) and establish a second Hatter Institute for Cardiology at the Medical School in Cape Town with Lionel as its Director. What this has done is allowed our two Universities to collaborate very closely and maintain our basic and clinical research output.
Working with Lionel over these years has been an immense pleasure and continues today with regular telephone and email contact. Lionel Opie is a man who has dedicated his life to the understanding of cardiovascular science and medicine. He is one of my heroes and mentors who it has been a joy to collaborate with over these past 25 years. Derek M. Yellon DSc Professor of Molecular & Cellular Cardiology, Director of the Hatter Cardiovascular Institute UCL, Programme Director (Cardiometabolic), NIHR UCLH Biomedical Research Centre. University College London & UCLH [email protected] Bernard Gersh, also a graduate of medicine from Cape Town University, adds: Derek’s very comprehensive comments really do summarize Lionel’s life and career.
Lionel Opie Hatter Group: left to right: Prof. Neil Davies, Prof. Karen Sliwa, Prof. Lionel Opie, Mrs Carol Opie, Ms Sandra Meyer (VisualSonics), Prof. Francis Peterson, Prof. Sandrine Lecour, Dr Fatima Kakal (Alliance Global), Dr Greg Northfield (Separation Scientific), Prof. Justiaan Swanevelder, and Dr Tamer Degheidy (Alliance Global). As part of this collaboration I was proud to partner with Lionel in the development of an international meeting entitled ‘Cardiology, Diabetes & Nephrology at the Limits’. This meeting arose as a means of celebrating the opening of the new Hatter Institute at UCT and took the form of a 1-day academic meeting which focussed on a range of diverse but highly important topics that challenged cardiologists, diabetologists, and nephrologists. The meeting proved so successful that it has continued unabated on an annual basis for the past 17 years and hopefully will continue for many more. Furthermore, the meeting now boasts partnerships with the Lancet and the Brigham & Women’s Hospital, Harvard Medical School.
To me he was a mentor and a friend. My closest association was as the Junior editor of Drugs for the Heart where I learned firsthand what a great medical author he was with his unbridled enthusiasm, attention to detail and passion for the project. His ability to explain mechanisms via detailed schematic diagrams is unparalleled in my view.
Lionel is undoubtedly one of South Africa’s premier medical scientists and he has been appropriately recognized for that. As an anecdote he is fond of telling, he states that I was responsible for his interest in clinical cardiology because his training was in Hypertension and Internal medicine. We used to live opposite each other, but the properties were divided by a stream called the Liesbeek River (somewhat euphemistically). The houses were quite far apart and there was no way to cross the river, so I when I saw him in his garden I would shout across the great divide and draw his attention to articles in the cardiology literature
doi:10.1093/eurheartj/ehw298
The Lionel Opie preclinical imaging core facility in Cape Town A state-of-the-art new imaging facility recently opened in Africa In October 2015, the long-life outstanding contribution of Professor Lionel Opie to Cardiovascular research was honoured in his country with the opening of the new Lionel Opie Preclinical Imaging Core Facility (LOPI) at the Faculty of Health Sciences, University of Cape Town, South Africa.
This new core facility is the first African Comprehensive Preclinical in vivo research facility, serving cancer, cardiovascular, and developmental biology researchers from across Africa housed at the Hatter Institute for Cardiovascular Research in Africa, Chris Barnard Building, Faculty of Health Sciences, Cape Town, and South Africa.
