VOL. 2 · NO. 2 · Pages 13-24, May 2003

P r o m o t i n g C a r d i o v a s c u l a r E d u c a t i o n , R e s e a r c h , P e o p l e a n d P l a c e s

E d i t o r i a l T e a mEditor:Ivan Berkowitz

Assistant Editors:Ian DixonLorrie Kirshenbaum

Editorial Board:Jaroslaw BarwinskyJohn DucasOtoni GomesSuresh GuptaKeld KjeldsenRicky ManPeter McLennanDennis McNamaraBohuslav OstadalArie PinsonGrant PiercePawan SingalBramah SinghRajinder SuriNobuakira Takeda

I n T h i s I s s u e

“Closing Global Cardio-vascular Research Gaps”

The American HeartAssociation

Report from India Meeting

The Burgeoning Cardiovascular DiseaseEpidemic

B.K. Sharma Honoured

K. Gopal Nair Honoured

Merck Frosst Canadabecomes CorporatePartner

Cardiovascular Education -Are We On The RightTrack?

Remembering SomeoneSpecial

Academy Meetings

n the last issue of the CV Network, Dr.Stephen Vatner wrote an eloquent articledescribing the need to promote cardiovascu-lar research on a global perspective. He

documented the growing disparity between medicalresearch in the United States and elsewhere in theworld. He described the problem particularly wellwith a figure depicting the geographic distributionof manuscripts received at Circulation Research.Medical researchers from the United States con-tributed the overwhelming majority of papers toCirculation Research. Western Europe, Japan andCanada lagged behind, but were still significantcontributors. Unfortunately, the rest of the world isfar behind in quality medical research contribu-tions. Asia (excluding Japan), South America,Africa, Eastern Europe and the Middle East are con-spicuous in their absence as major players in car-diovascular research.

As described by Dr. Vatner, the solution to the prob-lem is not an easy one. Ultimately researchrequires funding support. If medical research in

the cardiovascular field is to be stimulated in theseunder-represented parts of the world, two choicesare available: Either a) the individual countrieswithin this region must devote more resources tosupporting medical research or, b) the more activecountries (U.S., Japan, Canada and WesternEurope) must support the development of researchin these less active regions. With few exceptions,the first option is probably not available. Most ofthese countries simply do not have the financialresources to initiate and maintain a large cardio-vascular research effort. The second option there-fore, represents the most plausible one. Strategicinitiatives to stimulate an appreciation of cardio-vascular research across the globe should be wel-comed and supported enthusiastically within theUnited States, Japan, Canada and Western Europe.However, such ventures are unfortunately, not asnumerous as they should be.

The purpose of this article is to highlight an initia-tive undertaken by members of the InternationalAcademy of Cardiovascular Sciences to promote theappreciation and development of cardiovascularresearch in one of these areas that could contributemore to our understanding of cardiovascular dis-ease: The Middle East. Many of the countries with-in the Middle East have the financial resourcesavailable to support a significant research initiativein the area of cardiovascular disease. Part of thereason that a large research initiative has not beendeveloped from this area, in my opinion, is that anappreciation of the value of basic and clinical car-diovascular research has not yet been cultivated inthis region. Perhaps the best place to target andstimulate an appreciation of medical research is inthe front lines of health care: the medical students.If we can begin to pique their curiosity and engagetheir interest in the value of research, this may rad-

THE OFFICIAL BULLETIN OF THE INTERNATIONAL ACADEMY OF CARDIOVASCULAR SCIENCES

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EDITORIAL OFFICE: Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre,Faculty of Medicine, University of Manitoba

3006 - 351 Taché Avenue, Winnipeg, Manitoba R2H 2A6 Canada · Tel: (204) 228-3193 · Fax: (204) 233-6723e-mail the Editor: ivan@mts.net · Academy web site: www.heartacademy.org

Dr. Grant N. Pierce

The International Academy of Cardiovascular Sciences gratefully acknowledges the generous support of THE WINNIPEG FOUNDATION towards the publication of CV NETWORK

From the Director ofScientific Affairs

It is hoped that through examples of collabo-rative interactions like this more members ofthe International Academy of CardiovascularSciences can promote the scientific basis forthe practice of cardiology and cardiovascularsurgery on a global perspective. It is hopedthat this training will directly benefit notonly the clinicians in countries like Bahrainbut also the patients as well. It will also fos-ter the exchange of information among car-diovascular scientists in an internationalmanner. It is not insignificant to emphasizethat in these times of political unrest in theMiddle East any effort that scientists can doto promote friendly scientific and culturalinteractions should be supported andencouraged. It is through initiatives like thisthat we at the International Academy ofCardiovascular Sciences may achieve ourmission of promoting the cardiovascular edu-cation of both professionals and lay people toimprove medical research throughout theworld. It should also begin to address someof Dr. Vatner’s concerns regarding the widen-ing research gap in global cardiovascularresearch.

Grant N. Pierce, PhD, FACC, FAHA, FIACS,

Director, Division of Stroke & VascularDisease, St. Boniface Hospital ResearchCentre, Winnipeg, Canada

E-mail: Grant_Pierce@sbrc.ca

ways to stimulate interest in medicalresearch would be to encourage participa-tion of their medical students in a programlike the B.Sc. (Med.) Program at theUniversity of Manitoba. The Deans ofMedicine, Dr. Hossam Hamdy and BrianHennen and the two Presidents RafiaGhubash and Emoke Szathmary should becongratulated for their foresight and vision.They have recognized that this internationalcollaborative exchange is critical to thedevelopment of leaders and clinician scien-tists in the Gulf Region. One of the majorconcerns of a collaborative program such asthis is that the medical students that train inCanada will remain in North America and notreturn to their county of origin to transfertheir newly acquired skills to those in theirhome countries. This has certainly hap-pened with other countries like China wheremany of their scientists leave their homelandto receive training abroad and never return.However, this does not appear to be a con-cern for AGU. The students who have partic-ipated in the Program have enjoyed itimmensely but have already expressed astrong desire to return to practice in theirhome countries. It is significant because itmeans that the educational training thatthey receive in cardiovascular research has avery good chance of being transferred to oth-ers in the Middle East and stimulating awhole new generation of clinicians who havean appreciation (and hopefully a passion) forcardiovascular research.

ically change the way medical schools are runand health care is administered in this region.

