Bernard J. Gersh, MB ChB DPhil FRCP FACC
Dr. Bernard Gersh is Professor of Medicine at Mayo Clinic College of Medicine, Consultant in Cardiovascular Diseases and Internal Medicine and Associate Chair of Academic Affairs and Faculty Development in the Division of Cardiovascular Diseases at Mayo Clinic, and Honorary Professor of Medicine University of Cape Town, South Africa, from 2006 to present.
His past positions include The W. Proctor Harvey Teaching Professor of Cardiology and Chief of the Division of Cardiology at Georgetown University Medical Center. Dr. Gersh received his MB ChB from the University of Cape Town in South Africa. He received his Doctor of Philosophy Degree from Oxford University where he was a Rhodes Scholar.
Dr. Gersh is a Fellow of the South African College of Physicians and Royal College of Physicians in the United Kingdom as well as a Fellow of the American College of Cardiology and the American Heart Association.
Dr. Gersh’s interests include the natural history and therapy of acute and chronic coronary artery disease, clinical electrophysiology, adult congenital heart disease, and the cardiomyopathies and clinical implications of molecular genetics. He has written 575 articles and 117 book chapters. Dr. Gersh is the editor of 11 books and is on the editorial board of 25 journals including Circulation, Journal of the American College of Cardiology (Senior Consulting Editor), Nature Cardiovascular Medicine, and The European Heart Journal (North American Editor).
He is a member of the Advisory Board of the Reynolds Foundation, a Past Chairman of the Council of Clinical Cardiology of the American Heart Association, and a former Member of the Board of Trustees of the American College of Cardiology. He has served on the Steering Committees and Data Safety Monitoring Boards of multiple clinical trials sponsored by the National Lung and Blood Institute and other organizations.
Dr. Gersh’s honors include Teacher of the Year Award from the Division of Cardiovascular Diseases, Mayo Clinic, and numerous Visiting Professorships and Invited Lectures both nationally and internationally. He is an Honorary Member of the South African Cardiac Society and The South African Heart Association, and he is an Honorary Fellow of the Sociedad Chilena de Cardiología y Cirugía Cardiovascular.
Dr. Gersh was the 2004 recipient of the Distinguished Achievement Award of the AHA Council of Clinical Cardiology and the 2007 recipient of the ACC Distinguished Service Award.
Ph.D. (honoris causa) from The University of Coimbra, Portugal, in 2005. He summited Mount Kilimanjaro in 2002.
Management of Chronic Stable Angina: Do We Have the COURAGE?
Monday, March 17, 2008
4:30 PM
Download Dr. Gersh’s complete slide set [8.04 MB PPT].
Download Dr. Gersh’s featured preconference slides [231.53 KB PDF].
The optimal medical management of chronic stable management is based upon the use of standard anti-anginal agents, the addition of new drugs such as Ranolazine, and aggressive risk factor modification. It has been shown that in patients who have undergone percutaneous coronary intervention, the majority of events at five years are not related to the infarct-related artery and probably reflect progression of disease.
The indications for coronary revascularization include: persistent limiting symptoms or a strongly positive stress test, drug intolerance (particularly in the elderly), patient preference based upon lifestyle and occupation, left ventricular dysfunction, prior myocardial infarction or compelling angiographic anatomy. The recently published COURAGE trial has generated considerable controversy among interventionalists, general cardiologists, the media, and professional organizations.
Although this trial is subject to all the limitations of randomized controlled trials of revascularization in patients with stable coronary artery disease, the COURAGE trial has re-emphasized the conclusions of almost 3 decades of trials of coronary bypass surgery versus medical therapy and PCI versus medical therapy in patients with chronic stable angina and preserved left ventricular function. These trials have demonstrated a good prognosis characterized by a low cardiac mortality in addition to a significant “crossover” for persistent limiting symptoms. One cannot extrapolate these data to high risk patients, but the COURAGE trial would suggest that the current guidelines for patients with chronic stable angina are appropriate and raises the concern that PCI is being over utilized. The reasons are multifactorial, but need to be recognized and addressed by the profession.
The Global Burden of Cardiovascular Disease
Monday, March 17, 2008
6:00 PM
Download Dr. Gersh’s complete slide set [7.27 MB PPT].
Download Dr. Gersh’s featured preconference slides [907.27 KB PDF].
Recent data highlight that cardiovascular disease accounts for approximately 16.7 million of total global deaths of 57 million. Eighty-seven percent of worldwide cardiovascular deaths occur in the developing countries and at a younger age than the developed world. In contrast, total deaths due to HIV, tuberculosis, and malaria were approximately 5 million. Future projections are a concern in that it is estimated that death rates from stroke and coronary heart disease in the developing countries would be two- to three-fold greater than in the developed world.
The cost of countries dealing with the dual burdens of communicable and degenerative diseases in terms of loss of productivity and the impact upon the public and private sector is enormous and could be catastrophic. It is likely that the pace of the “epidemiologic transition” underlying the epidemic will vary according to the rapidity of economic development or the lack thereof, and the role of genetic vulnerability needs to be determined.
Nonetheless, the combination of a hostile cardiovascular environment as defined by changing diet, tobacco, lack of exercise, an aging society, air pollution, and the psychosocial and economic stresses in the developing world in conjunction with limited national resources and possible genetic vulnerability (the thrifty gene) is likely to lead to an explosion of the epidemic in the next 20 years.
The key question is whether population-based strategies based upon community public health programs and high risk clinic-based strategies can stem the tide or even halt the epidemic. It is likely that the epidemic will involve all developing countries in the future, but the time course is unpredictable, and there is a dire need for prospective data since the implications for resource allocation are profound. Not all developing nations are at the same stage of the “epidemiologic transition” and the shifting of resources from dealing with communicable diseases to cardiovascular disease needs to be based upon actual as opposed to perceived needs.
The low priority of cardiovascular and chronic diseases on the global health agenda is a cause for concern and integrating the treatment and prevention of chronic diseases into health systems dealing with communicable diseases will contribute to the strengthening of weak health systems and overall community health (Fuster V, et al. Low priority of cardiovascular and chronic diseases on the global health agenda: a cause for concern. Circulation 2007; 116:1966-1970).
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