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by Professors Sandrine Lecour and Neil Davies, follows the longtime vision of Lionel Opie to make available a state-of-the-art imaging facility to contribute to research excellence (facilitate publications in peer-reviewed journals with high impact factors), knowledge, capacity building (including student training programmes), and translation from bench to bedside on the African continent. Most importantly, the equipment made available is non-invasive and as such, it will assist researchers in achieving ethical goals of reducing the number of animals used for research and refining the procedures performed on animals. Additional information about the new Core Facility can be found on www.lopi.uct.ac.za
The Vevo 2100 at the LOPI Core Facility The facility currently offers an in vivo small animal surgical room, a high-resolution in vivo micro-imaging ultrasound system that provides resolution down to 30 mm. In the next few months, the acquisition of a non-invasive fluorescent and biochemilumescent in vivo system will hopefully be made available in the facility. Accessible to any researcher, the vision of this new Core Facility, co-directed
doi:10.1093/eurheartj/ehw299
More than 10 000 kilometres travelled in less than a week! Roberto Ferrari discusses the European Society of Cardiology (ESC) Global Scientific Activities to India and Saudi Arabia in 2016
The 67th Annual Cardiological Society of India Congress The Cardiological Society of India (CSI) traditionally meets every year in December, rotating locations between the most important cities in India. In 2015, their 67th meeting was scheduled to be held in Chennai ( previously Madras), which is a delightful, vibrant city. Located on the Coromandel Coast off the Bay of Bengal, it is the largest cultural, economic, and educational centre in Southern India—the most visited city by foreign tourists and 38th most visited city in the world. The delegation from the ESC were all excited to depart, tickets purchased, and luggage packed when we heard that Chennai was experiencing the heaviest rains that Southern India had seen in over a century with devastating consequences and loss of human life. The CSI had to cancel the meeting involving over 5000 Indian
colleagues. From a personal point of view, such devastation is traumatizing. From a professional viewpoint, it is every congress organizers nightmare to have a catastrophe just days before the start of a meeting. The total financial loss in India after this weather phenomenon is estimated to have been over 7 million US dollars. I did not want to ask Dr Santanu Guha if he was insured. Of course, the ESC was distressed but happy to know that relief efforts were in place. In traditional Indian spirit, the meeting was re-scheduled in the same city 2 months later during 10 – 13 February 2016. This provided a much needed boost to the city. As agendas are always busy, some other ESC members had to be found to travel to Chennai, and we all re-booked our tickets (some may have even used the same luggage) and in February travelled to sunny Chennai. It was a pleasure for me to be there with Dr Biscaglia, an expert in interventional cardiology, and Dr Andreotti, an expert in acute coronary syndromes. The event was splendid with two large sessions integrating views on how to deal with heart failure with reduced ejection fraction and chronic ischaemia as well as
2298 acute coronary syndromes and intervention, particularly related to modern technology. The discussion was strong, as always, and there were numerous questions and different viewpoints and approaches to the same problem. We should not underestimate the different international healthcare systems and number of patients to be treated. Photos from the event are available at the following link: http://www.csi.org.in/ gallerynext9.htm. The hospitality was excellent, and the ESC Leadership had the opportunity to meet with the CSI Leadership and agree on five important points: † CSI participation in some of the ESC registries, particularly those on heart failure and atrial fibrillation. † CSI would consider the European Heart Journal Supplement—the Heart of the Matter as a journal to possibly publish the abstracts from their annual meetings (as other Affiliates already have). † CSI would like to invite an ESC Guidelines representative to liaise and comment on the Indian guidelines. † ESC speakers would appear in the India media during the next CSI congress, taking advantage of the common English language. † More importantly, a memo of understanding was agreed between the ESC and the CSI to promote and allow sponsorship for Indian cardiologists to attend the ESC Annual Congress. This is indeed a very delicate matter internationally, and not only in India, which will have to be regulated by the two scientific societies, and a memo of intention will be essential. Apart from the successful science, it is always a joy for me to return to the multi-coloured atmosphere of Chennai. The city has fully recovered from the recent disaster: the people are smiling, the car horns and motorbikes are still as noisy, and the dahl and curry are as delicious as always. I only stayed for a day and a half, but it was enough time for me to get my bindi!
The 27th Annual Saudi Heart Association Congress, 12 – 15 February 2016 I had to move quickly to catch the night flight to Riyadh to attend the 27th Annual Saudi Heart Association (SHA) Congress. What a jump! Firstly, there are very few, if any, direct flights and the first moment you realize that you are in an Arabic country is when you land at the busy airport in Abu Dhabi. They are planning to build another airport as the current one is, believe it or not, still not sufficient for the traffic that passes through it. No more dahl or curry but the Arabic breakfast fowl along with more international snacks. Off I go to Riyadh airport. On landing, I immediately notice the difference in colours. Chennai is multi-coloured, whereas the dominant
CardioPulse
colours in Riyadh are white ( for men) and black ( for women). The drive to the venue is through the desert instead of the palms in Chennai. Again the SHA chose the Ritz Carlton as the venue. It was previously a palace built by the King to accommodate international guests and . . . the international guests are treated like royalty. The entrance in the evening is truly spectacular with the fountains in front of the dominant white fac¸ade. The hospitality was impeccable, and the scientific levels improve each year. There were over 60 sessions, 17 tracks including Cardiac Surgery, Cardiac Anaesthesia & Critical Care, Cardiac Imaging, Echocardiography, Cardiac Nursing, Cardiac Technology, Electrophysiology, Preventive & Rehabilitation Cardiology, Heart Failure, Adult Congenital Heart Disease, Interventional Cardiology, Paediatric Cardiology, Fellows & Registrars Workshops, Research Workshops, and CPR. There was a larger ESC contingent as the SHA congress allowed us 2 full days. ESC President Prof. Fausto Pinto, Prof. Thierry Gillebert, Dr Matteo Bertini, and I had the pleasure of giving presentations to over 4000 delegates, packing the rooms to capacity. Besides the ESC delegation, there were many other ESC-related colleagues including Gunther Breithardt and Khalid Al Habib. The excellent level of science and technology that Saudi Arabia has reached was very evident this year. There was special focus on genetics and cardiovascular surgery and an important participation from the Cleveland Clinic as one of the ‘ventricles’ of the SHA (the other of course being the President, Khalid Al Habib), Prof. Hani Najm—has joined the Cleveland Clinic and is Chief of the Paediatric Cardiovascular Surgery department. The ESC President, Fausto Pinto, gave an enormous amount of presentations on various subjects and with his classic eloquence, promoted the success of the ESC to the maximum. A selection of the ESC contingent presentations is available on the ESC website (http://www.escardio.org/Congresses-&-Events/ Global-scientific-activities/Middle-East/Riyadh-KSA). Finally, the forthcoming ESC Annual Congress in Rome featured very prominently because the dates do not clash with Ramadan this year. There are also excellent flight links from the Saudi capital to Rome. I finished my last talk, there was just enough time to sample the cuisine one more time and then catch another night flight back to Italy . . .. What a week!