To provide an example of a collaborative ini-tiative that may stimulate research in theMiddle East, it was my honour to travel toArabian Gulf University (AGU) in Bahrain tosign a Memorandum of Understandingbetween Arabian Gulf University and theUniversity of Manitoba. The initiative was sig-nificant. It formally acknowledged agree-ments between these two universities to initi-ate collaborative research endeavours and tosupport student exchanges. Specifically, theAgreement formally acknowledged a collabo-rative research interaction between theCollege of Medicine and Medical Sciences atAGU and St. Boniface Hospital ResearchCentre, within the Faculty of Medicine at theUniversity of Manitoba. AGU is an importantuniversity within the Gulf because it exists asa feeder school for a number of countries inthe area. Instead of simply recruiting its stu-dents from Bahrain, AGU also receives itsmedical students from Kuwait, Saudi Arabia,Qatar, Oman and many other countries withinthe Gulf. This leads to a very rich culturalexperience as well as a stimulating education-al environment in medicine. Last year, twoyoung medical students from the College ofMedicine and Medical Sciences at AGU cameto the Faculty of Medicine at St. BonifaceHospital Research Centre to participate in theB.Sc. (Med.) Program. This Program wasdeveloped over 40 years ago to provide med-ical students an introduction to research dur-ing two consecutive summers after their firstyear in medicine. Students work with theirsupervisor on pre-approved projects for threemonths the first summer and a further threemonths in the second summer before present-ing their data to their colleagues and facultymembers. If the students pass the program,they receive a B.Sc. (Med) Degree, upon com-pletion of their M.D. Degree. Many of themedical students that participate in thisProgram continue to do research during theirentire career as physicians. Thus, theProgram serves not only as a learning experi-ence regarding the importance of medicalresearch but also as a stimulus to continue asclinician scientists throughout their career.Perhaps predictably, the Program has pro-duced a large proportion of leaders in theirrespective fields over the years.

The significance of medical students fromAGU participating in this Program should beobvious. Medical research is just developingat AGU. They have recognized that one of the

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(from left to right: Dr. Hassam Hamdy, Dean of Medicine, Arabian Gulf University, Manama,Bahrain; Dr. Grant Pierce, Director, Division of Stroke & Vascular Disease, St. BonifaceHospital Research Centre, Winnipeg; Dr. Riyad Yousif Hamzah, Vice President, Arabian GulfUniversity, Manama, Bahrain.

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It is my pleasure to write this overview articleabout the American Heart Association (AHA) –an organization that many of you belong to. TheAHA is a national voluntary not for profit healthagency whose mission is to reduce disabilityand death from cardiovascular diseases andstroke. The AHA also has a major divisionknown as the American Stroke Association(ASA), which helps focus educational effortsabout stroke. We have more than 22.5 millionvolunteers and supporters who carry out ourmission in communities across the country. TheAHA’s National Center is located in Dallas,Texas. The 50 states and Puerto Rico are organ-ized in 12 regional affiliates. General informa-tion about the AHA and the ASA and about cardiovascular health, risk factors, and CV disease and stroke can be found at: www.americanheart.org

To help focus efforts, the association has adopteda strategic plan, which contains a strategic driv-ing force and year 2010 impact goal. The currentstrategic driving force, most recently updated bythe Board of Directors in February, 2003 reads:"Effecting change by providing information andsolutions for the prevention and treatment of car-diovascular diseases and stroke in people of allages, with special emphasis on those at highrisk." Our 2010 impact goal is to reduce coronaryheart disease, stroke and risk by 25%.

The scientific backbone of our organization isthe 13 scientific councils, which have about31,000 professional members. These include:

1) Arteriosclerosis, Thrombosis and VascularBiology;

2) Basic Cardiovascular Sciences;

3) Cardiopulmonary and Critical Care;

4) Cardio-Thoracic and Vascular Surgery;

5) Cardiovascular Disease in the Young;

6) Cardiovascular Nursing;

7) Cardiovascular Radiology and Intervention;

8) Clinical Cardiology;

9) Epidemiology and Prevention;

10) High Blood Pressure Research;

11) Kidney in Cardiovascular Disease;

12) Nutrition, Physical Activity & Metabolism;

13) Stroke

We also have recently started threeInterdisciplinary Working Groups (IWGs).These groups serve as a resource for topicalareas that are not covered by one of the coun-cils or that had been diffused through several ofthe councils. The three current IWGs areQuality of Care and Outcomes Research,Atherosclerotic Peripheral Vascular Disease,and Functional Genomics and TranslationalBiology.

Our new professional membership program,which is currently being rolled out, has fourmembership levels, including premium profes-sional, early career, student/trainee, and gener-al professional. An individual now joins theAHA and depending on the category of member-ship, can affiliate with up to two councils andone IWG. More information on membership cat-egories and on joining or renewing your mem-bership is available on our new web portal forprofessionals: www.my.americanheart.org Youwill also be able to see new additions for mem-bers to the website, such as textbooks, clinicalupdates, Facts and Comparisons drug databaseand other medical/scientific information.

Our councils and their science subcommitteesare responsible for writing scientific state-ments, recommendations and guidelines for theassociation. Statements are published inCirculation and/or one of the other official AHAjournals (Circulation Research, Stroke,Hypertension, and Arteriosclerosis,Thrombosis, and Vascular Biology). All of ourscientific statements and practice guidelinesare available online (go to the professional por-tal and click on the "library" or "practice guide-lines" tab.)

