Pioneer in Cardiology: Philip Poole-Wilson, MA, MD,...
Transcript of Pioneer in Cardiology: Philip Poole-Wilson, MA, MD,...
Philip Poole-Wilson, emeritus professor of cardiology at the National Heart and
Lung Institute in the Faculty of Medicine of Imperial College, London, UK, honorary
consultant physician, Royal Brompton Hospital, formerly British Heart Foundation
Simon Marks Professor of Cardiology, and past president of both the European Society
of Cardiology and the World Heart Federation, talks to Barry Shurlock, MA, PhD.
European Perspectives in CardiologyEuropean Perspectives in Cardiology
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Circulation March 3, 2009
Pioneer in Cardiology: Philip Poole-Wilson, MA, MD, FRCP, FESC, FACC, FMedSci
“I Am Pleased to Have Had a Part in Introducing the
6-Minute-Walk Test for the Assessment of Heart Failure”
Gowns flapping, morning lectures, practicals, rugby in
the afternoon, Latin grace, calling tutors “Sir,” Beyond
the Fringe in New York, NY, the Cuban Missile Crisis, the
assassination of US President John F. Kennedy, and cardio -
logists down the road in Addenbrooke’s Hospital,
Cambridge, UK, with little
more than a stethoscope and an
electrocardiograph. A young
man in this scenario of
Cambridge, England, in the
1960s, Philip Poole-Wilson,
MB, BChir, MA, MD, FRCP,
FESC, FACC, FMedSci, now
occupies a world in which
medics wear open-necked
shirts and swap first names
with patients, in which science
and medicine have become
bedfellows, and in which car-
diologists have a huge and
ingenious technology available
to them. Professor Poole-Wilson,
emeritus professor of cardiology
at the National Heart and Lung
Institute in the Faculty of
Medicine of Imperial College,
London, UK, has thus experi-
enced a technical and social
revolution during his lifetime. From the confines of a tradi-
tional English education, his professional career has led
him to straddle the world, though he quips, “I haven’t been
to Antarctica or the Galapagos Islands—but I don’t sup-
pose I’ll get there now.”
Professor Poole-Wilson has had one of his most fruitful
overseas links with India, from where he recently returned.
He delivered 6 lectures, met many fellow researchers, and
spent several days working on a new project on heart
failure—the origins of symptoms, activation of the inflam-
matory system in untreated
disease, prevalence and
causes, and the prevalence
and detection of rheumatic
heart disease in school chil-
dren. He knows India well
and believes the country has
huge potential and a great
future. He says, “I don’t think
Europe and the developed
world in general appreciate
the speed with which other
parts of the world are catch-
ing up. There are some very
clever people in India and
China—the genes go back a
long way and are definitely
there! The West has had a
huge advantage since the
17th century, and if we don’t
get the necessary structures
in place, we will decline.”
“I Decided a Career in Pure Physiology Might Be
Difficult and Switched to Medicine”
Although Poole-Wilson came from a medical family (his
father worked as one of the first genitourinary surgeons in
England), he went to university with the intention of
Photograph of about half the members of the undergraduate Part
II Physiology class of 1963 at Cambridge University, Cambridge,
UK. Professor Poole-Wilson (third from right) says “I decided a
career in pure physiology might be difficult and switched to medi-
cine.” Despite never studying biology at school, he managed to
obtain an exhibition at St Thomas’ Hospital Medical School,
London (on the south bank of the River Thames, opposite the
Houses of Parliament) on the condition that he obtain the then-
necessary A-level (junior qualification) in biology (“including
botany!”) and “mug up” on anatomy. He qualified as a doctor in
1967. Photograph courtesy of Professor Poole-Wilson.
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“A Breadth of Ideas and a Very International View
That I Would Never Have Found in London”
For his MD (in the UK equivalent to a PhD), granted at the
University of Cambridge (but with research at St Thomas’
Hospital), Poole-Wilson studied the movement of hydrogen
and potassium ions in the heart, a subject that has some par-
allels with the studies of ionic mechanisms in nerve cells that
had won the Nobel Prize in Cambridge in 1963.
