SALIM YUSUF: The golden age of cardiology.
I recently had the privilege of reviewing an inspiring book on Dr. Salim Yusuf, a distinguished member of AKMG, and the remarkable era that helped shape modern cardiology—the Golden Age of Cardiology. I am reproducing my Google review in its entirety for the benefit of cardiologists, physician-scientists, and physicians interested in the origins and evolution of evidence-based medicine in cardiovascular care. Dr. Yusuf’s career and contributions offer a fascinating perspective on how rigorous clinical research, large-scale trials, epidemiology, and critical appraisal of evidence transformed the practice of cardiology.
Climbing Mountains - The Journey to Beat the World's Biggest Killer is an extraordinary biography of Dr. Salim Yusuf, arguably one of the most accomplished and influential cardiovascular researchers of the 21st century. Authored by James Mathew and Dennis Xavier, the book traces Yusuf’s remarkable journey from humble beginnings in Kottarakkara, Kerala, India, to global leadership as President of the World Heart Federation. A brilliant physician-scientist, cardiologist, and epidemiologist, Yusuf has led groundbreaking, practice-changing mega-trials at Oxford University, the U.S. National Institutes of Health, and the Population Health Research Institute (PHRI) in Canada. His work has transformed cardiovascular medicine worldwide and helped usher in what can truly be called the golden age of cardiology.
The stark limitations of cardiovascular care were evident in 1955, when U.S. President Dwight Eisenhower suffered a myocardial infarction (heart attack). Treatment consisted largely of prolonged bed rest, and no medication. He subsequently experienced multiple (a total of 14) cardiac events before his death in 1969. Against this backdrop, the young Rhodes Scholar Salim Yusuf, working at Oxford under Peter Sleight and Richard Peto, pioneered large, randomized, placebo controlled, multinational mega-trials. His early studies of atenolol, streptokinase, and aspirin each demonstrated approximately 20-25% reductions in mortality among patients with acute myocardial infarction. These findings rapidly changed clinical practice and helped establish the foundation of modern evidence-based cardiology.
His major trial in the US, SOLVD-a $38 million publicly funded study demonstrated that the ACE inhibitor enalapril reduced cardiovascular mortality by approximately one-sixth and heart-failure hospitalizations by about one-quarter in patients with heart failure. He subsequently led the landmark HOPE trial, showing that ramipril substantially reduced myocardial infarction, stroke, and cardiovascular death even in high-risk individuals without heart failure. These discoveries drove the widespread adoption of ACE inhibitors and helped establish evidence-based medicine as the global standard of cardiovascular care.
Yusuf is particularly proud of donating $4 million, along with key partners, from a patent on discoveries that showed the remarkable cardiovascular benefits of Ramipril .The money was used to endow research chairs and train doctors from developing countries like India . It was matched by institutions, so they were able to double it to $8 million.
The landmark DIG trial showed that, although digoxin did not reduce mortality, it reduced hospitalizations for worsening heart failure.
In 1992, Yusuf moved to McMaster University in Canada as Director of the Division of Cardiology, where he founded the Population Health Research Institute (PHRI). During his 25-year leadership, PHRI grew from a small group of three researchers into a global research enterprise with approximately 75 researchers and 325 support staff, conducting studies across 75 countries and about 1,000 research centers and involving more than 1.5 million participants. PHRI researchers have raised more than $1 billion in research funding.
Yusuf is particularly proud of donating $4 million, along with key partners, from a patent on discoveries that showed the medication Ramipril lowered the risk of heart attack and strokes. The money was used to endow research chairs and train doctors from developing countries like India. It was matched by institutions, so they were able to double it to $8 million.
Yusuf also pioneered landmark epidemiological studies including INTERHEART, INTERSTROKE, and PURE-that placed particular emphasis on low- and middle-income countries, including India. These studies demonstrated that rural populations have a low prevalence of conventional risk factors and yet experience higher cardiovascular mortality, likely reflecting limited access to proven, affordable, and available therapies. A small number of modifiable risk factors account approximately 65-70% of cardiovascular disease worldwide.
Despite the discovery and widespread availability of safe and effective cardiovascular medications, only a minority of people who could benefit from them, actually receive appropriate treatment. To address this enormous global treatment gap, Yusuf conducted a series of major studies evaluating the polypill and subsequently contributed to meta-analyses of these trials. His research demonstrated that a fixed-dose combination pill containing aspirin, ramipril, atenolol, simvastatin, and hydrochlorothiazide can substantially reduce cardiovascular events and mortality (50%). If broadly implemented in appropriate populations, such strategies could potentially prevent millions of cardiovascular events and deaths worldwide each year.
As one of the most quoted productive and visionary Presidents of the World Heart Federation, Yusuf raised more than $1 million to establish the Emerging Leaders Scholarship, now renamed the Salim Yusuf Scholarships. The program is dedicated to training and supporting the next generation of cardiovascular leaders worldwide, with the ambitious goal of reducing cardiovascular morbidity and mortality by 50% within one generation.
Climbing Mountains captures the remarkable transformation of cardiovascular medicine, the golden age of cardiology-shaped in large measure by Yusuf's visionary research and leadership. His work has contributed substantially to the dramatic decline in cardiovascular mortality, including reductions of more than 80% in heart-attack mortality in countries such as the United States and Finland over the past five decades. More than 50 other countries have also achieved reductions in cardiovascular mortality exceeding 50%.
Concise, lucid, and deeply informative, Climbing Mountains is much more than a biography. It is a compelling account of how rigorous science, visionary leadership, and commitment to global health can transform the lives of millions. It is essential reading not only for cardiologists and physician-scientists, but also for anyone whose everyday cardiovascular care rests on the evidence that Salim Yusuf and his colleagues helped build.
Enas A. Enas, MD, FACC
Author, Treatise on Heart Disease in Indians (2026)
President AKMG 1985-88
Only one word- Fantastic
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