The association receives no government fund-ing – all of our income is from contributions,

special fund-raising events and bequests. Ourlargest single expense is funding research – inthe past fiscal year the AHA funded over $134million in cardiovascular/stroke research,bringing our total to more than one billion inthe past decade alone, and about $2 billionsince the research program started in 1949.The $134 million included 873 continuingawards and 1073 new awards in 48 states. Theassociation offers a variety of grants, awardsand fellowships at the national and affiliate lev-els. A listing of these, as well as applicationforms and deadlines can be found on the AHAprofessional website at: www.my.american-heart.org (click on the "research" tab).

The association holds multiple scientific con-ferences each year. Our annual scientific ses-sions is the largest meeting devoted to cardio-vascular disease. Held each November with30,000+ attendees, there are some 3,500-4,000abstracts selected from the approximately14,000 submitted. The annual InternationalStroke conference draws over 2,000 attendees,and continues to grow by about 10% per year.We have other annual conferences as well as"one time" conferences on specialty topics.Information on these meetings, abstract formsand deadlines, and registration forms can beobtained from the professional website.

Finally, the association is committed to increas-ing our focus on, and opportunity for, earlycareer investigators. There is a special programfor them on the day before the official start ofthe annual scientific sessions, as well as specialsessions geared to them held during some of theother AHA conferences. Early career clini-cians/investigators now sit on council leader-ship committees, the research committee, andother science-governing committees. We arealso working on an early career mentoring pro-gram, and a handbook for mentors and menteesis in development.

I hope this information has been helpful tothose of you who were not fully aware of theassociation and its activities. The InternationalAcademy of Cardiovascular Sciences will have abooth at AHA’s 2003 Scientific Sessions so thatour constituency will be able to learn moreabout you.

The American HeartAssociation

C H A L L E N G E S & O P P O R T U N I T I E S

by Kathryn A. Taubert, Vice President, Sciences andMedicine AHA National Center, Dallas TX

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The Fourteenth International Society of HeartResearch – Indian Section, Annual Conferencewas organized by Department of Cardiology,PGIMER, in Chandigarh February 7 – 9, 2003.The Conference was also sponsored by theInternational Academy of CardiovascularSciences.

It was a successful step in pursuit of the globalmission of containing the surging epidemic ofcardiovascular disorder. There was an urgentneed to initiate steps of mutual discussion, tak-ing ideas from benches of experimental laborato-ry to patient’s bedside; by sharing of ideas to pre-vent, reverse and/or reduce the development ofpremature cardiovascular diseases. The organiz-ers were Dr. Anil Grover (Chairman), Dr. RajeshVijayvergiya and Dr. Archana Bhatnagar(Organizing Secretaries), with Dr. Pawan K.Singal as the International Coordinator.

Academy Fellows from various parts of India andabroad participated in this conference. TheIndian experts included Professor N.K. Ganguly,Director-General ICMR, Dr. K.G. Nair, HeadHinduja Hospital, Mumbai, Professor K.K. Talwar,Head, All India Institute of Medical Sciences(AIIMS), New Delhi, and Professor S.K. Guptafrom AIIMS, New Delhi.International speakers included: Prof. MakotoNagano from Japan, Prof. Jasbir S. Juggi fromKuwait, Prof. G. Singh Chhatwal and Prof.Bernhard Maisch from Germany, and Prof. N.S.Dhalla and Prof. P.K. Singal from Canada.

The Conference was declared open by ProfessorS.K. Sharma, Director, PGIMER on February 7The Inaugural issue of the Indian Journal ofCardiology was released on this occasion. Thejournal included abstracts of this conference. AHindi book on "You & Your Healthy Heart" wasalso circulated.

During this two day conference, over 40 oral pre-sentations were made by various distinguishedspeakers from India & abroad. On Feb. 8, theP.L.Wahi Memorial Oration was delivered by Prof.N.S. Dhalla from Winnipeg, Canada. Prof. Dhallaspoke on "Role of renin angiotensin system in subcellular remodeling in congestive heart failure".The session was chaired by Dr. K.K. Talwar & Dr.N.K. Ganguly. This was followed by an interesting

session on endothelial dysfunction. Prof.N.K.Ganguly delivered a perspective lecture on"Gene polymorphisms/mutations in coronaryartery disease in young Indians."

The Berry Memorial Oration, an institute func-tion, was organized on Feb. 8. Professor S.K.Sharma, Director PGIMER, presided over thisfunction, which was attended by a very largeaudience. Professor Bernhard Maisch, arenowned cardiologist from Phillips University,Marburg, Germany delivered this oration. Hedelivered his talk on "InflammatoryCardiomyopathy - A multifaceted approach toaetiology, pathogenesis & treatment". The talkwas appreciated by the august gathering. Theoration was followed by lunch which was organ-ized in honor of Professor B. Maisch and otherdignitaries who attended this oration.

The other sessions on Coronary Artery Diseaseand Heart Failure were also well attended andequally appreciated. All distinguished guests werealso awarded a memento for oral presentation.

In order to encourage young scientists, a YoungInvestigator Awards Session was held. Six select-ed participants made oral presentations followedby questions from Jury. The Judges included -Prof. B. Maisch, Prof. Paresh Dandona, ProfessorV.K. Bhargava & Prof. C.C.Kartha. Dr. IdrisAhmed Khan was awarded first prize for hispaper on "Effect of roxythromycin in CAD: A casecontrol study". Ms. F. F. Eghlim, was awardedsecond prize for her paper on "Genetic determi-nants of hyperhomocystenimia".

Dr. Pawan Singal and Dr. S.K. Gupta presentedDr. Bal K. Sharma with the Academy’s annualMakoto Nagano Award in Chandigarh with Dr.Nagano assisting. Dr. Gopal Nair received theAcademy’s Howard Morgan Award, presented byDr. S. K. Sharma and Dr. M. Nagano. At this galaevening, the P. L. Wahi Memorial Award waspresented to Dr. N. S. Dhalla by the organizers inappreciation of his help to the Conference as wellas to the Institute.