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doi:10.1093/eurheartj/ehw300
Saudi Arabia’s Mecca cardiac hospital describes how it copes with the Hajj The hospital’s Hajj Committee works year round to plan services for this large event Mecca’s cardiac hospital has described how it copes with the huge patient influx during the Hajj and gave details of the echocardiography service in an abstract presented at the 27th Annual Conference of the Saudi Heart Association (SHA). The conference was held on 12 – 15 February 2016 in Riyadh, Saudi Arabia. Experts from the European Society of Cardiology (ESC) Faculty presented a special programme on 13 February. ‘Planning ahead is vital for successfully delivering cardiac services during a large event like the Hajj,’ said abstract author Dr Mohamed Ali Hassan, a cardiologist at King Abdulla Medical City (KAMC) in Makkah (Mecca), Saudi Arabia. ‘Our hospital’s Hajj Committee works year round to ensure that we are prepared.’ Around 2– 4 million people attend the annual Hajj (pilgrimage) in Mecca, and medical services are provided free of charge. King Abdulla Medical City provides almost all cardiac care in Makkah, including during Hajj month when it treats 700 – 1000 cardiac patients. Of these, 60 – 70% are Hajj visitors. Most Hajj visitors who have a cardiac event are older than 65 years. Diabetes and hypertension are the most common co-morbidities. King Abdulla Medical City has a Hajj committee, which has monthly meetings at the end of one Hajj and convenes more frequently as the next Hajj approaches. The committee reviews the hospital’s performance during the previous Hajj season and identifies areas for improvement. It also collects information from the Hajj authority and Ministry of Health in Saudi Arabia, plus the Hajj missions of visiting countries. The most crucial piece of information is how many people are expected to attend. The second issue is which countries they will come from. ‘Hajj visitors come from more than 150 countries but the majority are from the Indian subcontinent,’ said Dr Hassan. ‘Knowing the main countries of origin helps us to have interpreters available, since language barriers are one of the difficulties we commonly face.’ King Abdulla Medical City asks its staff to come forward if they know other languages. Hajj missions, who are in charge of citizens from their country during the event, also help with interpreting. Additional doctors, nurses, echocardiography technicians, and information technology (IT) staff are recruited to work during the Hajj season. Dr Hassan said: ‘The good thing is that most of the extra staff work for us during the Hajj almost every year. So they know the hospital and they know what we need them to do. This helps us with
our preparations. It’s also important when there is a high volume of work to make sure that our IT systems are up to scratch and that any failure will be corrected immediately.’ The abstract described the additional demands on the hospital’s echocardiography service. The number of echo studies performed during the Hajj more than doubled between 2011 and 2015, from 318 to 708. Correspondingly, the number of echo machines deployed increased from 4 to 9 and the number of technicians increased from 7 to 13. Hajj missions can help during the event. ‘Hajj missions with the bulk of visitors tend to have medical services,’ said Dr Hassan. ‘Their doctors come to our hospital to see patients from their country, interpret, explain procedures and get consent for transoesophageal echocardiography and other procedures.’ He concluded: ‘Planning cardiac services for the Hajj goes on all year and becomes more intense nearer the time. To get ready for a large event, gather all the information you need for the service you will provide including demographic data about the people who will be coming. Make sure you have a reliable source of manpower. Specify the equipment you will need and how many staff are required to operate and maintain it. Things should run smoothly if you are prepared.’ Professor Hani Najm, SHA vice president, past president and head of international affairs, said: ‘Saudi Arabia and most of the Gulf countries continue to experience an increase in coronary risk factors and with the young population there would be a sharp increase of myocardial infarctions in the next decade. This calls for a wide and aggressive move to control these risk factors in order to avoid this tidal wave that may outstretch the resources available.’ Professor Roberto Ferrari, a past president of the ESC and course director of the ESC programme in Riyadh, said: ‘Delivering a high quality cardiac service requires teamwork. The ESC advocates setting up a ‘Heart Team’ of all the specialties, who come together to manage patients with cardiovascular disease. This team would need to be scaled up to deal with any anticipated rise in demand on the service.’ A. Tofield