In 1973, Poole-Wilson received a British-American
Travelling Research Fellowship (funded by the British
Heart Foundation and the American Heart Association) at
the Cardiovascular Research Laboratory of the University
of California, Los Angeles—affectionately called the “Heart
Lab.” The family went to California. There, he continued
studies of potassium flux in the myocardium, working and
greatly influenced by the head of the department, distin-
guished experimentalist and scientist Glenn A. Langer,
MD, and also by Kenneth I. Shine, MD, a clinical scientist
at that time who later would become dean, president of the
American Heart Association [1985–1986], and head of the
Institute of Medicine in Washington, DC.
“‘Rumble and Click’ Cardiology Was Prominent.
Clinical Thinking Had Not Yet Moved Into the
Metabolic Era”
At the age of 32 years, Poole-Wilson was appointed a sen-
ior lecturer in the Cardiothoracic Institute and honorary
consultant at the National Heart Hospital, London, UK,
under the leadership of the head of department, Peter
Harris, MD. At the time, Poole-Wilson did not know that,
12 years later, he would take charge of the department.
Professor Poole-Wilson recalls, “When I arrived at the
National Heart Hospital in 1976, I have to say that British car-
diology was not at its peak. Looking back, consultants were
rather conservative and would be considered old-fashioned
becoming a physical chemist. From Marlborough College,
Marlborough, UK (a public school, which in England
means a fee-paying private school), he won a major schol-
arship to Trinity College, Cambridge, UK, to read natural
sciences. He recalls, “My father worked in Manchester, and
we lived in Cheshire. I had a most happy childhood, and at
Marlborough I was taught by some brilliant schoolmasters,
several of whom went on to be headmasters of other
schools. At Cambridge, I studied maths, physics, chem-
istry, and biochemistry. At that time, in Part 1 of natural
sciences, one had to study a range of subjects, so I added
physiology, having never done any biology. I got a first in
Part 1 but chose to do physiology in Part 2 and did not do
so well, getting only a lower second. When asked why, I
usually say that I enjoyed myself too much—I rowed,
played cricket and rugby, and had many friends, especially
in other subjects, such as law and moral sciences. I like to
think ‘I got educated!’ I graduated in the year (1963) that
Hodgkin [OM, KBE, FRS] and Huxley [OM, FRS], who
were in the physiology department, won the Nobel Prize
with Eccles [AC, FRS, FRACP, FRSNZ, FAAS]. I decided
a career in pure physiology might be difficult and switched
to medicine.”
Professor Poole-Wilson’s early medical training all
took place in London, at St Thomas’ Hospital, the Royal
Brompton Hospital, and the Hammersmith Hospital. He
says, “In a way, I have spent my entire medical career
going back into physiology! Having studied mathematics
and physics at Cambridge the simple understanding of
blood flow and haemodynamics was pretty straightforward.
It was perhaps natural to specialise later in the cardiovascu-
lar area.”
In 1974 Professor Poole-Wilson was taught to use the perfused
interventricular septum (shown above) to study ion fluxes. He says,
“It [the ‘Heart Lab’] was a wonderful laboratory to work in, and
it changed my life. It was very lively. I was able to attend various
major meetings in the United States and to discover a breadth of
ideas and a very international view that I would never have found
in London. I made many friendships that have lasted for decades. I
was tentatively offered a position at the University of California,
Los Angeles, but my wife and I decided that I should seek a post in
the United Kingdom, and we returned to London.” Photograph
courtesy of Professor Poole-Wilson.