During this conference, 48 posters were dis-played. Awards were given to two best posters oneach of the two days.

Awards for poster presentation on Feb. 8 were:

1st: Reversal of "slow" or "no reflow" during

Academy Sponsored ISHRINDIA Annual Meeting

P E O P L E A N D P L A C E S

percutaneous transluminal coronary angio-plasty wing boluses of infracoronary drugs.K. H. Parikh, K. Mehta, M. C. Chag et al.

2nd: Time course studies on the initiation ofacute myocardial infarction and comple-ment fixation in Albino rats. M. Sumitra, P. Manikandan, MohammedNayeem et al.

Awards for poster presentation on Feb. 9 were:

1st: Vitamin A in Adriamycin - induced heartfailure. I. Danielson, T. Sudha, H. Lou, P. K.Singal et al.

2nd: Development of sustained release oraldosage form of trimetazidine dihydrochlo-ride using hydrogen microspheres. S.S.Agarwal, Anu Shilpa & Alok R.Roy.

A Banquet was organized on Feb. 8. Over 350 peo-ple enjoyed this dinner and cultural programwhich included typical Punjabi music andBhangra dance. This evening was held in thebeautiful setting of Chandigarh Golf Club.

by Archana Bhatnagar, Chandigarh, India

ACADEMYto sponsor

International Symposiumon Pharmacotherapy

of Heart Failure

New Delhi, IndiaJan. 7 - 8, 2004

Inquiries: Dr. Suresh K. Gupta,All India Institute of MedicalSciences, Department ofPharmacology,Ansari Nagar, New Delhi,110 029, India

Tel: +91-11-2658-9691Fax: +91-11-2686-2663E-mail: skgup@hotmail.com

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The burgeoning epidemic

Cardiovascular diseases (CVD) account for11% of the global burden of disease and33% of global deaths. Three-fourths of thismorbidity and mortality are from low andmiddle income countries. It is projectedthat by the year 2020, there will be 25 mil-lion deaths due to CVD, 19 million from lowand middle-income countries. Urbanisationassociated with adoption of adverse lifestyles and increasing life expectancy areimportant factors contributing to the epi-demic. The social and economic impact ofthe CVD burden in low and middle-incomecountries is particularly severe as a sub-stantial proportion of deaths due to CVD inlow and middle-income countries are pre-mature (figure 1).

According to first ever global analysis ofimpact of risk factors on global health con-ducted by the World Health Organization,major cardiovascular risk factors hyperten-sion, elevated cholesterol and tobacco useare the top 10 risks to global health even inhigh mortality developing countries (figure2). More than three-quarters of CVD is dueto these risk factors. Overall, elevatedblood pressure causes 7 million prematuredeaths a year, tobacco use causes almost 5million and elevated cholesterol more than4 million (figure 3).

Although scientific evidence indicates thatheart attacks and strokes can be halvedthrough population wide and individualprevention strategies, 32 million heartattacks and strokes occur every year;three-fourths of them in low and middle

income countries. About 12 million suc-cumb to the first attack and the remainderrequire long-term treatment to preventrecurrent attacks and death resulting in adevastating socioeconomic impact on fam-ilies, communities and governments. Fewrisk factors explain these life-threateningconditions. In the case of ischemic heartdisease about 49% of it is due to subopti-mal blood pressure, 36% due to high cho-lesterol, 31% due to low intake of fruit andvegetables, 22% due to tobacco, 21% dueto a BMI above 21 kg/m and 22 % due tophysical inactivity (figure 4). Similarly inthe case of stroke, 62% of it is due to sub-optimal blood pressure, 18% due to highcholesterol 11% due to low intake of fruitand vegetables and 22% due to physicalinactivity (figure 5).

Taking concrete action to improve thehealth outcomes of 32 million people whodevelop heart attacks and strokes is amajor challenge. An even more urgentchallenge is the task of addressing thehigh cardiovascular risk of an estimated 2billion of the world population due totobacco use, physical inactivity, unhealthydiet, overweight, diabetes, hypertensionand high lipids singly or in combination.An estimated 1.3 billion due to tobacco usealone, 1 billion due to overweight (300 mil-lion of them obese) and at least anotherbillion due to hypertension, diabetes andhigh cholesterol. A substantial proportionof major cardiovascular events could beprevented if preventive action is taken toreduce the cardiovascular risk of these

C H A L L E N G E S & O P P O R T U N I T I E S

The burgeoning CardiovascularDisease epidemic in low andmiddle income countries:Urgent need to implementwhat is known.by Shanti Mendis, Coordinator, Cardiovascular Diseases, World Health Organization, Geneva, Switzerland

Figure 1

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individuals through an appropriate mix-ture of population wide and high riskstrategies.

What type of strategies have beenshown to be effective?

Indiscriminate increase in resources forhigh technology CVD care will neitheryield desired results nor be sustainable inthe long-term for most of these countries.

As the World Health Report 2002 demon-strates individuals are at risk of developingstroke and IHD even at blood pressure andcholesterol levels previously consideredbelow normal; systolic blood pressure of>115 mm Hg and total cholesterol levels of>3.8 mmol/l. These optimal levels cannotbe obtained in an equitable way throughcurative care alone as medications arecostly and risks may outweigh the benefitswhen drugs are used at these levels.Therefore curative care by itself, does nothave the potential to control the CVD epi-demic particularly in low and middleincome countries.

