26 January 2016

Part 3: The ‘four seasons’ of a clinical academic without borders

Franco Cappuccio, Professor of Cardiovascular Medicine & Epidemiology, continues his journey through the ‘four seasons’ of his career to date as a clinical academic which we hope will inspire and delight you and hopefully encourage some of you to follow suit in this challenging but fulfilling medical career path.

Part 3. The Season of Ripening (2000-2005)

The opportunity to apply for a suitable Chair came at St George’s in 2000 where I became Professor of Clinical Epidemiology, and my confidence in being able to pursue independent ideas strengthened. I secured funding for two large epidemiological studies, IMMIDIET and the Kumasi Study, and established a research group around these two studies, whilst continuing exploiting the results of the WHSS.

The IMMIDIET study was a European-funded consortium whose aim was to look at gene-environment interactions of risk factors for coronary heart disease to explain the geographic gradient in heart disease across Europe. We studied three population samples in Surrey (England), the Flanders (Belgium) and Abruzzi (Italy), all with the same standardised protocol.
IMMIDIET in Surrey
The Consortium was a mix of clinical researchers, epidemiologists, statisticians, biochemists, geneticists, IT experts, nutritionists and health promotion and communication specialists. The memories of those three intense years offset the feeling of hard work and tight deadlines. We met regularly rotating each participating Partners as host. We enjoyed hand-made pasta in Abruzzi, the pre-Christmas atmosphere of a traditional pub in Surrey (see picture), ate fondue (cheese as well as chocolate) on the hills of Lyon and drank good Belgian beer in Leuven. The study had a successful completion and created a repository that is still producing data now.

High blood pressure is very common in sub-Saharan Africa alongside stroke and kidney failure. Due to the scarce resources to detect and treat these problems in rural areas I developed the idea of applying the knowledge accumulated in studying hypertension and salt in my patients to the people leaving in Africa. The underlying hypothesis was that they were at a greater risk of salt-dependent rise in blood pressure and stroke and kidney failure, and that a reduction in salt intake would be cheap, feasible and beneficial in those settings. It took me a few years to convince the Wellcome Trust that it was a good idea to set a population study in sub-Saharan Africa and to carry out a randomised clinical trial of salt reduction.

The Kumasi Study Team
No one had ever managed to complete one, and most reviewers deemed it impossible to do. It took resilience, beliefs, determination and teamwork to produce pilot data that would eventually convince the funding body to grant us the money to go ahead with it. The Kumasi Study became the first ever population based study of hypertension and salt that performed a longer-term (six months) controlled intervention trial (key publications 1 2 3 4 5). The results are still highly quoted. They have also influenced more recent global recommendations on population salt reduction (more on this in Part 4 next week).

I reached a personal milestone when Her Majesty The Queen visited the modern St George’s premises in Tooting in December 2002 to unveil a sculpture donated by Sir Joseph Hotung to celebrate the 250th Anniversary of St George’s Hospital (established at Hyde Park Corner in 1752).  
Her Majesty at the Queen at
St George's

During Her visit, Her Majesty met selected groups and key areas of research were highlighted to Her in a mini-symposium with short eight-minute presentations.  The Kumasi Study was one of them. Never in my professional life did I experience such level of adrenaline flowing during a presentation. If asked ten years earlier, I wouldn’t have predicted such a level of exposure of my work!

Whilst on the home front my work was recognised and showcased, internationally it received unexpected accolade. In 2003, I received the International Society of Hypertension in Blacks (I.S.H.I.B.) Distinguished Researcher Award. The motivation was “…in recognition of significant research contributions in the control of hypertension and cardiovascular risk factors in ethnic minority populations around the world.”  The award was undoubtedly flattering but, more importantly, indicated to me the importance and outreach of my research findings. 

Next time: The Harvest Season (2005-2015). If you have any questions or comments for Professor Cappuccio please post below. 

Career learning points:

  • Achievements are hard to get, but possible...
  • Be resilient in your work.
  • Believe in yourself but do not underestimate the value of working with others.

What did my research show about salt?

  • Reductions in salt intake can be achieved in difficult low-resource settings to help control high blood pressure and its complications. 
  • Population salt reduction should be a global strategy to tackle the epidemic of cardiovascular disease. 

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