Photograph of the Pooole-Wilson family. Professor Poole-Wilson
married Mary in 1969 and says “I have been supported by her
throughout my career.” They have 3 children, the first born in
1973. In 1974, the family moved to California, for 15 months
when Poole-Wilson received a British-American Travelling
Research Fellowship at the Cardiovascular Research Laboratory
of the University of California, Los Angeles. Photograph courtesy
of Professor Poole-Wilson.
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today—the smart suit, the entourage, the Harley Street
practice, and, perhaps, a rose in the lapel! My wife, Mary,
rather admires those characteristics as indicative of com-
petence and conscientiousness. The celebrated London
cardiologist Paul Wood had died in 1962, but his ghost was
everywhere. ‘Rumble and click’ cardiology was prominent.
Clinical thinking had not yet moved into the metabolic era,
and attempts to understand the function and biochemistry
of the heart under normal conditions and in disease states
were still in their infancy. Peter Harris was appointed as the
first British Heart Foundation Simon Marks Professor of
Cardiology in 1966 and initially worked from one room,
with a table, a chair (the sort you sit on), and a secretary.
Professor Winifred Nayler [DSc] had joined the depart-
ment from Australia so that, by 1976, there was a lively
group of scientists at work. Now, with all the changes we
have had, the department has 10 professors and has become
part of Imperial College London.”
“Harris was a great thinker and innovator—but not
always popular—and was very keen on what we now call
translational research. Our approach over the years has
been to bring clinicians and scientists together to work
together in ‘both ways’—that is, so that clinicians could
learn more about science and scientists could appreciate
clinical problems. The main difficulty has been the large
difference in pay structures—often, brilliant scientists were
working shoulder to shoulder with junior clinicians for far
less pay. It was an art form to get them to work together.
And we did it with camaraderie, and with the excitement
engendered by the pursuit of knowledge! There were, of
course, many institutional changes—first there was the
Institute of Cardiology (1966–1973), then the
Cardiothoracic Institute (1973–1988), next the National
Heart and Lung Institute (NHLI) by itself (1988–1997),
and, finally, as a division of the Faculty of Medicine of
Imperial College London (since 1997).”
Professor Poole-Wilson was the first head of the NHLI
from 1997 to 2000. These various academic bodies were
always closely linked to the associated hospitals. In 1988,
the National Heart Hospital closed and moved to join the
Royal Brompton Hospital in Dovehouse Street, in the
Chelsea district of London; the NHLI also moved. There
were many who resisted and mourned the demise of the
National Heart Hospital, which was famous worldwide.
“I Always Viewed the Changes Positively:
An Individual Shouldn’t Stay in the Same Place for
Their Entire Working Life—Change Stops You
From Becoming Rusty!”
The roll call of the most conspicuous of Professor Poole-
Wilson’s studies, published with others, certainly shows little
sign of rust. Over the years, he has led a productive group
of clinicians and scientists.
A central theme in his early work involved the role of
hydrogen, potassium, and calcium ions in ischaemic heart
muscle studied in animal experiments and then in man. The
year 1979 proved extremely productive: in that year, he and
his colleagues demonstrated the effect of acidosis on the
myocardium in animals, leading to a new understanding of
the role of hydrogen, potassium and calcium in the function
and death of ischaemic cells. Three years later, his group
made the first continuous measurement of pH in a human
heart, using a catheter tip electrode and, thereby, demonstrat-
ing the very early development of acidosis during ischaemia.
During the late 1980s, he turned to heart failure, show-
ing how one could activate the neurohormonal system by
treatment with diuretics and describing fluid volumes in
untreated patients in India. This was a team achievement by
colleagues/friends who had come together and worked in
London: Professor Inder Anand. MD, FACC, FRCP, DPhil,
now professor of medicine at the University of Minnesota,
Minneapolis, MN; Professor Roberto Ferrari, MD, PhD,
Left, The National Heart Hospital, London, where Professor Poole-Wilson was appointed senior lecturer and honorary consultant in
1976. In 1988, it closed and moved to join the Royal Brompton Hospital, London. Right, Professors Peter Harris, Inder Anand, Roberto
Ferrari and Philip Poole-Wilson—all members of the team studying untreated heart failure in India in the late 1980s. Photographs courtesy
of Professor Poole-Wilson.