For example, in the case of blood pressureabout 15-25% of the population have bloodpressure levels above 140 mmHg . When ahigh risk approach is used only these indi-viduals at the tail end of the populationrisk distribution are targeted (figure 6).But twice as many heart attacks andstrokes occur in those with blood pressure

risk factors. For example, increased pricesthrough taxation, combined with a ban ontobacco advertising, better access tosmoking cessation and bans on smoking inpublic places have led to declines in smok-ing rates in several countries. Other costeffective interventions such as nationalhealth education campaigns that increaseconsumption of fruits/vegetables reduceblood cholesterol; interventions to reducesalt consumption through health educa-tion, legislation or voluntary agreementswill help to shift the blood pressure andlipid distribution of the entire populationto more optimal levels. These preventivemeasures, if effectively implemented, havethe potential to impact on millions.Implementing them however requirescomplex alliances led by governments butdrawing upon the full range of partnersthat comprise professional organizations,private sector and civil society.

In addition to management of cardiovascu-lar risk through a combined approach asreferred to above, if cost-effective second-ary prevention interventions can be madeavailable and accessible to those withestablished CVD, two-thirds to three-quar-ters of future vascular events can be pre-vented in developing countries. Given theabove robust evidence on what is cost-effective, developing countries can deploylimited resources more effectively by iden-tifying and reallocating inefficient andwasteful expenditure devoted to ineffec-tive high technology CVD management. It

levels between 115-140 mmHg. The onlyviable way of lowering their blood pressureto more acceptable levels is throughaffordable and sustainable populationstrategies. Similar reasoning applies to theneed for combined population wide andhigh risk approaches to control of choles-terol levels.

It is estimated that such a combinedapproach could have population-leveleffects exceeding a 50% reduction in car-diovascular events. Many population widestrategies have been shown to be very costeffective in reducing the level of individual

Figure 2

Figure 3

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is imperative that some of these resourcesbe reassigned for strengthening of primaryhealth care for delivery of CVD care equi-tably.

What is hampering progress?

Lack of progress in prevention and controlof the CVD epidemic is certainly not due tolack of knowledge and scientific evidenceabout what works to prevent CVD.

There is strong scientific evidence aboutwhat works to prevent CVD. Massivedeclines in CVD mortality in Finland (fig-ure 7), the United Kingdom, USA andAustralia show that a combination of riskfactor control and effective treatment canmake a significant difference. However,several important factors are hamperingthe progress in CVD control activities par-ticularly in low and middle income coun-tries. Failure of governments in prioritis-ing prevention, lack of investment instrategies that have the most cost-effec-tive impact and the influence of powerfulcommercial interests that block progressare some of them.

As exemplified in tobacco industry docu-ments that became public after the USAlitigation of the late 1990’s, industry canresort to a variety of covert measures toavoid public health action in order to pro-tect profits. Further, both tobacco andmultinational fast food chains that arelooking for profits all over the developingworld often advance powerful arguments

through the media on individual freedom.This is an effective way of misleading theyoung and the public at large. They whoadvance such arguments choose to ignorethe fact that choice has little meaningwhen advertising campaigns target minorsand uninformed or illiterate adults whoare unable to gauge the future health risksassociated with the products that are pro-moted. A full range of policy responses arerequired to overcome the powerful andglobalized marketing and production cam-paigns of the tobacco and food industries.Regrettably, the capacity and resources forthis response are limited in low and middleincome countries and over 57% of coun-

tries have no cardiovascular health policy,and 65% have no national cardiovascularprogrammes. International collaborationand North-South links have to be strength-ened to help low and middle income coun-tries to build national capacity to respondto the colossal challenges of the CVD epi-demic.

Finally, in many populations in the devel-oping world low levels of literacy, genderinequality and poverty are major con-straints for prevention and control of CVD.One billion people in the world who live onless than 1 dollar a day are deprived ofopportunities for education, prevention ofillness as well as health care. InSeptember 2000 at the United NationsMillennium Summit, world leaders agreedto a set of time-bound and measurablegoals and targets aimed at combatingpoverty, hunger disease, illiteracy environ-ment degradation and discriminationagainst women. To guarantee chances ofsuccess, it is imperative that CVD controlstrategies and programs in developingcountries be placed within the context ofother government programmes thataddress these fundamental developmentgoals related to alleviation of poverty, illit-eracy and gender inequality.

WHO activities

The World Health Report 2002 provides sci-entific and economic information that pro-vide strong justification and legitimacy forFigure 4

Figure 5

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bold policy decisions for risk managementby governments. The World HealthOrganization has stepped up its activitiesfor prevention and control of cardiovascu-lar diseases. It is targeting the main riskfactors of cardiovascular disease throughglobal action such as the FrameworkConvention on Tobacco Control and thedevelopment of the global strategy on diet

and physical activity. National surveillancesystems for key risk factors have beenstrengthened through standardizedapproaches. In addition, regional net-works are been established to strengthencapacity and advocacy for prevention andcontrol of noncommunicable diseases atcountry level. Further, WHO has also initi-ated a multi-country program to scale-up

secondary prevention of major cardiovas-cular diseases within the WHO'sInnovative Care for Chronic Conditionsframework and is also in the process ofintroducing a cost effective cardiovascularrisk-management package into lowresource settings.

E-mail: mendiss@who.ch

Figure 6 Figure 7

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"Rare Honour for Dr. B. K. Sharma"Dr. B. K. Sharma, a former Director of thePGI, was honoured with the Makoto NaganoAward at a combined meeting of theInternational Academy of CardiovascularSciences and the Indian Chapter of theInternational Society for Heart Researchheld at the PGI recently.

The award is constituted by theInternational Academy of CardiovascularSciences in the name of the well known

Japanese medical scientist Dr. M. Nagano.Another Indian cardiologist, Dr. K.G. Nair,was also honoured.

Dr. B. K. Sharma has been given this awardfor his consistent research work and teach-ing in the field of cardiovascular medicine,especially hypertension. He has been work-ing in the field of hypertension for the pastthree decades and has published numerouspapers in this field. He has especially done alot of research on a disease known as"Takayasu Arteritis", a disease which wasthought to be prevalent in Japan but seemsto occur in India also with great frequency.