CardioPulse contact: Andros Tofield, Managing Editor. Email: [email protected]
New joint European cardiovascular prevention guidelines Population approaches are emphasized for the first time The highly anticipated document gives the latest advice on prevention of cardiovascular disease (CVD) in individuals and populations. It was published in European Heart Journal,1 the European Journal of Preventive Cardiology, and other specialty journals, and presented in a dedicated session at Heart Failure 2016 and the 3rd World Congress on Acute Heart Failure in Florence, Italy.2 ‘The last 30 years have witnessed a decrease in deaths from CVD, mainly due to improved treatment of heart disease, and falls in cholesterol, blood pressure and smoking,’ said Professor Massimo F. Piepoli, Chairperson of the guidelines Task Force. ‘This trend is partly offset by rising obesity and type 2 diabetes, and poor adherence to lifestyle changes.’ The document was written by the sixth joint Task Force of the European Society of Cardiology and nine other societies chaired by Professor Massimo F. Piepoli. It argues that CVD mortality rates could be halved by modest risk factor reduction. New scientific evidence has led to adapted target levels for important risk factors, such as blood pressure and lipids. Special attention has been dedicated to younger adults and to the elderly. Reducing population risk by 1% would prevent 25 000 CVD cases and save E40 million per year in a single European country. Stronger laws and policies on food, physical activity, and smoking are needed, as follows:
Food † Legislate food composition to reduce calories, salt, saturated fat, sugar, and limit portion sizes † Eliminate industrially produced trans fats † Legislate to restrict marketing foods high in fat, sugar, and salt to children † Tax foods rich in sugar and saturated fat, and alcoholic drinks † Make water and healthy food available in schools and workplaces † Regulate location and density of fast food outlets
Physical activity † Consider physical activity when planning new landscaping, buildings, or towns † Post signs to encourage use of stairs † Increase fuel taxes
† Provide tax incentives to buy exercise equipment or gym membership † Give financial incentives to lose weight and increase fitness
Smoking † Restrict advertising, marketing, and sale of smokeless tobacco † Ban smoking in school, pre-school, and child care to protect from passive smoking † Advise parents to be tobacco-free when children are present and never smoke in cars or at home † Give electronic cigarettes the same marketing restrictions as cigarettes The detrimental impact of air pollution on heart health is highlighted, and the authors say that the media can inform the public about air quality (e.g. by using apps) and provide smog alerts. Air quality can be improved by reducing taxes on electrical and hybrid cars. New houses and schools should be built away from highways and polluting industries. Professor Piepoli said: ‘A healthy environment is essential for preventing CVD. Lawmakers need to take more responsibility for their nation’s wellbeing by taxing unhealthy choices and giving incentives to healthy ones.’ Novel recommendations are given for patients with rheumatoid arthritis, erectile dysfunction, and patients receiving treatment for cancer. Women with a history of pre-eclampsia, premature birth, polycystic ovary syndrome, or gestational diabetes should be screened for diabetes and hypertension. Cardiovascular disease risk varies considerably between immigrant groups and ethnicity should be considered in CVD risk assessment. Professor Arno W. Hoes, Task Force Cochairperson, said: ‘The recommendations cover the entire spectrum of CVD prevention in individuals and populations. We all have a role to play to stop heart disease.’
A. Tofield ESC Press Office [email protected]
References References are available as supplementary material at European Heart Journal online.
Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2016. For permissions please email: [email protected].
