Our Medical Director sets out his ambitions for the BHF
After a distinguished scientific career, our new Medical Director Professor Sir Nilesh Samani is helping us shape the direction of research in the UK and beyond. He talks to Sarah Brealey.
“When I started training as a doctor,” says Professor Sir Nilesh Samani, “around two-thirds of people didn’t survive a heart attack. Now, more than seven in ten survive.”
Professor Samani started his medical training in the mid-1970s. Now, he’s Medical Director of the BHF. During this time, there have been developments ranging from new surgical techniques and tests for inherited heart conditions, to the availability of statins and the introduction of angioplasty.
“Our ability to treat heart and circulatory disease has advanced enormously, and I’ve had the privilege to live through this,” he says. “I think there have been more advances in the treatment of heart and circulatory disease in the last 20 or 30 years than almost any other area of medicine – maybe only cancer comes close.”
There is no aspect of heart treatment that BHF research has not helped to advance
The BHF has played a big role in these advances and also supported Professor Samani’s own research career. “There is no aspect of heart treatment that BHF research has not helped to advance,” he says. “I don’t want to say the BHF is responsible for all of it, but it has undoubtedly had a major impact in improving patient care.”
There are still many more discoveries to be made. “I think the next 20 years will be even better,” says Professor Samani. “And the BHF has a critical role to play in terms of making sure research happens and is carried out with patients and the benefits to them in mind.”
This, really, is what being the BHF’s Medical Director is all about. It’s a role well suited to a world-leading researcher and cardiologist, who was knighted in 2015 for services to medicine and medical research. Professor Samani continues to work once a week as a cardiologist at Glenfield Hospital in Leicester. He does this alongside leading his research team at the University of Leicester, so it’s a lot to fit in, but the patient contact shapes and enriches both his research and his role at the BHF.
Putting patients first
“Patients are at the heart of everything we should be doing,” says Professor Samani. “The questions I want to answer in the lab are often informed by what I have seen in the ward. This is not only in terms of treatments, but causes and prevention because, ultimately, the goal of the BHF is to prevent heart disease.”
This is something he has put into practice in his own research career, which has focused on the role genes play in heart disease. Ten years ago, Professor Samani and his colleagues in Leicester identified one of the first common genetic variants linked to risk of heart attack. Now more than 90 of these variants have been discovered, most of these through an international collaboration established by Professor Samani.
The BHF was pivotal in this research. With a large BHF grant, Professor Samani and BHF Professor Stephen Ball in Leeds, set up the BHF Family Heart Study in the late 1990s, studying families where more than one person had coronary heart disease.
Some inherited conditions are caused by a single gene mutation, but heart attacks aren’t like that. “You may be born with some variations that increase your risk and some that reduce your risk,” says Professor Samani. “It’s like a game of cards – it’s about the total hand that you are dealt.
“If you carry one variant, it doesn’t mean you will have a heart attack. If you carry 40, 50, or more, this is associated with a six times higher lifetime risk of heart attack.”
It’s like a game of cards – it’s about the total hand that you are dealt
This is important because it opens up the way for better prevention and treatment of heart attacks. “At the moment, we don’t look at someone’s risk of heart disease until they are in their 40s, when they might have already had a heart attack, and certainly some furring up of their arteries has happened,” Professor Samani says. “If you really want to prevent this, you need to give lifestyle advice and treatments much earlier. We can’t do that for the whole population, but if you can identify people who are at high risk you can do much more.
“For example, in future we could give statins early to people who were born with the highest risk, who could get the maximum benefit in terms of preventing heart attacks.”
This is the idea behind personalised medicine – understanding which drugs and treatments will help individuals most, and treating them accordingly.
Identifying genes that cause heart attacks can offer insight into how the disease develops. “Most of these genes don’t affect your risk in ways we know about, for example by raising cholesterol or blood pressure,” he says. “There must be other mechanisms and understanding these has the potential for profound benefits in terms of developing new treatments.”
Further down the line, we might even learn how to influence the action of these genes, in order to reduce a person’s risk in a very individualised way.
Encouraging joined-up research
This kind of research relies on data from vast numbers of patients, and collaboration from researchers around the world. Professor Samani says: “I want to increase the amount of international collaboration that we fund in partnership with other organisations. The research we do has benefits that are not confined to the UK. Working across borders will be more productive, so will bring more value to the money our supporters raise for us.”
He wants to encourage more joint working between UK universities and researchers, too. This is an area where BHF funding can play a big role. “We want people in different locations to get together and decide the key questions and how to answer them,” he says. “We will still fund the projects and individuals that we already fund, but we want to encourage people to work together. If we can raise more funds, that will give us more money to do this.”
I want our researchers to innovate, to do things that haven’t been done before
Professor Samani also wants to build on the work of his predecessor, Professor Peter Weissberg, who helped to establish BHF Centres of Regenerative Medicine. These focus on ways to repair the heart when it gets damaged, which isn’t possible at the moment, meaning heart attack and other conditions can lead to debilitating and incurable heart failure.
“We are currently reviewing the achievements of the Centres and awarding new grants to take the work forward,” says Professor Samani. “I hope that in my time as BHF Medical Director we will take major steps to realise the potential of regenerative medicine for patients. At the moment, the only real option for people with advanced heart failure is a heart transplant – but it would be so much better if we could make more muscle grow in the heart.”
The BHF is funding researchers to take advantage of the latest technologies. These include creating stem cells from a patient’s own skin, and editing genes so we can understand what causes diseases. Another area of huge potential is the use of new computing techniques, such as machine learning, to analyse large or complex datasets to provide insights in ways currently not possible.
“I want our researchers to use these new approaches,” says Professor Samani. “I want them to innovate, to do things that haven’t been done before. These are exciting times.”
CV - Professor Sir Nilesh Samani
1978 BSc (Medical Sciences, first class), University of Leicester
1981 MB ChB University of Leicester
1981–85 Clinical training
1985–88 MRC Clinical Training Fellow, University of Leicester
1988–93 Lecturer in Cardiology, University of Leicester
1993–97 Senior Lecturer in Cardiology, University of Leicester
1997–present Professor of Cardiology, University of Leicester, and Honorary Consultant Cardiologist, Glenfield Hospital
2003–16 British Heart Foundation Personal Chair in Cardiology, and Head of Department of Cardiovascular Sciences, University of Leicester
2009–present Director of NIHR Leicester Biomedical Research Unit in Cardiovascular Disease
2015 Knighthood for services to medicine and medical research
2016–present Medical Director, British Heart Foundation