Professor Sir Nilesh Samani interview - research of the heart
The British Heart Foundation’s new medical director looks ahead to new breakthroughs in cardiovascular research
Professor Sir Nilesh Samani’s relationship with the British Heart Foundation (BHF) is a longstanding one. In 2014 he was knighted for services to medicine and medical research after building a world-class research centre at the University of Leicester.
As well as an impressive career in research – much of it supported by the BHF – including breakthroughs in genetics relating to cardiology and hypertension, he has been the charity’s Professor of Cardiology at Leicester’s university hospital.
Next month he steps up to become the BHF’s new medical director, taking over from Professor Peter Weissberg who spent twelve years in the post.
It will be a key role in the development of cardiovascular research across the world. In October last year the BHF announced its new research strategy, committing to invest over half a billion pounds in research over the next five years. Samani will lead the strategic direction of that money.
It’s a role he says he is “very privileged and very honoured” to be appointed to.
Growing up in a small town in Kenya, the town doctor was seen as the person who commanded the most respect, and his parents were keen for him to follow a career in medicine. After his family moved to the UK he became one of the first intake of students into Leicester medical school in 1975.
And he has lived and worked in Leicester ever since. “I’ve been here most of my life now,” he says, reflecting on a career which saw him co-lead the discovery of over 50 genes associated with coronary heart disease.
From 2000-05 he conducted what was then the largest ever study of families to examine genetic predisposition to heart disease, alongside now-retired fellow BHF professor Stephen Ball.
“If you look at heart attacks or coronary heart disease, one of the questions we ask, and all our medical students ask of course is ‘do you have a family history?’,” says Samani.
“It’s not as simple as if your parents have it you will develop it, but there is still a very strong genetic contribution to coronary heart disease and other cardiovascular diseases.”
Recent advances and new understanding of DNA and the human genome means specific genes can be identified.
“We’ve done very large studies with collaborators around the world to identify genes that affect your risk of getting coronary heart disease. We’ve identified more than 60 such genes already.”
The aim is to map out who is at risk at a much earlier stage in order to make more effective – and cheaper – preventative interventions.
“Often our prevention of coronary heart disease at individual level is very late. When someone reaches forty or fifty we say, let’s see whether you have high blood pressure or diabetes, you know? We assess what their ten-year risk is. But by that time the process has already started if you’re more susceptible.”
But how early could such genetic maps be made? “You can do it from birth, to be honest.”
It is clear Samani is passionate about his own research, and the ease with which he explains it will be an asset in his new role of BHF medical director.
He says he hopes to be an “honest broker” when it comes to commenting on research to the media. “People who are publishing it and have done it obviously think it’s very good but they need somebody to provide a context for that research.”
But the role will not just be a public voice and advocate.
“The main role of course is to oversee the research funding the BHF provides and the direction of the strategy for which research the BHF funds,” says Samani.
“The BHF funds over £100 million’s worth of research a year which is more than half of the total spend of cardiovascular research in the UK. It’s responsible for more than half. So this is a big player, both in the UK and internationally. What the BHF funds is very relevant.”
Developments and breakthroughs are especially relevant in Scotland, which still has some of the poorest heart health statistics in Europe. Samani says he’s “very aware” of the situation in Scotland, not just of the challenges but also of the ground-breaking research which takes place north of the border.
“Glasgow particularly still has the worst cardiovascular rate in the UK. As you’ll know, there has been a lot of effort on this,” he says, highlighting the seminal West of Scotland Coronary Prevention Study in the 1990s which heralded the start of the use of statins as a preventative measure.
“One in four people in Scotland will die of cardiovascular disease, 15,000 deaths a year,” he points out.
“Coronary heart disease is still the biggest killer. We worry about cancer and other things but despite the advances coronary heart disease is still the most important cause, particularly of premature death. People are dying early.
“Every twenty minutes someone in Scotland is admitted with a heart attack. These are very powerful statistics. If Scotland has around six million people, around ten per cent are living with heart disease at the moment.”
And the nature of the disease is changing, Samani points out.
“Rhythm problems of the heart, a condition called atrial fibrillation is becoming very common. Although we are tackling some of the premature death because of the ageing population, we are replacing it with other challenges in terms of managing heart disease,” he says.
Does that present new challenges for research to address? Has the agenda moved on?
“If every 20 minutes we are admitting a patient with a new heart attack we still have a long way to go. But you’re right, it’s providing a new challenge. I guess heart failure is the main one, when you can survive the heart attack but be left with a heart that is damaged. It impacts on the quality of life, on your prognosis. There is an increasing number of people, particularly elderly people living with heart failure.
“Lots of advances have been made. New types of pacemakers have been deployed to help with that. Medication has helped, and some of the key studies with the new medicines that have been tested and shown to be beneficial are from Scotland.”