CardioPulse
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doi:10.1093/eurheartj/ehw297
Leaders in cardiovascular medicine
Lionel H. Opie MD DPhil DSc FRCP to London to become a consultant in Medicine at the Hammersmith Professor Lionel Opie is one of the most respected international Hospital and Imperial College where he continued as a Research cardiovascular scientists of our generation who has contributed sigFellow under another Nobel Laureate, Sir Ernst Chain. nificantly to both basic and clinical cardiovascular research for the This very productive period covered the 1960s and in the early past five decades. His contribution to cardiovascular research has 1970s he returned to his country of birth, namely South Africa, to been immense and it has been my privilege to be associated with take up the position as Director, of the MRC Research Unit for him for so many years. Ischaemic Heart Disease, UCT. As one of the world leaders in the pathophysiology of myocardial It was around that time that I, as a young graduate, was leaving ischaemia and reperfusion, his research over the decades have inSouth Africa to undertake a PhD in the UK so our paths just failed volved an understanding of the metabolic imbalances of carbohyto cross. In fact, the first time I was privileged to meet Lionel was drate and fatty acid metabolism of the ischaemic heart. Here he when I was a PhD student and he was already a house-hold name. was able to demonstrate how myocardial ischaemia affects the This was at a British Society for Cardiovascular Research meeting in ability of the heart to induce adrenergic stimulation which increased Scotland in the late 1970s. He was invited to give one of the importcirculating fatty acids which then proceeded to harm cardiac conant presentations and I was one of those ‘academic groupies’ who traction, with subsequent inhibition of glucose uptake triggering sat in the front row listening to the great man. I refurther ischaemia. These ideas were the forerunner member going up to him at the dinner afterwards of one of the mainstay treatments in the setting of and introducing myself, naively thinking that he would acute coronary syndromes, namely the use of talk to me as I was originally from Cape Town—my b-blockers. thinking at the time being that—if we did not have inHis glucose hypothesis published in 1970 has proved tellectual similarities (my being a mere student) we durable and his discovery of the role of excess cyclic would have at least had cultural similarities—but if I AMP in sudden myocardial infarction has made world remember correctly I was dismissed, although in a ponews. lite manner. In the setting of myocardial reperfusion his research The following two decades the name of Lionel demonstrated that insulin can directly protect the Opie was synonymous with three items—an excelmyocardium from ischaemia-reperfusion injury, exlent research output, international travel and tending his studies to the concept of preconditioning Lionel H Opie awards—too many to mention—and what many of where he observed that tumour necrosis factor alpha us agree on as arguably his greatest asset, and that is his ability to discan prevent myocardial damage following myocardial reperfusion. seminate knowledge—by this I mean in both his own scientific writStudies of this type helped to understand the mechanism of the pheings (he has published in excess of 500 manuscripts) in addition to nomenon of preconditioning, which is known to be the most his now legendary books including Drugs for the Heart (now in its powerful form of protection to date. 8th edition) and Heart Physiology, From Cell to Circulation (now in Professor Opie will always be known as creative investigator who its 4th edition) to name just two. Two of his books have also been undertook original studies in a precise, visionary, and meticulous translated into Chinese and one is the standard reference on the manner. He combined his unique basic science knowledge with treatment of heart disease. In short, Lionel Opie’s research has his clinical acumen—creating an unbeatable combination. benefitted millions of people across the world. Lionel was born in South Africa in 1933 and after attending It is difficult to pick out the highlights of his career, as there are so school in Cape Town he went on to undertake his medical degree many, but one of them must surely be his instigation in forming at the University of Cape Town (UCT) where he obtained a 1st what was initially called the Study Group for Research in Heart MeClass honours as well as the gold medal in his final year. Therefore, tabolism, and which became the International Society for Heart Refrom the beginning it was possible to see his academic credentials search. Concurrently with this, he become the founding editor of evolving. the Journal of Molecular and Cellular Cardiology (‘the yellow journal’) After his internship at the famous Groote Schuur Hospital, he which is the scientific journal of the ISHR. This contribution alone went to Oxford University, in 1957, as a Rhodes Scholar where has solidified cardiovascular science in a major way. he continued his medical training undertaking house jobs at the RadTo end on a more personal note. As we all know events changed cliffe Infirmary in addition to obtaining a Wellcome Trust Fellowship politically within SA and in the mid-1990s I was honoured to be to undertake research under the Nobel Laureate, Sir Hans Krebs approached by the Medical School of the UCT to help them plan where he earned his DPhil investigating myocardial metabolism. for the future in the new South Africa. Lionel and I decided to create Further clinical positions followed at Harvard Medical School in links between the UCT and my University, that is University College Boston and the Toronto General Hospital in Toronto, and then
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London (UCL) and establish a second Hatter Institute for Cardiology at the Medical School in Cape Town with Lionel as its Director. What this has done is allowed our two Universities to collaborate very closely and maintain our basic and clinical research output.
Working with Lionel over these years has been an immense pleasure and continues today with regular telephone and email contact. Lionel Opie is a man who has dedicated his life to the understanding of cardiovascular science and medicine. He is one of my heroes and mentors who it has been a joy to collaborate with over these past 25 years. Derek M. Yellon DSc Professor of Molecular & Cellular Cardiology, Director of the Hatter Cardiovascular Institute UCL, Programme Director (Cardiometabolic), NIHR UCLH Biomedical Research Centre. University College London & UCLH [email protected] Bernard Gersh, also a graduate of medicine from Cape Town University, adds: Derek’s very comprehensive comments really do summarize Lionel’s life and career.