Because of this he has had a long collabora-tive research with well known Japanese doc-tor Fujio Numano. He was invited to Japanalmost annually during the past decade. Healso had a collaboration with the Institute ofCardiovascular Sciences, University ofManitoba, Winnipeg, Canada. Incidentally,

Dr. Nagano from Japan and Drs. NaranjanDhalla and Pawan Singal from Winnipegwere also present on the occasion.

Readers will be familiar with Dr. Sharma’shealth column "Keeping Fit" in The Tribune,running well over two years.

Bal K. Sharma2003 Makoto Nagano Award Honours

reprinted from The Sunday Tribune, Chandigarh, India, February 16, 2003

www.heartacademy.org

Visit The Academy At:

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P E O P L E A N D P L A C E S

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As a highlight of the meeting co-sponsoredby the Academy in Chandigarh, India, Feb. 7 – 9, K. Gopal Nair was presented withthe second "Howard Morgan Award forDistinguished Achievements inCardiovascular Sciences".

Dr. K. G. Nair was born in 1931 in Kerala, buthe had most of his education outside theState. He studied in St. Vincent’s HighSchool, Pune, where he topped the class andhe later on did his Inter-science from theFergusson College where he was first in hisclass and won many prizes. He then went onto Seth. G. S. Medical College where he didhis M.B.B.S. and M.D. He had a distin-guished academic career winning manyprizes and obtaining record marks at thefinal examination. He went on a RotaryFoundation Fellowship to the famousMassachusetts General Hospital in Bostonwhere he did his Cardiology Fellowship in1956-57 under the famous Dr. Paul DudleyWhite. Even as a post-graduate student, hewas quickly invited to become an AssistantProfessor at the Harvard University. He wasa pioneer in Vector-cardiography. He spent12 years in USA mainly at the University ofChicago where he obtained his Ph.D. inPhysiology. His work was on the now known2nd messenger, cyclic AMP. He was the first

to purify the enzyme hydrolyzing cyclic AMP.The presentation on this subject attractedwide attention in the USA. Dr. Nair went onto the renowned National Institute forMedical Research in London where he didpioneering work on ribosomes. He thenreturned to the University of Chicago wherehis first article on this subject appeared in‘Nature’. He then took up the subject of themolecular basis of cardiac hypertrophy. Heis internationally recognized as the first per-son to study this subject in this manner – asearly as 1963. Important publications on thissubject have appeared in ‘CirculationResearch’. For his original and brilliantwork he was awarded the United State’sP.H.S. award for 5 years.

Dr. K. G. Nair returned to India in 1971 as theProfessor Director of Medicine and the Headof the Department of Cardiology at his ownalma mater Seth. G. S. Medical College andK. E. M. Hospital. He started the first DMCardiology program in Maharashtra.Simultaneously he set up the first Ph.D. pro-gram in Applied Biology. At the K. E. M.Hospital he was widely known for his aca-demic activities and was easily the best clin-ical teacher. After 10 years of services Dr.Nair joined the Jaslok Hospital and later theP. D. Hinduja National Hospital. In additionto being an Honorary Cardiologist at theseplaces, he was the Director of Research atthe Hinduja Hospital. At the HindujaHospital he set up one of the best researchlabs in the country. It is at this place that heworked on allopurinol and adenosine in car-diac surgery. His was the first paper to showby using Electron Spin Resonance methods,the protective role of Allopurinol and

Adenosine in bypass surgery.

Other research activities include:

• Role of taurine in cardiomyopathy,

• Homocysteinemia in endothelial damage,

• Genetic mechanisms in hyperlipidemia, and

• Polymorphisms in the ACE and angiotensinogen gene.

Dr. K. G. Nair has been the President of theAPI, CSI and several other societies nation-ally as well as internationally. Currently heis the President of the Indian Section of theInternational Society for Heart Research. Hehas to his credits more than 200 publicationsin national and international journals. He isa contributor to several textbooks includingthe Oxford Textbook of Medicine. He hasgiven many orations and won many awards.

Currently Dr. K. G. Nair is the MedicalDirector of Breach Candy Hospital and theChief Executive of the Breach Candy MedicalResearch Centre.

Recently Dr. Nair was awarded theFellowship of the European College ofCardiology. He is a Fellow of the AmericanCollege of Cardiology and the PhillipineCollege of Cardiology and in November lastyear he was honoured by the ChineseAcademy of Medical Sciences. He is also oneof the very few persons in medicine, who is aFellow of the Academic Sciences, Bangalore.

At the Mapicon meeting in Bombay he wasrecognized by the API as one of the most dis-tinguished teachers of Maharashtra.

Dr. Nair is also known as a brilliant clinicianand he is an excellent bedside teacher of car-diology.

K. Gopal Nair

P E O P L E A N D P L A C E S

2003 Howard Morgan Award Honours

by Ivan Berkowitz · Winnipeg, Canada

❤

Dr. Naranjan Dhalla, C.E.O., is delighted to announce a new association with MerckFrosst Canada which agreed:

"To support the development program with young professionals in developingcountries, directed by the Academy of Cardiovascular Sciences. The Academy’splans to assist these young professionals in academic endeavors, including furtherscientific training, is a worthwhile one and falls within our corporate mission."

MERCK FROSST CANADA is Corporate Partner of the ACADEMY!For additional details on the corporate development programs, please contact:

Ivan Berkowitz, Director of Development

Telephone: (204) 228-3193

E-mail: ivan@mts.net

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Cardiovascular Education:Are We On The Right Track?