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FESC, now chair of cardiology, University of Ferrara, Italy,
and Cardiovascular Research Centre, Salvatore Maugeri
Foundation, IRCCS Gussago (BS), Italy, and the new pres-
ident of the European Society of Cardiology; and Professor
Harris, who died in 2002. Professor Poole-Wilson also
demonstrated important histological changes in the skeletal
muscle of patients with heart failure.
Then, in the early 1990s, Professor Poole-Wilson’s
group started to publish the first of many articles that
described the functions of isolated myocytes taken from
patients with heart failure undergoing transplantation.
In 1994, Professor Poole-Wilson and his colleagues
brought together their work on heart failure in a seminal
article published in the British Heart Journal and entitled
“Symptoms and quality of life in heart failure: the muscle
hypothesis,”1 which explained heart failure symptoms in
terms of persistent activation of the neurohormonal sys-
tems from signals emanating from skeletal muscle. Later
articles put forward the hypothesis that cytokine activation
in heart failure is partly due to endotoxins entering the
body through the gut or lung; strong evidence was adduced
to support the idea.
One can see that Professor Poole-Wilson’s research in
myocardial ischaemia and heart failure followed a clear
logical pathway, but there were other fruitful side shoots.
In 1986,2 he published an article proposing the use of the
6-minute-walk test for assessment of patients with heart
failure. Unknown to him, Guyatt and colleagues3 in
Canada had published a similar article a few months earli-
er. Professor Poole-Wilson comments, “We both copied the
idea from the lung doctors, but the test is now used world-
wide, and that is what matters.”
In 2000, Professor Poole-Wilson and others described
the first implantation of the Jarvik 2000 valveless ventricu-
lar assist device4 for the intended lifetime treatment of a
patient with heart failure; the patient lived for another 7½
years. Professor Poole-Wilson comments, “He died of
renal disease, [which is] the major reason why a heart
transplant was not done.”
A few years later, Professor Poole-Wilson served as lead
investigator for reports on the influential Carvedilol Or
Metoprolol European Trial (COMET)5 and on the trial of
the effect of long-acting nifedipine on mortality and cardio-
vascular morbidity in patients with stable angina requiring
treatment—ACTION—A Coronary disease Trial
Investigating Outcome with Nifedipine.6 Another impor-
tant trial he led, SENIORS—Study of Effects of Nebivolol
Intervention on Outcomes and Rehospitalisation in Seniors
with heart failure—showed “the benefit of a beta-blocker
(nebivolol) in heart failure regardless of age and ejection
fraction.”7
Asked to identify which of his research findings he rates
highest, Professor Poole-Wilson says, “I am very proud of
the papers published a long time ago showing the involve-
ment of calcium in the death of heart cells due to hypoxia
and ischaemia. A pleasing topic was the demonstration that,
in man, acidosis and the intracellular loss of potassium ions
were largely responsible for the changes in the electrocardio-
gram and contractility within 2 to 3 beats of heart muscle
becoming ischaemic. I am also proud to have been
involved, with others, in one of the first groups to work
with single cardiac myocytes. A group at Oxford had been
preparing myocytes from the hearts of animals, and we
obtained information from them and adjusted the ‘cookery’
to break up the matrix of the human heart and prepare
single cells. Recently, these techniques have been used to
show the effects of a gene inserted into cells from patients
with heart failure, and that has led to early trials by col-
leagues at Harvard of gene therapy for heart failure in man.
I am pleased to have had a part in introducing the 6-minute-
walk test for the assessment of heart failure. At the time,
there was much work, especially in the United States, with
relatively complex, impracticable methods of measuring
exercise tolerance—the 6-minute-walk test is so easy; all
you need is a level corridor of a certain length!”