The BHF’s current £61m investment in Scotland includes research in Edinburgh, Glasgow, Dundee and Aberdeen. “The institutions in Scotland are an essential part of the BHF family. They’ve done some seminal work.”
The work of the University of Glasgow’s Professor of Cardiology John McMurray is the example which springs to Samani’s mind.
“He led one of the recent major trials that has shown a new class of drug is beneficial in reducing death in patients who have heart failure. It’s a multinational study, but he’s provided the leadership for that particular trial,” he says.
Regenerative medicine is the other new area of cardiovascular research, according to Samani, describing breakthroughs in work to regenerate parts of the heart using stem cells as “really exciting”.
He predicts there will be “increasing traction” in the area over the next 10 or 20 years.
“This concept of ‘regenerative medicine’, the BHF is playing a very key role in that.”
Stem cell research has shaken off any controversy, Samani insists.
“I think the excitement at the moment is that in the last few years we’ve learnt two things: one is that we all have our own stem cells, you know, in our heart and elsewhere. So we’re trying to learn whether we can reactivate those stem cells to reproduce the tissue that you want.”
He adds: “What’s more exciting is that you can now take a cell from somebody’s skin, or from their mouth or in their blood, and you can re-programme the cell to become a stem cell. From that you can then develop the tissue of interest, whether you want to help the heart or the liver. That presents some very exciting options.”
New ways to support and regenerate the heart are on the way then, and Samani says he is “very excited” about the prospects for those with heart failure.
New approaches are being sought to prevent atrial fibrillation, too, he says, which includes looking at “the epidemic in diabetes”.
The BHF has been widening its focus to other disease types in recent years, recognising the links and common contributing factors to many non-communicable diseases, as recognised by the World Health Organisation. Samani welcomes the approach.
“Absolutely, I think the BHF generally wants to do more of that. You can stay in silos and say ‘I’m working on heart disease and diabetes is something different’, but that’s certainly not the way the BHF sees things.
“We know diabetes is an important risk factor for heart disease, just like stroke. Stroke used to be a Cinderella subject in many ways, but it’s a really important cause and the BHF is committed to understanding the causes of stroke and how we can prevent them as it is for coronary heart disease.”
And with the responsibility for guiding the direction of the BHF’s substantial research clout, Samani says there will be opportunities to set the wider agenda.
“The BHF has always tended to be a response-mode funder, where people put ideas forward, and the BHF supports good science wherever it comes from. I think that’s great and that will remain the main way we fund things, but we also need to think about whether there are ways the BHF can influence the research agenda.”
The use of big data is one example, he suggests. “The fact is there is a huge amount of data sitting in various studies, in various organisations, routinely collected data which is of enormous benefit to research.”
In England the concept of a central database raised hackles amongst the public in 2014 and concerns over privacy led to the scrapping of the ‘care.data’ concept. In Scotland the Information Services Division has been collating NHS data without the same levels of controversy, however, some researchers have expressed frustration with a lack of access to useful data.
“You’re still considerably more advanced than people in England! I feel some of the programmes I’ve seen in Scotland, especially the ones from Dundee University, are held up as good exemplars of how if you get access to information you can make connections which otherwise you wouldn’t be able to,” says Samani.
His own experience suggests the public are not as concerned as politicians may believe.
“I do research at the moment in genetics and I talk to a lot of patients who participate in this research and I can say the majority of people actually feel very happy, provided their privacy is respected, for their data to be used in this manner. Very rarely do I see people who feel this isn’t a worthy thing to do. Yet the public perception and public support hasn’t got translated into policy changes.”
International collaborations will be another focus for Samani as BHF medical director, who advocates a single mechanism of funding applications for international teams. But hasn’t this potentially been made more difficult by the vote to leave the European Union?
“A decision has been made and we have to respect that, but it’s obviously vital the UK is able to remain a world-class research environment. That means working with people internationally.”
The UK’s international research reputation must be protected, he suggests, and that includes attracting the best researchers to the country.
“When I got my first European grant it was 1993 or 94 and the last 20 years of my research career have been marked by a succession of high-quality collaborations right across Europe with some fantastic investigators which have led to the best output we’ve had. It’s difficult to see us being left out of that access to funding and also access to collaborators.”
He hopes that the additional responsibilities of his new role will still allow him to carry on his own research and retain some clinical practice.
“I still wake up in the middle of the night and put stents into people’s arteries. If someone is dying from a heart attack it unblocks their arteries,” he says.
“It’s difficult when you’ve been doing research for 30 years to suddenly stop. I have a very strong research team here, with some exciting work going on. I hope to continue that for a while, and we’ll see how it works out over the next few years. The BHF and others have invested a lot of money in Leicester, and I wouldn’t want that to go very quickly. So I’ll continue both in research and clinical activity and somehow juggle my time!”
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