CardioSource WorldNews | Interview by Katlyn Nemani, MD

Dr. Valentin Fuster, MD, PhD, MACC, serves The Mount Sinai Medical Hospital as Physician-in-Chief, as well as director of Mount Sinai Heart, the Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health. He is also the Richard Gorlin, MD/Heart Research Foundation Professor at the Icahn School of Medicine at Mount Sinai and the editor-in-chief of the Journal of the American College of Cardiology. The innumerable positions he has held include serving as president of both the American Heart Association and the World Heart Federation. Dr. Fuster is the only cardiologist to have received the highest awards for research from the four leading cardiovascular organizations: the American Heart Association, the ACC, the European Society of Cardiology, and the Interamerican Society of Cardiology. Dr. Fuster, in addition to his dedication to research, is strongly committed to his responsibility to communicate to the public.  This commitment has in the last 4 years produced six top-selling books and led to Dr. Fuster launching the Science, Health and Education Foundation (SHE), which is directed at improving public health, especially in the young.

As a young man you were a talented tennis player competing at a national level. How did you decide to pursue a career in medicine?

I love tennis. I spent so many years playing 2 to 3 hours each day, but I reached a point one day where I decided that I would not make it, and that day I decided to do something else. I wanted to pursue agriculture, because I like biology. The way plants talk to each other is interesting. I thought the biology of agriculture was similar to human biology, but I couldn’t do it because, at that time, you used to stay home where your parents were from, and there was no university for agriculture in Barcelona. I was very lucky, because someone I knew from the same tennis club I played at in Barcelona told me something I couldn’t believe—he told me I would make a great physician.

I thought that if someone of such caliber tells you to do medicine, you do it. You give credit to someone you respect. Throughout my career I have been guided by people who inspire me, and now I am obsessive about mentoring others. I think it’s critical.

Early in your career you were involved in basic research investigating the role of platelets in atherothrombotic disease. Was it a mentor of yours who lead you to this field of study?

It was. I went to Liverpool for a few months where I had a fantastic mentor in Harold Sheehan, MD. He was one of the best pathologists in the UK, and he told me I had to research blood clots. I went to the University of Edinburgh to start my research career, and my thesis was about whether blood clots are the cause or consequence of a heart attack. From there I became interested in platelets, one of the ingredients of blood clots.

And how did you segue from basic science into public health?

I have always been driven to get to the root of problems. My research on blood clots lead me to ask the question, “What causes a blood clot?” Most clots are related to atherosclerotic disease. What causes atherosclerosis? The world of consumption we live in—obesity, tobacco, lack of exercise. So from there I segued into the world of health promotion and prevention.

However, I never left basic investigation. I’ve been surrounded by talented people who do in vivo imaging, and I’m still working in this field today. From imaging the heart I’ve moved into imaging the brain, because when you look at our world of consumption, it is our brain that decides whether we take care of ourselves or we don’t. The roots of cardiovascular disease are behavioral.

What kind of brain research are you doing?

My research in the brain has three main objectives. The first is to determine the role of risk factors that impact the micovasculature of the brain, leading to lacunar lesions, cognitive dysfunction, and the acceleration of Alzheimer’s disease. The second objective is to determine how we can motivate the individuals who are developing atherosclerotic disease to change their behavior. The third objective is to determine how best to engage children. Age 3 to 6 is critical time. Lessons that children learn at this time could last for a lifetime.

How can you motivate people to take care of themselves when they are developing atherosclerotic disease that has not manifested itself yet clinically?

We have a group therapy model which is similar to Alcoholics Anonymous. People meet every 2 weeks in groups of 10 to discuss smoking cessation, exercising, and eating healthier. We piloted it in five communities and we found it to be extremely helpful.

Sometimes it is a cultural shift that you have to target. With Rajesh Vedanthan, MD, FACC, we have an NIH project in Kenya, where many people are hypertensive because they heavily salt their food. We have community health workers who measure blood pressure in the street, and we created a registry of blood pressure with smart phones. When you go to that region, everybody is talking about blood pressure. It’s a new culture.

But to really make an impact, you have to start with children.

What kind of programs have you established with children?

In Colombia we have 25,000 children in our program. In Spain we have 75,000. The children are 3 to 6 years old. Our program is 70 hours of teaching health over a 6 month period which has four modules: the first is how your body works; the second is healthy food; the third is physical activity; and the fourth is how to control your emotions and learn to say no when confronted with alcohol, drugs, smoking, and so forth. We have followed these children—2,000 in Colombia and 2,000 in Spain—for 9 years in Colombia and for 3 years in Spain—and the impact of what we do at this age appears to be very significant.

I assume that for children this young, you’re involving the parents as well?

Yes, and we are learning a lot. Children have more of an impact on the behavior of their parents than the parents have on the behavior of their children. If you want to stop smoking as an adult, there is nothing better than your child telling you to stop.

I heard that Sesame Street in Spain has a Muppet physician named “Dr. Valentin Ruster.” How did you find your way to Sesame Street?

It’s true. I don’t know how Sesame Street found me, but I convinced them that what children learn when they are young impacts their behavior as adults, and I convinced them to get into health. Sesame Street was not about health, with the Cookie Monster and all. They did make a muppet of me, which is on Spanish Sesame Street now but will be coming to the United States. There are 20 episodes with this character. What we want to see is that training at a young age affects behavior at 20 years old.

Please tell us about the Science, Health and Education (SHE) Foundation and its innovative approach to improving the health of young people.

SHE is a non-profit foundation, while focused on basic and clinical research (Science), is aimed at promoting health habits (Health), through communication and education of the population. Health is like a car. Every age has different signs of disease—in childhood it is behavioral issues, in middle age it is subclinical, in the elderly it appears in quality of life and the brain and degenerative disease. The motor is different at every stage, but the gasoline is education. Then there is a bumpy road—the world of consumption, the world of pollution. That is how we came up with the Foundation for Science, Health, and Education. The SHE Foundation applies to all ages. For example, it promotes the education of children with the idea that healthy habits acquired in childhood will be sustained for a lifetime.

At the ACC’s Annual Scientific Sessions in 2012, you were honored as one of the two American “Legends in Cardiovascular Medicine.” What do you hope to be your legacy?

First, it would be the number of young people who I was able to motivate. There is a society called “VF Society” of all the fellows I trained—150 people—we meet every 2 years, and it’s very emotional to see how many people you motivated or created an impact on. And second, my life in research—from basic science to global health. Some of the concepts I developed are being taken up now by governments and communities. I’ve moved from platelet research to imaging research to health promotion and prevention, from adults to children to families and communities, from local health projects to global health, always trying to get to the root of the problem.

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Katlyn Nemani, MD, is a physician at New York University.

Read the full May issue of CardioSource WorldNews at ACC.org/CSWN

Keywords: CardioSource WorldNews, Public Health

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