C H A L L E N G E S & O P P O R T U N I T I E S

by Pallab K. Ganguly, Department of Anatomy, Arabian Gulf University, Kingdom of Bahrain

The recent explosion in scientific and profes-sional knowledge, the growing realization of theneed for health promotion, disease prevention,effective utilization of the research-based dataand global efforts for cost saving program haveplaced new demands on the education of the car-diovascular community of the 21st century.Medical education must, therefore, equip thestudents, researchers and physicians with theknowledge and the skills necessary for criticalappraisal, clinical reasoning, and problem solv-ing, continuing self-study and practicing evi-dence-based medicine. Although the task is diffi-cult particularly at the global perspective, theInternational Academy of CardiovascularSciences can take an effective role in promotingcardiovascular education at various levels oforganizations of the health care system. It is nec-essary at this stage to redefine the goals andobjectives of cardiovascular education so thatthe Academy can monitor the planning andimplementation of some of the critical issuesrelated to cardiovascular sciences. We should bemore active in promoting excellence in cardio-vascular education so that health care is deliv-ered at the highest standards without compro-mising specialty training in the field of cardio-vascular sciences.

CARDIOVASCULAR EDUCATION: WHERE CAN WE HELP?

1. Undergraduate curricular developmentIn spite of the fact that many of us are activelyinvolved in undergraduate teaching, we tend toshy away from curricular development. Weshould be part of the overall philosophy, goalsand objectives of a medical program so that weunderstand the pitfalls of the system. We shouldknow the scientific validity of the new conceptsand recent developments of medical educationin order to fine tune the existing cardiovascularprogram. For example, one can consider the car-

diovascular sciences within the integrated prob-lem based learner-directed learning (PBL) cur-riculum. Several important changes and develop-ment were introduced in various medical col-leges throughout the world. The PBL curriculumwill help to acquire clinical, psychomotor andlaboratory skills related to cardiovascular systemin an effective way. The students are divided intosmall groups with a tutor for each group, whoworks as a facilitator, rather than an instructor,to help the students learn by solving the prob-lems in the cardiovascular system. It may bepointed out that the essential characteristics ofPBL also include the development of the skills ofself-assessment.

2. Introduction of better system of evaluationfor students, faculty and curriculum

A global effort has been made establishing crite-ria for a better system of evaluation for students,faculty and curriculum. The cardiovascular com-munity must be aware of the various centers ofthe world who are leading the way in this rapidlydeveloping domain.

3. Medical practice along the evidence-basedmedicine

If it is a duty of every practitioner to evaluatenew development critically, then evidence-basedmedicine requires new skills for decision-mak-ing, including efficient literature search and theapplication of formal rules in evaluating scientif-ic literature. Medical practitioners have aresponsibility to learn some basic interpretiveresearch skills and should identify the researchevidence upon which their practice is based.

4. Understanding of the community orientedhealth problems

Care must be taken to address the preventiveaspect of some of the cardiovascular diseasesparticularly in relation to the need of the devel-oping world.

5. Distance learning and participation in car-diovascular research programs

We should not forget that E-learning is integral toour day-to-day activities. We must develop con-tact so that we are in a position to carry out car-diovascular research activities in a state-of-the-art way. For that reason, it is often unnecessaryto duplicate research while the innovative ideascould be still refined through distance learning.

6. Strengthening basic sciences programleading to M.Sc. and Ph.D. in cardiovascularsciences

Perhaps the time has come when the leadingInstitutes must offer and pursue graduate pro-grams in Cardiovascular Sciences. Once again,the program needs a careful thought process.

7. Faculty development program via continu-ing education and workshop

The activities related to this program are essen-tial if we are to survive in this rapidly developingworld.

8. Participation in comprehensive healthcareplanning and resource management relatedto cardiovascular sciences

This can only be achieved if our politicians hearour ideas. Our active participation in the man-agement, therefore, is pivotal to healthcare plan-ning in relation to cardiovascular sciences.

9. Ethical aspects of cardiovascular research

Organ transplant, stem cell research, gene ther-apy involve ethical aspects. The Cardiovascularcommunity is certainly not immune to those eth-ical aspects. Although there is no clear answer inthis issue, we have to respect the opinion partic-ularly when it involves human research.

10. New discovery and the patients’ aware-ness

If our main aim is to provide the best health caresystem to our patients, then we all have theresponsibilities so that each and every patient ofthe 21st century should know what is going on incardiovascular research. Such communicationundoubtedly is key to the success of our modernmedicine.

ARE WE ON THE RIGHT TRACK?

The 21st century professionals must be able toadapt to change, for learning how to reason criti-cally, for delivering a holistic approach to medi-cine and also for participating in education by cut-ting across his/her own boundary. Each one of uscan identify our strength/weakness allowing us tomeasure whether or not we are on the right track.The Academy may provide crucial information towhich some of the expectations can be met. ❤

23

Peter Harris was not only the doyen ofinternational cardiology but also was agreat human being who believed in andhelped young people to achieve their

On a personal note, His Royal Highness(as I always addressed him) will beremembered for a long time.

potential. He was highly skillful in blendingcardiovascular education, research andpractice, and the Academy will continue topromote his vision.

Peter HarrisR E M E M B E R I N G S O M E O N E S P E C I A L

by Inder Anand, University of Minnesota, Minneapolis, USA

Peter Charles Harris was born in 1923 to Davidand Nelly Harris, an electrical engineer and ahomemaker. He recognized and honored hislove for art, literature and all things beautifulas bequests of his heritage. His father too was agifted artist. Till the very end, Peter tendedwith the characteristic warmth and dedicationof his mother, the roses he had transplanted ather death, from her home to his garden inIslington, London. His initial education was atSt. Olaf’s Grammar School and as a sciencescholar at the Kings College, London. He quali-fied in medicine at Kings College Hospital in1946 where he became a house surgeon beforemoving to the Brompton Hospital as housephysician. He obtained his MD degree in 1951winning the University Gold Medal and his PhDin 1955. This was followed by a two yearNuffield fellowship with the Nobel LaureateAndre Counard, at Bellevue Hospital andColumbia University, New York, USA. On hisreturn to the UK, he was appointed lecturer in1957, and reader in medicine, in 1962, at theBirmingham University.