“Cardiac Disease and Heart Failure Are Exemplars of
What Is a General Paradigm in Chronic Disease States”
Professor Poole-Wilson recalls the great difficulty he had
publishing research on the prevalence of heart failure. “I
think it was a matter of we, as cardiologists, invading the
territory of epidemiologists with something as ill-defined
as heart failure—they wanted to know what we were trying
to detect—but the criticisms were wrong! We went on to
show that heart failure was a much more common condi-
tion than was then perceived—at the time, it was regarded
as the Cinderella of cardiology and only an end-stage dis-
ease. We had an equally difficult time publishing on damage
Left, Professor Poole-Wilson in
India on a lecture tour. Right
Professors Poole-Wilson (centre),
Sidney Smith (president of the
American Heart Association
1995–1996) and Shahryar Sheikh
(president of the Asian-Pacific
Society of Cardiology [1999–
2003], the Pakistan Society of
Cardiology [2002–2004], and the
World Heart Federation [2007–
2008]) in Japan. Photographs
courtesy of Professor Poole-Wilson.
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to skeletal muscle. I’m not sure that people understood the
pathology of muscle and that all organs are involved in
heart failure. We were the first to show that neurohormonal
activation in heart failure was largely due to treatment with
diuretics. We were able to show the effect of treatment in
studies in Northern India, where patients with severe heart
failure still walk into clinics having never seen a doctor. We
now know that in heart failure there is neurohormonal acti-
vation, a large part being due to drug treatment, but that
other systems such as the immune system are also activated.
The critical question is, ‘Why?’ Peter Harris thought it was
due to an initial drop in blood pressure—we have
expanded that hypothesis and now think that the reduced
cardiac output leads to a deterioration in the function of
all body organs and activates those body systems refined
by evolution to allow the survival of the species under
adverse conditions; the critical systems are maintenance
of the blood pressure, the exclusion of infectious agents,
and the prevention of haemorrhage. Cardiac disease and
heart failure are but exemplars of what is a general para-
digm in chronic disease states. And it is one of the easiest to
study. This, for me, is an exciting change of perspective.”
Professor Poole-Wilson believes that the far-reaching
implications of the heart studies that he and others have
carried out now mean that cardiologists must reinvent
themselves as cardiovascular physicians (as the British
Cardiac Society recently morphed to the British
Cardiovascular Society), making use of knowledge from a
wider range of other specialties.
“I Am a Little Argumentative by Nature and Wallow
in the Joy of Debate, Believing That Scientific
Argument Is Best Resolved by Challenge”
One cannot doubt that Professor Poole-Wilson has had a
hugely original career, though in an age of seemingly
endless grant applications, his philosophy of research
management might seem rather old-fashioned. He shows
enthusiasm for the “gossipy coffee room” and describes
his department as “like a rose garden—you are not sure
where the finest flower will grow and what it will be like.”
He comments, “I believe strongly in the freedom of
research direction and judging people on their outcome.
It’s a matter of finding bright people and telling them to ‘go
away for 5 years’ and come back and tell you what they’ve
found. I’m often asked how a particular idea arose, and it’s
generally impossible to say. I am a little argumentative by
nature and wallow in the joy of debate, believing that sci-
entific argument is best resolved by challenge.”
Along with pursuing a distinguished research career and
publishing more than 500 articles, Professor Poole-Wilson
has amassed a huge list of other achievements. Where to
begin? Where to end? Of the many prizes and honours he
has received, he remembers particularly the Le Prix Europe
et Medecine 2001 de l’Institut des Sciences de la Santé,
Paris, France, and the Mackenzie Medal of the British
Cardiovascular Society, awarded in 2007. Since his
appointment as head of the department, no fewer than 29 of
the staff have gone on to professorships.
