As the European Society of Cardiology gets ready to welcome a new journal to its prestigious family, we meet the Editor-in-Chief, Professor Stefan Agewall, to find out how he came to specialise in this field and what he has in store for the European Heart Journal – Cardiovascular Pharmacotherapy.
What encouraged you to pursue a career in the field of cardiology?
I qualified as a doctor at Göteborg University in Sweden in 1986. I became fascinated by emergency medicine early on in my career. I was soon drawn to cardiology as it covers such a broad spectrum of medicine, from acute emergency medicine to physiology, invasive and non-invasive examination and treatment techniques, pharmacology and cardiovascular prevention. I have mainly worked at coronary care units; first at the coronary care unit of Sahlgrenska University Hospital and then at Karolinska University Hospital in Sweden. At Karolinska, I was the head of the coronary care unit. In 2006 I became professor in Cardiology and moved to Oslo University Hospital.
What do you think are the challenges being faced in the field of cardiovascular pharmacotherapy today?
Professor Stefan Agewall, the new Editor-in-Chief of European Heart Journal – Cardiovascular Pharmacotherapy
Pharmacological treatment is very good now and the mortality rate in patients with acute coronary syndrome is quite low. Clinical studies therefore need to be huge in order to demonstrate beneficial effects on hard end-points. We need to put more focus on quality of life in these larger studies and it is also extremely important that some emphasis is placed on preventive medicine, both with and without pharmacotherapy.
How do you see this field developing in the future?
Although the market place for cardiology-related journals is crowded and competitive, I believe the new publication will cover an area that has changed dramatically over the last few decades. This new journal will focus specifically on clinical cardiovascular pharmacology. The production of papers within this area is enormous; in Medline there are almost 500,000 references to the search term ‘cardiovascular pharmacology’ and the rate of publication in this field appears to be steadily increasing. Despite this fast development, we still need even more data from pharmacology studies aimed at improving prognosis for cardiovascular disease as it remains the most common cause of death world-wide.
What are you most looking forward to about being Editor-in-Chief for EHJ-Cardiovascular Pharmacotherapy?
I am looking forward to launching this key new journal and establishing it as a member of the European Society of Cardiology journal family. I hope and believe the Journal will help readers to improve their knowledge in pharmacological treatment of patients with cardiovascular disease through the publication of high quality original research and reviews.
What does your typical day as the Editor-in-Chief look like?
Each day, I will start by handling new submissions and making decisions on papers which have been reviewed by experts within the field. If the submitted papers are of potential interest, they will be sent out for review. We have already recruited a fantastic editorial board, which guarantees a high quality review process. Time will be spent at different kinds of meetings to consider how to develop the journal, how to market it, and how to attract quality submissions from authors in the field.
How do you see the journal developing in the future?
The number of submissions to the journal will hopefully increase every year. In 2015 we aim for four issues and the number of issues will increase year on year. Monthly publication is a goal to achieve within five years. We will of course aim for an increasing impact factor and to become number one within the field of cardiovascular pharmacotherapy.
What do you think readers will take away from the journal?
We hope that by inviting respected and well-known authors, readers will be provided with excellent review papers. We want to provide readers with new information about cardiovascular therapy and, above all, we hope to help the readers to interpret and integrate new scientific developments within the area of cardiovascular pharmacotherapy.
European Heart Journal – Cardiovascular Pharmacotherapy is an official journal of the European Society of Cardiology and the Working Group on Cardiovascular Pharmacology and Drug Therapy. This Journal will launch in 2015 and aims to publish the highest quality research, interpreting and integrating new scientific developments within the field of cardiovascular pharmacotherapy. The overarching goal of the Journal is to improve the care of patients with cardiovascular disease with a specific focus on cardiovascular pharmacotherapy.
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Image credit: Headshot courtesy of Professor Stefan Agewall. Do not re-use without permission.
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By Dr Alex Dregan
Do vascular risk factors such as high blood pressure and smoking make us forgetful?
As our bodies start to show the signs of ageing, our brain is naturally ageing too. But some older people can become forgetful and have trouble remembering common words or organising daily activities more than others. There are few proven interventions to prevent this kind of cognitive decline in older adults, although treating modifiable risk factors for vascular disease and stroke, such as cholesterol and body mass index (BMI), has been suggested as a promising approach to preventing or delaying cognitive impairment for a growing UK population of older adults. So is there a link between high blood pressure and forgetfulness?
Despite much recent interest, studies to date have reported inconsistent relationships between blood pressure and cognitive functioning. Evidence suggests that people diagnosed with high blood pressure levels tend to perform more poorly on most domains of cognitive functioning, including memory, learning, attention, and reasoning. However, clinical trials have so far failed to demonstrate that antihypertensive drugs used to lower or control high blood pressure levels are effective in preventing cognitive decline in older adults. This inconsistent evidence poses a challenge when developing recommendations for the prevention of cognitive ageing.
Cognitive ageing, such as symptoms of forgetfulness, is increasingly seen as the result of the joint effect of several vascular disease risk factors, including high blood pressure, BMI, cholesterol levels, and smoking. However, the combined influence of these on cognitive decline is less commonly explored among older adults at increased risk of both cardiovascular disease and cognitive decline.
In a recent paper, we looked at Framingham stroke and cardiovascular risk scores (a measure used to assess an individual’s probability of developing stroke or cardiovascular disease over a 10-years period) and investigated their association with cognitive decline in older adults. The study included over 8,000 adults aged 50+ living in private households in England. Participants with the highest risk of future stroke or cardiovascular events, based on their risk factors values, were found to perform more poorly on tests of memory and executive functioning after a four year period. This adds weight to the theory that the combined effects of risk factors for vascular disease and stroke may be associated with more rapid cognitive decline in older adults. In other words, those at greater risk of cardiovascular problems were likely to experience a more rapid onset of symptoms associated with cognitive decline, such as forgetfulness.
We believe that these findings support the need for a multifaceted approach when seeking to prevent cognitive decline. The main implication of this is the need for addressing the combined effect of multiple risk factors, including lowering high blood pressure and high cholesterol levels, weight loss, and stopping smoking. Thus, healthcare professionals should encourage older people to adopt healthy lifestyles that would include stopping smoking and increased exercise (as well as improved diet not investigated here) and taking prescribed medicines aimed at controlling high blood pressure and high cholesterol levels. Such recommendations could potentially prevent or delay future declining memory or reasoning capacities in older adults, particularly those in higher risk groups.
The results also suggest that a harmful effect of high blood pressure on memory or reasoning abilities may develop over a prolonged period of time. This may be one reason why short-term trials have failed to show a consistent benefit from antihypertensive treatment on cognitive decline. For instance, since the negative impact of high blood pressure on memory or reasoning abilities takes place over a prolonged period of time, short-term treatment may not be sufficient to reverse or delay its adverse influence. Therefore, we would expect that any potential cognitive benefits from lowering blood pressure may only be observed over substantial periods of time.
These new results suggest that attention to the combined effects of multiple vascular risk factors may hold some promise as a strategy to prevent cognitive decline in older adults.
Dr Alex Dregan is a Lecturer in Translational Epidemiology within the NIHR Biomedical Research Centre at the Guy’s and St Thomas’ NHS Trust and King’s College London. He trained in Public health at the Institute of Education, University of London. His research interests are in translational epidemiology research as applied to public health. He is co-author of the paper Cardiovascular risk factors and cognitive decline in adults aged 50 and over: a population-based cohort study for the Age and Ageing journal, and this has been made freely available for a limited time.
Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life.
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