Prof. Harris committed his life’s work to explor-ing the cardiovascular system and the origins ofheart disease, greatly advancing knowledge,and pioneering and facilitating radical newmodalities of research and treatments in thefield. In the early stages of his career he uti-lized established methods of hemodynamic

tain sickness. This lethal condition affectedHan infants born in the plains of China andbrought to live at high altitude. He believed thesyndrome demonstrated the evolutionaryprocesses involved in pulmonary circulation topromote the survival of the species.

In 1970, he organized a meeting of theEuropean section of the international studygroup for research in cardiac metabolism whichresulted in the publication of Calcium and theHeart, a work of enormous significance andinfluence in the field of cardiology. The studygroup laid the foundation of the InternationalSociety of Heart Research, whose President hewas from 1981-83. In 1986, the Society createdthe prestigious Peter Harris Award forAchievement in Research.

After his retirement, he moved to Venice to editthe journal Cardioscience. Venice also offeredhim the opportunity to further his appreciationof art and nurture his immense facility to paint.He was able to complete his book on the Bricksof Venice and had all but the final chapter of hisbook on the Angels to be completed. Besides,he was a musician of talent, playing the violinwith dexterity. He was also an able writer. Hiswritings spoke of his evolved sensibilities, sharpwit and humor.

‘Prof’ as he was fondly known, succumbed tocancer on December 11, 2002 surrounded by hisfamily. For the last quarter of a century hiswork and persona had been a vital presence inthe world of cardiovascular medicine andresearch. His life lived with verve, in worth andsubstance, greatly enriched all those in hisassociation.

Peter Harris is survived by his wife Francesca,daughters Sophie and Libby, brother David, sis-ter Dorothy, stepsons Mark and Rick, andeleven grandchildren.

measurements to explore the pulmonary circu-lation and metabolism of the heart muscle.These studies culminated in the monographThe Human Pulmonary Circulation co-authoredwith his colleague and dear friend DonaldHeath. It still remains the authoritative text onthe subject.

In 1966, he was appointed to the first SimonMarks British Heart Foundation Chair ofCardiology at the University of London. By nowhe was veering to the view that the future ofcardiovascular research lay in the physiologyand biochemistry of the abnormalities of theheart muscle. Starting with one room and askeletal staff of a single technician and a secre-tary, over the years Peter Harris’s laboratorybecame a focal centre for the study of theunderlying physiology and biochemistry ofheart disease. The number of clinical cardiolo-gists and scientists in vantage positions allaround the world and in whose work and liveshe still remained involved, bear witness to hisresearch acumen and teaching abilities.

In his St. Cyres lecture in 1986 he argued thatthe origins of clinical heart failure lay in ancientreflexes established by an evolutionary processto promote maintenance of the arterial bloodpressure. An intense intellect and enthusiasmfor learning made him an inveterate traveler.This together with his interest in pulmonary cir-culation led him to the Andes, Ladahk and Tibetto research animals and man at high altitude.His study of the blood flow to the lungs of theyaks showed that they had adapted geneticallyto high altitude by eliminating the vasocon-strictor response to hypoxia. An examination ofcross breeds with cows, the dzo and stolsrevealed that this characteristic was transmit-ted as a simple autosomal dominant.

In 1988, Prof. Harris described a new diseaseoccurring in Tibet, sub acute infantile moun- ❤

Academy pays highest tribute to its FellowQuote from Naranjan S. Dhalla, Executive Director, International Academy of Cardiovascular Sciences

ACADEMYto sponsor

Joint InternationalConference with

International Societyfor Heart Research

(Indian Section)

Encouraged by the great success ofthe 2003 meeting, Prof. V. K. Puri

has announced plans for the confer-ence entitled; ‘Coronary Artery

Disease - Molecule to Man’ to beheld from January 9-11, 2004 in

Lucknow, India.

Inquiries: Prof. V.K. Puri, Head,Department of Cardiology, King

George's Medical College, Lucknow-226003, INDIA.

Phone & Fax: +91-522-2255830;

E-mail: vijaykurmarpuri@hotmail.com& aniket@sancharnet.in

24

Chairman:Dr. Otoni M. GomesR. José do Patrocínio, 52Santa Mônica - Belo Horizonte, MG,Brazil - 31.525-160 Tel. / Fax: (55) 31 3452.7143 E-mail:servicor@servicor.com.br

WEB SITE:www.heartconference.com

The Symposium is being organized byMasaryk University in cooperation withthe Academy of Sciences of CzechRepublic, the Slovak Academy of Sciencesand the Czech Cardiological Society, andsponsored by the International Academyof Cardiovascular Sciences, August 26 – 29,2003, Brno, Czech Republic.

GENERAL INFORMATION:

Venue: Abbey of St. Thomas, Mendel Square 1, Brno, Czech Republic

Date: August 26 – 29, 2003Language: EnglishAccommodation: Hotel Voron · 10 minutes walking distanceInformation: morwen.rect.muni.cz/conference/E-mail: braveny@med.muni.cz

majka@med.muni.czSee also: www.mendel-museum.org

From Basic Science to Clinical Perspectives

From Basic Science to Clinical Perspectives

The IV International Symposium on MyocardialCytoprotection will be held in Pecs, Hungary,September 25-27, 2003.

The Department of Experimental Surgery and ExperimentalSection of the Hungarian Society of Cardiology will organize the Symposium in collaboration with: International Academy of Cardiovascular Sciences.

• 2003 Scientific Secretariat: Prof. Dr. Elizabeth Roth,University of Pecs, Faculty of Medicine,Department of Experimental Surgery, Kodaly Z. str.20,H-7624 Hungary; Fax:36-72-535821;

• E-mail: zsoka@expsurg.pote.hu• Web Site: http://expsurg.pote.hu/ismc2003s