Lionel Opie Hatter Group: left to right: Prof. Neil Davies, Prof. Karen Sliwa, Prof. Lionel Opie, Mrs Carol Opie, Ms Sandra Meyer (VisualSonics), Prof. Francis Peterson, Prof. Sandrine Lecour, Dr Fatima Kakal (Alliance Global), Dr Greg Northfield (Separation Scientific), Prof. Justiaan Swanevelder, and Dr Tamer Degheidy (Alliance Global). As part of this collaboration I was proud to partner with Lionel in the development of an international meeting entitled ‘Cardiology, Diabetes & Nephrology at the Limits’. This meeting arose as a means of celebrating the opening of the new Hatter Institute at UCT and took the form of a 1-day academic meeting which focussed on a range of diverse but highly important topics that challenged cardiologists, diabetologists, and nephrologists. The meeting proved so successful that it has continued unabated on an annual basis for the past 17 years and hopefully will continue for many more. Furthermore, the meeting now boasts partnerships with the Lancet and the Brigham & Women’s Hospital, Harvard Medical School.
To me he was a mentor and a friend. My closest association was as the Junior editor of Drugs for the Heart where I learned firsthand what a great medical author he was with his unbridled enthusiasm, attention to detail and passion for the project. His ability to explain mechanisms via detailed schematic diagrams is unparalleled in my view.
Lionel is undoubtedly one of South Africa’s premier medical scientists and he has been appropriately recognized for that. As an anecdote he is fond of telling, he states that I was responsible for his interest in clinical cardiology because his training was in Hypertension and Internal medicine. We used to live opposite each other, but the properties were divided by a stream called the Liesbeek River (somewhat euphemistically). The houses were quite far apart and there was no way to cross the river, so I when I saw him in his garden I would shout across the great divide and draw his attention to articles in the cardiology literature
doi:10.1093/eurheartj/ehw298
The Lionel Opie preclinical imaging core facility in Cape Town A state-of-the-art new imaging facility recently opened in Africa In October 2015, the long-life outstanding contribution of Professor Lionel Opie to Cardiovascular research was honoured in his country with the opening of the new Lionel Opie Preclinical Imaging Core Facility (LOPI) at the Faculty of Health Sciences, University of Cape Town, South Africa.
This new core facility is the first African Comprehensive Preclinical in vivo research facility, serving cancer, cardiovascular, and developmental biology researchers from across Africa housed at the Hatter Institute for Cardiovascular Research in Africa, Chris Barnard Building, Faculty of Health Sciences, Cape Town, and South Africa.
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by Professors Sandrine Lecour and Neil Davies, follows the longtime vision of Lionel Opie to make available a state-of-the-art imaging facility to contribute to research excellence (facilitate publications in peer-reviewed journals with high impact factors), knowledge, capacity building (including student training programmes), and translation from bench to bedside on the African continent. Most importantly, the equipment made available is non-invasive and as such, it will assist researchers in achieving ethical goals of reducing the number of animals used for research and refining the procedures performed on animals. Additional information about the new Core Facility can be found on www.lopi.uct.ac.za
The Vevo 2100 at the LOPI Core Facility The facility currently offers an in vivo small animal surgical room, a high-resolution in vivo micro-imaging ultrasound system that provides resolution down to 30 mm. In the next few months, the acquisition of a non-invasive fluorescent and biochemilumescent in vivo system will hopefully be made available in the facility. Accessible to any researcher, the vision of this new Core Facility, co-directed
doi:10.1093/eurheartj/ehw299
More than 10 000 kilometres travelled in less than a week! Roberto Ferrari discusses the European Society of Cardiology (ESC) Global Scientific Activities to India and Saudi Arabia in 2016
The 67th Annual Cardiological Society of India Congress The Cardiological Society of India (CSI) traditionally meets every year in December, rotating locations between the most important cities in India. In 2015, their 67th meeting was scheduled to be held in Chennai ( previously Madras), which is a delightful, vibrant city. Located on the Coromandel Coast off the Bay of Bengal, it is the largest cultural, economic, and educational centre in Southern India—the most visited city by foreign tourists and 38th most visited city in the world. The delegation from the ESC were all excited to depart, tickets purchased, and luggage packed when we heard that Chennai was experiencing the heaviest rains that Southern India had seen in over a century with devastating consequences and loss of human life. The CSI had to cancel the meeting involving over 5000 Indian