Between 1994 and 1996, Professor Poole-Wilson
served as president of the European Society of Cardiology
(ESC), and from 2003 to 2005 he served as president of
the World Heart Federation. He recalls these as very dif-
ferent experiences; he says, “Although the ESC started in
1950, it was not until 1990 that there was an annual con-
ference and, a few years later, the European Heart House
in Nice, France was opened. I remember, as president-
elect of the ESC, helping Professor Michel Bertrand [MD]
lay the foundation stone—what a moment! Now, the influ-
ence of the ESC is massive. There were some problems,
which still exist. In 1994, when guidelines on the preven-
tion of heart disease were first published by the ESC, there
were differences with the US guidelines published at the
same time. We had to iron that out. It’s best if guidelines
are similar across the world—otherwise politicians con-
cerned with health will take what they wish. After all, the
risk factors for atheromatous heart disease are the same
everywhere—there’s no great difference between India,
Africa, the European Union, and the United States. And
yet, in other areas of cardiovascular medicine, real differ-
ences still persist.”
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Professor Poole-Wilson says, “Although the ESC started in 1950, it was not until 1990 that there was an annual conference and, a few yearslater, the European Heart House in Nice, France (left) was opened. I remember, as president-elect of the ESC, helping Professor MichelBertrand [MD] lay the foundation stone (right)—what a moment! Copyright © 2009, European Heart House, Nice, France. Photographscourtesy of Professor Poole-Wilson.
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“The World Heart Federation was an entirely different
challenge. It’s much smaller than the ESC and not so rich;
it’s much harder for it to raise money. It needed major
changes and a new mission, so that it has now become an
influential and powerful organisation punching well
beyond its weight. One third of the world [population] dies
of heart disease and 80% of these deaths are in developing
nations! We need to touch the consciences of the ESC and
the American Heart Association—which are 10 times richer
than the World Heart Federation. I was disappointed in the
Millennium Development Goals, which concentrated on
infectious diseases and hardly mentioned chronic disease;
chronic diseases across the world are now at least as impor-
tant. This was a serious and mistaken omission. But attitudes
are slowly changing for the better”
“I Enjoy Most of the Things I Do and Am Unbelievably
Fortunate That My Work Is My Hobby!”
As Professor Poole-Wilson steams beyond his mid-60s, still
in the midst of the powerhouse of London cardiology, he
has an enviable attitude to all things, commenting, “I have
never done a day’s work in my life! I enjoy most of the
things I do and am unbelievably fortunate that my work is
my hobby! I dislike the word ‘retirement,’ though, now that
I am an emeritus professor, I have almost no administrative
responsibilities. My university has generously allowed me
to continue to hold grants and have an office; and I still have
PhD students to supervise. I am carrying on my research,
with projects in India, etc, and I am really rather busy.”
Professor Poole-Wilson gives his hobby as “cardiovascu-
lar medicine,” and it seems hard to believe that he has any
leisure, but he says he does. Typically, when asked for
details, he can provide a list of his interests, and he
even has a slide: favourite film, Dr Zhivago; actors,
Julie Christie, Shirley MacLaine, and Jean Moreau;
book, Candide by Voltaire (especially the tutor Dr
Pangloss, whose motto is “all is for the best in the
best of all possible worlds”); opera, Norma by
Bellini; and composers, Brahms and Wagner. He
also has strong interests in ornithology and spends
time (“not enough”) in his cottage in Wiltshire, in the
West of England, where he enjoys gardening (no
doubt heeding Voltaire’s dictum that “we must culti-
vate our garden”). Among the activities he will pursue,
one has a curiously topical flavour—namely, the
archaeology of Iron Age Britain in relation to climate
change. He has a hunch that all those settlements on
the tops of hills in Southern England developed there
not just to see off invaders from adjacent villages but
to avoid the quagmire in the valleys below, populated
with dangerous beasts and infective agents. Perhaps
someone will fund him to go away for 5 years to find
out the truth of the matter.
