Pioneer in Medicine
Braunwald Recalls His Early Days at NIH
Photo: Chia-Chi Charlie Chang
Dr. Eugene Braunwald, a cardiologist and distinguished Hersey professor of medicine at Harvard Medical School, has seen his field come a long way since starting his career in the early 1950s at NIH. At that time, the outcomes for patients were bleak. Without the life-saving strategies that Braunwald and his peers would later develop, there was little to be done for patients after a heart attack (or myocardial infarction) and many died within a year. Cardiovascular death rates were 3 times what they are today. There were no sophisticated tools like the modern echocardiogram to diagnose patients. Where others might just see challenges and obstacles, young Braunwald saw opportunity. He spent a lifetime moving the field of cardiology further, particularly by developing new, less invasive ways to monitor the heart and by advancing cardiac surgery.
Those were the themes of Braunwald’s career, which he described at his recent lecture “Clinical Cardiovascular Research Inspired by the NHLBI: A Personal Odyssey.” It was a special occasion to celebrate the 70th anniversary of the National Heart, Lung, and Blood Institute, where Braunwald became a research fellow in 1954 and later served as clinical director from 1959 to 1968.
He was introduced by NHLBI director Dr. Gary Gibbons and NHLBI scientific director Dr. Robert Balaban. Gibbons, who remembers presenting cases to Braunwald during his morning report as an intern at Brigham and Women’s Hospital, described him as an “American master” of biomedicine who is both humbling and inspiring.
During his time at NHLBI, Braunwald, with his colleagues and mentors, performed what are now considered classical studies in blood flow mechanics and heart function. At the time, he said, there were no clinical trials and no evidence-based medicine in cardiology. But there were also three Nobel Prize winners walking the halls of the Clinical Center, one of whom was Dr. Andres Cournard, honored in 1956 for the development of cardiac catheterization—threading a tube through a blood vessel to measure blood flow and pressure within the heart. Cournard became Braunwald’s mentor and helped him understand the importance of hypothesis-driven research and how studying a disease intervention can provide a deeper understanding of the disease.
Braunwald also extended his mentor’s work to develop an important tool called left-heart catheterization. Although Cournard and others had successfully “cathed” the right side of the heart, the left side—”where the action is”—had yet to be measured. Braunwald developed a safe and effective way to collect this vital measurement.
His studies of heart attack—done in collaboration with his wife, the first board-certified female heart surgeon in the U.S., Dr. Nina Starr Braunwald—helped establish that opening clogged vessels to the heart could help prevent damage to cardiac muscle. That work led to earlier and more aggressive intervention for heart attack patients, which has greatly improved long-term survival rates. (To see more about Nina Starr Braunwald’s contributions to cardiology, check out the exhibit “Innovation and Invention: NIH and Prosthetic Heart Valves” in the Clinical Center south lobby.)
Photo: Jerry Hecht
Braunwald left NHLBI in 1968, but throughout his career, he has maintained a close affinity with the institute, including serving as founding chair of the NHLBI-funded thrombolysis in myocardial infarction group, which conducts trials that have led to some of the most commonly used medications to treat and prevent heart attacks. (Thrombolysis refers to breaking apart the blood clots that can cause myocardial infarction.)
The group’s first study found that the clot-busting drug tissue plasminogen activator was far more effective for acute heart attacks than the previous standard of care. The group was also the first to show that angiotensin-converting enzyme inhibitors could preserve heart function and reduce mortality after a heart attack.
Braunwald ended the lecture with his thoughts and predictions for the future of his field. “There are now many cardiologies,” he said, explaining that it will be important to understand how cardiology interfaces with other fields of medicine such as pulmonology, diabetes and oncology. For example, he noted that the second most common cause of death for breast cancer patients is heart failure, and that it will be critical for cardiologists and oncologists to work together on improving patient outcomes.
Braunwald also noted the potential for genomic research and big data to bring new precision medicine approaches to his field. Going forward, “it will be important for cardiology to move into the molecular age using big data and new tools,” he concluded.