colleagues. From a personal point of view, such devastation is traumatizing. From a professional viewpoint, it is every congress organizers nightmare to have a catastrophe just days before the start of a meeting. The total financial loss in India after this weather phenomenon is estimated to have been over 7 million US dollars. I did not want to ask Dr Santanu Guha if he was insured. Of course, the ESC was distressed but happy to know that relief efforts were in place. In traditional Indian spirit, the meeting was re-scheduled in the same city 2 months later during 10 – 13 February 2016. This provided a much needed boost to the city. As agendas are always busy, some other ESC members had to be found to travel to Chennai, and we all re-booked our tickets (some may have even used the same luggage) and in February travelled to sunny Chennai. It was a pleasure for me to be there with Dr Biscaglia, an expert in interventional cardiology, and Dr Andreotti, an expert in acute coronary syndromes. The event was splendid with two large sessions integrating views on how to deal with heart failure with reduced ejection fraction and chronic ischaemia as well as
2298 acute coronary syndromes and intervention, particularly related to modern technology. The discussion was strong, as always, and there were numerous questions and different viewpoints and approaches to the same problem. We should not underestimate the different international healthcare systems and number of patients to be treated. Photos from the event are available at the following link: http://www.csi.org.in/ gallerynext9.htm. The hospitality was excellent, and the ESC Leadership had the opportunity to meet with the CSI Leadership and agree on five important points: † CSI participation in some of the ESC registries, particularly those on heart failure and atrial fibrillation. † CSI would consider the European Heart Journal Supplement—the Heart of the Matter as a journal to possibly publish the abstracts from their annual meetings (as other Affiliates already have). † CSI would like to invite an ESC Guidelines representative to liaise and comment on the Indian guidelines. † ESC speakers would appear in the India media during the next CSI congress, taking advantage of the common English language. † More importantly, a memo of understanding was agreed between the ESC and the CSI to promote and allow sponsorship for Indian cardiologists to attend the ESC Annual Congress. This is indeed a very delicate matter internationally, and not only in India, which will have to be regulated by the two scientific societies, and a memo of intention will be essential. Apart from the successful science, it is always a joy for me to return to the multi-coloured atmosphere of Chennai. The city has fully recovered from the recent disaster: the people are smiling, the car horns and motorbikes are still as noisy, and the dahl and curry are as delicious as always. I only stayed for a day and a half, but it was enough time for me to get my bindi!
The 27th Annual Saudi Heart Association Congress, 12 – 15 February 2016 I had to move quickly to catch the night flight to Riyadh to attend the 27th Annual Saudi Heart Association (SHA) Congress. What a jump! Firstly, there are very few, if any, direct flights and the first moment you realize that you are in an Arabic country is when you land at the busy airport in Abu Dhabi. They are planning to build another airport as the current one is, believe it or not, still not sufficient for the traffic that passes through it. No more dahl or curry but the Arabic breakfast fowl along with more international snacks. Off I go to Riyadh airport. On landing, I immediately notice the difference in colours. Chennai is multi-coloured, whereas the dominant
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colours in Riyadh are white ( for men) and black ( for women). The drive to the venue is through the desert instead of the palms in Chennai. Again the SHA chose the Ritz Carlton as the venue. It was previously a palace built by the King to accommodate international guests and . . . the international guests are treated like royalty. The entrance in the evening is truly spectacular with the fountains in front of the dominant white fac¸ade. The hospitality was impeccable, and the scientific levels improve each year. There were over 60 sessions, 17 tracks including Cardiac Surgery, Cardiac Anaesthesia & Critical Care, Cardiac Imaging, Echocardiography, Cardiac Nursing, Cardiac Technology, Electrophysiology, Preventive & Rehabilitation Cardiology, Heart Failure, Adult Congenital Heart Disease, Interventional Cardiology, Paediatric Cardiology, Fellows & Registrars Workshops, Research Workshops, and CPR. There was a larger ESC contingent as the SHA congress allowed us 2 full days. ESC President Prof. Fausto Pinto, Prof. Thierry Gillebert, Dr Matteo Bertini, and I had the pleasure of giving presentations to over 4000 delegates, packing the rooms to capacity. Besides the ESC delegation, there were many other ESC-related colleagues including Gunther Breithardt and Khalid Al Habib. The excellent level of science and technology that Saudi Arabia has reached was very evident this year. There was special focus on genetics and cardiovascular surgery and an important participation from the Cleveland Clinic as one of the ‘ventricles’ of the SHA (the other of course being the President, Khalid Al Habib), Prof. Hani Najm—has joined the Cleveland Clinic and is Chief of the Paediatric Cardiovascular Surgery department. The ESC President, Fausto Pinto, gave an enormous amount of presentations on various subjects and with his classic eloquence, promoted the success of the ESC to the maximum. A selection of the ESC contingent presentations is available on the ESC website (http://www.escardio.org/Congresses-&-Events/ Global-scientific-activities/Middle-East/Riyadh-KSA). Finally, the forthcoming ESC Annual Congress in Rome featured very prominently because the dates do not clash with Ramadan this year. There are also excellent flight links from the Saudi capital to Rome. I finished my last talk, there was just enough time to sample the cuisine one more time and then catch another night flight back to Italy . . .. What a week!
