Dr. Salim Yusuf: why clinical trials are “one of the most important innovations ever” in the history of evaluating medical strategies

November 13, 2014

Making Clinical Trials Happen

When Canadian cardiologist and epidemiologist Dr. Salim Yusuf began practice in 1976, the world was a different place for people with cardiovascular disease. “For people with heart disease, we had very few treatments we knew actually saved lives. For people with heart attacks, I don’t think we had any treatments (other than defibrillation, an electric shock), that we knew saved lives,” says Dr. Yusuf.

Salim Yusuf

“There was no aspirin, no cholesterol lowering, no thrombolytic therapy, no PCI [angioplasty], no ACE-inhibitors, no beta blockers. Coronary artery bypass graft surgery ― we were still debating its value. There were several useless therapies that were used quite widely.”

And then clinical trials―specifically randomized trials― “completely transformed the field,” says Dr. Yusuf, former Vice President for Research at Hamilton Health Sciences (HHS) and Executive Director of the Population Health Research Institute at McMaster University in Hamilton, Ontario.

“Clinical trials have helped establish the value of so many treatments that in the last 30 years we’ve reduced mortality rates from heart attacks and strokes by 50% in most of the developed world. Equally, we got rid of a lot of ineffective or unsafe therapies.”

Now, the challenge is to “fully implement” what we know to further reduce cardiovascular disease, and to help people in developing countries, says Dr. Yusuf. As President-elect of the World Heart Federation, he is initiating an Emerging Leaders program in 100 countries with the aim of halving the cardiovascular burden globally within a generation.

Dr. Yusuf has published over 900 articles in refereed journals–many stemming from clinical trials he has led. He was the second most cited researcher in the world for 2011.

His trials, to name just a few, have established the roles of ACE-inhibitors in heart failure, left ventricular dysfunction and in those with atherosclerotic disease, and the roles of novel antithrombotics and invasive interventions in acute coronary syndromes.

He has built capacity over the last three decades for clinical and population research across Canada and the world by establishing networks at over 1,500 sites in 85 countries.

This year, Dr. Yusuf received a Canada Gairdner Wightman Award “for his exceptional leadership in global clinical trials and population studies of cardiovascular disease that shaped best guidelines for prevention and treatment.”

Medically trained in Bangalore, he worked in England and the U.S. before moving to Ontario in 1992. Dr. Yusuf was drawn to McMaster and HHS “because of a reputation here for doing very high-quality clinical research and some inspirational figures here in clinical research.”

As Vice President for Research at HHS, Dr. Yusuf has facilitated efforts by colleagues to create “the infrastructure, environment, culture and mutual support” to assist investigators. This includes “minimizing bureaucracy” by, for example, merging the city’s three ethics review committees into one.
“It means that when we do a study across several sites in the city, we only need a single approval. This also allows us to have a significant expertise across all the hospitals serving on the committee. So it’s been a very positive step.”

Dr. Yusuf would like to see a streamlining of research ethics review processes, contracting processes and several other aspects of clinical trials both provincially and nationally. Clinical Trials Ontario (CTO) is implementing a streamlined research ethics review process in Ontario.

“Clinical trials are extraordinarily important,” he says. “I think they are one the most important innovations ever in the history of evaluating preventive and therapeutic strategies, and have contributed to benefitting some millions of individuals.”