References1. Coats AJ, Clark AL, Piepoli M, Volterrani M, Poole-Wilson PA.
Symptoms and quality of life in heart failure: the muscle hypothesis. Br
Heart J. 1994;72(2 suppl):S36–S39.
2. Lipkin DP, Scriven AJ, Crake T, Poole-Wilson PA. Six minute walking
test for assessing exercise capacity in chronic heart failure. Br Med J.
1986;292:653–655.
3. Guyatt GH, Sullivan MJ, Thompson PJ, Fallen EL, Pugsley SO, Taylor
DW, Berman LB. The 6-minute walk: a new measure of exercise capac-
ity in patients with chronic heart failure. Can Med Assoc J.
1985;132:919–923.
4. Westaby S, Banning AP, Jarvik R, et al. First permanent implant of the
Jarvik 2000 Heart. Lancet. 2000;356:900–903.
5. Poole-Wilson PA, Swedberg K, Cleland JG, Di Lenarda A, Hanrath P,
Komajda M, Lubsen J, Lutiger B, Metra M, Remme WJ, Torp-Pedersen
C, Scherhag A, Skene A; Carvedilol Or Metoprolol European Trial
Investigators. Comparison of carvedilol and metoprolol on clinical out-
comes in patients with chronic heart failure in the Carvedilol Or
Metoprolol European Trial (COMET): randomised controlled trial.
Lancet. 2003;362:7–13.
6. Poole-Wilson PA, Lubsen J, Kirwan BA, van Dalen FJ, Wagener G,
Danchin N, Just H, Fox KA, Pocock SJ, Clayton TC, Motro M, Parker
JD, Bourassa MG, Dart AM, Hildebrandt P, Hjalmarson A, Kragten JA,
Molhoek GP, Otterstad JE, Seabra-Gomes R, Soler-Soler J, Weber S; A
Coronary disease Trial Investigating Outcome with Nifedipine gas-
trointestinal therapeutic system investigators. Effect of long-acting
nifedipine on mortality and cardiovascular morbidity in patients with
stable angina requiring treatment (ACTION trial): randomised con-
trolled trial. Lancet. 2004;364:849–57.
7. Flather MD, Shibata MC, Coats AJ, Van Veldhuisen DJ, Parkhomenko
A, Borbola J, Cohen-Solal A, Dumitrascu D, Ferrari R, Lechat P, Soler-
Soler J, Tavazzi L, Spinarova L, Toman J, Böhm M, Anker SD,
Thompson SG, Poole-Wilson PA; SENIORS Investigators.
Randomized trial to determine the effect of nebivolol on mortality and
cardiovascular hospital admission in elderly patients with heart failure
(SENIORS). Eur Heart J. 2005; 26:215–225.
Barry Shurlock is a freelance medical journalist.
From left to right: Professor Paul Hugenholtz, Professor Michel Bertrand,
Professor Philip Poole-Wilson, Mrs Wilma Thieme, Professor Günter
Breithardt, Professor Lars Rydén, Professor Jean-Pierre Bassand, Professor
Michal Tendera. Professor Poole-Wilson says, “All have been presidents of
the ESC at some time between 1984 and 2006. Mrs Wilma Thieme kept us all
in order.” Missing are Professor Hans-Peter Krayenbuhl (deceased),
Professor Attilio Reale (deceased), and Professor Maarten Simoons.
Photograph courtesy of Professor Poole-Wilson.
Editor: Helmut Drexler, MD, FESC
Managing Editor: Lindy van den Berghe, BMedSci, BM, BS
We welcome comments. E-mail [email protected]
The opinions expressed in Circulation: European Perspectives
in Cardiology are not necessarily those of the editors or of the
American Heart Association.
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Print ISSN: 0009-7322. Online ISSN: 1524-4539 Copyright © 2009 American Heart Association, Inc. All rights reserved.
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