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doi:10.1093/eurheartj/ehw300
Saudi Arabia’s Mecca cardiac hospital describes how it copes with the Hajj The hospital’s Hajj Committee works year round to plan services for this large event Mecca’s cardiac hospital has described how it copes with the huge patient influx during the Hajj and gave details of the echocardiography service in an abstract presented at the 27th Annual Conference of the Saudi Heart Association (SHA). The conference was held on 12 – 15 February 2016 in Riyadh, Saudi Arabia. Experts from the European Society of Cardiology (ESC) Faculty presented a special programme on 13 February. ‘Planning ahead is vital for successfully delivering cardiac services during a large event like the Hajj,’ said abstract author Dr Mohamed Ali Hassan, a cardiologist at King Abdulla Medical City (KAMC) in Makkah (Mecca), Saudi Arabia. ‘Our hospital’s Hajj Committee works year round to ensure that we are prepared.’ Around 2– 4 million people attend the annual Hajj (pilgrimage) in Mecca, and medical services are provided free of charge. King Abdulla Medical City provides almost all cardiac care in Makkah, including during Hajj month when it treats 700 – 1000 cardiac patients. Of these, 60 – 70% are Hajj visitors. Most Hajj visitors who have a cardiac event are older than 65 years. Diabetes and hypertension are the most common co-morbidities. King Abdulla Medical City has a Hajj committee, which has monthly meetings at the end of one Hajj and convenes more frequently as the next Hajj approaches. The committee reviews the hospital’s performance during the previous Hajj season and identifies areas for improvement. It also collects information from the Hajj authority and Ministry of Health in Saudi Arabia, plus the Hajj missions of visiting countries. The most crucial piece of information is how many people are expected to attend. The second issue is which countries they will come from. ‘Hajj visitors come from more than 150 countries but the majority are from the Indian subcontinent,’ said Dr Hassan. ‘Knowing the main countries of origin helps us to have interpreters available, since language barriers are one of the difficulties we commonly face.’ King Abdulla Medical City asks its staff to come forward if they know other languages. Hajj missions, who are in charge of citizens from their country during the event, also help with interpreting. Additional doctors, nurses, echocardiography technicians, and information technology (IT) staff are recruited to work during the Hajj season. Dr Hassan said: ‘The good thing is that most of the extra staff work for us during the Hajj almost every year. So they know the hospital and they know what we need them to do. This helps us with
our preparations. It’s also important when there is a high volume of work to make sure that our IT systems are up to scratch and that any failure will be corrected immediately.’ The abstract described the additional demands on the hospital’s echocardiography service. The number of echo studies performed during the Hajj more than doubled between 2011 and 2015, from 318 to 708. Correspondingly, the number of echo machines deployed increased from 4 to 9 and the number of technicians increased from 7 to 13. Hajj missions can help during the event. ‘Hajj missions with the bulk of visitors tend to have medical services,’ said Dr Hassan. ‘Their doctors come to our hospital to see patients from their country, interpret, explain procedures and get consent for transoesophageal echocardiography and other procedures.’ He concluded: ‘Planning cardiac services for the Hajj goes on all year and becomes more intense nearer the time. To get ready for a large event, gather all the information you need for the service you will provide including demographic data about the people who will be coming. Make sure you have a reliable source of manpower. Specify the equipment you will need and how many staff are required to operate and maintain it. Things should run smoothly if you are prepared.’ Professor Hani Najm, SHA vice president, past president and head of international affairs, said: ‘Saudi Arabia and most of the Gulf countries continue to experience an increase in coronary risk factors and with the young population there would be a sharp increase of myocardial infarctions in the next decade. This calls for a wide and aggressive move to control these risk factors in order to avoid this tidal wave that may outstretch the resources available.’ Professor Roberto Ferrari, a past president of the ESC and course director of the ESC programme in Riyadh, said: ‘Delivering a high quality cardiac service requires teamwork. The ESC advocates setting up a ‘Heart Team’ of all the specialties, who come together to manage patients with cardiovascular disease. This team would need to be scaled up to deal with any anticipated rise in demand on the service.’ A. Tofield
CardioPulse contact: Andros Tofield, Managing Editor. Email: [email protected]
