François Abboud, MD, has been honored with the 2009 George M. Kober Medal from the Association of American Physicians, an award dedicated to recognizing leaders in internal medicine. Abboud, professor, researcher, and clinician with a nearly 50-year career at University of Iowa Health Care, talks about his career and this honor:
When you started as a young physician, what was considered the 'state of art' treatment for heart disease?
I would say it was very primitive when I started out. We knew we had a major killer on our hands in heart disease, but all we had to sometimes offer patients was bedrest after a heart attack, a drug like digitalis, or drugs like diuretics. We had no idea what the normal level of blood pressure ought to be, or the normal level of cholesterol. And there were enormous risk factors we were unaware of. Since then, of course, there have been fantastic advances that reduced the mortality from heart disease very significantly.
What major studies have you been involved with as founder and director of the UI Cardiovascular Research Center and how have those studies influenced clinical care?
Several other investigators have contributed to the research in the cardiovascular center from a variety of disciplines. One of the most important areas of research was started in the 70s. In 1970, The University of Iowa was one of 12 major clinics in the nation that examined the question of the effectiveness of lowering blood cholesterol using a drug called cholestyramine and thousands of patients were enrolled, and, as I said, we were among the first 12 clinics that demonstrated that lowering cholesterol in patients over a period of six or seven years reduced the risk of heart attacks. At the same time, the most basic work in that area was done also here at Iowa in which lowering cholesterol was able to reverse the hardening of the arteries.
There was also work done on salt sensitivity causing hypertension, on the discovery of chemicals that are released from the lining of blood vessels that can prevent clotting. We did some of the earlier studies on patients who had sleep apnea who stopped breathing at night. We measured the nerve activity and found that it was extremely high and contributed to their mortality—sudden death—and discovered how to reverse that.
There was another important trial in stroke that identified a window of opportunity that was critical to dissolve the clot in the brain that caused the stroke. We also found that the nervous system is a major regulator of the cardiovascular system and how the communication between the brain and the heart is so important and can cause a significant percentage of the mortality from heart disease.
There was also the seminal work done by the Department of Surgery on gastric bypass in obese individuals, showing that this surgery can decrease the risk of diabetes.
These are some of the major directions of research that impacted greatly on clinical care.
What cardiovascular research projects are you currently working on?
We’ve been particularly interested in sensors in the blood vessels. These are nerve endings in the heart and the blood vessels that send signals to the brain when the heart and the circulation are under a particular stress.
The signals from those nerves to the brain tend to tell the brain to lower the stress on the heart and relax the circulation. When those sensors are malfunctioning we get situations where you have very high blood pressure and increased mortality from cardiovascular disease. So our job is to find what goes wrong with those sensors and what connections in the brain those sensors have and the brain sites where we can affect the signal from the brain to the heart and reduce that very high risk.
What do you believe has been the single most important discovery with reference to cardiac disease since you started your career nearly 50 years ago?
There isn’t one single thing, but I would say there have been very important discoveries in three areas.
- • The identification of chemicals and drugs that lower arterial blood pressure and lower cholesterol—the drugs that can be very, very effective in reducing mortality from heart disease
- • The technological development, the techniques and imaging approaches that allow us to look inside the heart and identify where for example the clots or obstructions are in the heart, and where to put the stents and artificial valves to relieve these obstructions in the heart.
- • Finally and probably most importantly, has been the appreciation of the significant cardiovascular risks, such as smoking or obesity and the behavioral modification that is essential to reduce and reverse those trends. From a public health prospective, has been an extremely important factor in reducing mortality
The Kober medal recognizes leadership and you were head of internal medicine for the UI Hospitals and Clinics for 26 –years. What significant challenges did you face?
The challenge that I’ve had has been the recruitment and retention of the very best. The Department of Internal Medicine is one of the largest departments. It has close to 1,000 members and several hundred physicians. It’s one of the largest administrative units in the university—larger than most colleges.
That challenge was met with great opportunities that we had to take advantage of, which have been primarily in the explosion of medical science and the expansion of the support from National Institutes of Health.
We had to recruit the very best and build and develop science and technology at Iowa. At the same time, we needed to keep in mind that our primary purpose in doing all of this is to provide the best care to our patients.
In teaching our medical students, we also provide the best physicians to serve the state of Iowa and the patients in Iowa. As we did all that, we had some negative challenges, for example the challenge of managed care. But basically we recruited and retained the very best, and we’ve done that extremely effectively. We’ve recruited hundreds of individuals and that has been very important. They are the ones who made the difference.
What does winning the Kober medal mean to you, personally?
It’s an enormous honor, obviously, and I’m humbled by it. I’ve always felt that awards like this transcend the individual who gets them because they really represent the values of the whole society; the values of the university we’re from; the contributions of the teams that make such a recognition possible.
The one thing that it does is attract attention of the nation to Iowa, to the University. I feel strongly that the contribution of Iowa and Iowans is not as recognized as it ought to be nationwide and such an award tells the whole nation that this is a great place, it has wonderful people, and the credit should go to the university and to the state and to every Iowan. |
