AHA Marks 100 Years: ‘We Truly Stand on the Shoulders of Giants’

The American Heart Association (AHA) is celebrating its 100th birthday today, marking the occasion in its flagship journal with a perspective by one of the most celebrated names in cardiology.

A century ago, writes Eugene Braunwald, MD (Brigham and Women's Hospital, Boston, MA), most cardiologists were “general practitioners with relatively little postgraduate training,” who relied on influential tomes like Osler’s Principles and Practice of Medicine. Their patients with CVD should be advised to live “a quiet, regulated, orderly life, free from excitement and worry” and, ideally, not even told about any serious heart problems (a friend or relative should be informed instead). Patients with hypertension were advised to rest and reduce sodium, but also to bathe in tepid water and irrigate the colon once or twice weekly. Acute MI was treated with bed rest, a liquid diet, and general supportive measures.

By 1924, some physicians were challenging those ideas with careful follow-up and research to understand the natural history of various cardiac disorders. The AHA, Braunwald says, was formed amid these novel approaches, which sowed the seeds of contemporary cardiology and ushered in a new era that included primary and secondary prevention measures. With time, innovations expanded to the development of right and left heart catheterization, coronary arteriography, and advances in the detection and treatment of arrhythmias, heart failure, congenital diseases, accompanied by a revolution in cardiac imaging.

“Although our predecessors had little to work with, they clearly established cardiology as an important medical specialty; we truly stand on the shoulders of giants,” Braunwald writes. “Although cardiology has progressed enormously, cardiovascular disease still remains the most common cause of death worldwide, and there is much that remains to be accomplished. Importantly, the foregoing achievements are not available to large segments of the worldwide population.”

Past Presidents Weigh In

TCTMD reached out to a range of AHA past presidents, too, asking them to reflect on the organization’s 100-year footprint.

Robert O. Bonow, MD (Northwestern University Feinberg School of Medicine, Chicago, IL), 2002-03:

“The most important contribution of the AHA in its first 100 years was transforming its mission in the late 1940s from a professional and scientific society to become a national voluntary health agency. These plans, which started in 1941 but were interrupted by World War II, broadened the AHA’s scope to include fundraising for public education and research. Between 1946 and 1948, campaign funds grew from zero to $2.6 million and research funding from zero to $700,000. The AHA’s public investment in cardiovascular disease research, totaling $5.6 billion since 1949, is second only to the National Institutes of Health.”

Donald Lloyd-Jones, MD (Northwestern University Feinberg School of Medicine, Chicago, IL), 2021-22:

“The first century of AHA was about scientific discovery: discovery and demonstration of the major (behavioral and physiological) causal risk factors underlying the vast majority of cardiovascular diseases. Along the way we also began to discover effective treatments for these diseases and risk factors, and we also began to learn how to curate scientific evidence for clinicians, patients, and policymakers, and how to get that evidence-based knowledge to places where it could do the most good—the hospital bedside, the clinician office, the consumer's consciousness, and the policymaker's agenda. I am continually amazed with how well AHA catalyzes the entire scientific discovery cycle.”

“In this next century, our commitment to discovery and innovation is greater than ever. But I think the truly impactful work will involve the synthesis of our science, our clinical work, and our advocacy to ensure more widespread and equitable implementation of our science and evidence-based knowledge. It remains true that we know all we need to know to prevent 80-90% of CVD and stroke events. But we fail in that last mile of delivery and implementation to patients and the people who need the information the most. This is where the frontier and focus need to be in our science and advocacy, and will prove that we are a relentless force for a world of longer, healthier lives.

Robert Harrington, MD (Weill Cornell Medicine, New York, NY), 2019-20:

“For me, the most important contribution of the AHA this last century has been the commitment to funding research and stressing science as foundational to all the AHA does. Since the late 1940s, the AHA has contributed more than $5 billion to research, ranging from basic discovery science to population health research. Importantly, the majority of annual research awards are to early-career investigators, and many academic researchers count AHA funding as the initial step that helped to start and support their careers. The AHA’s commitment to science extends to clinical practice guidelines, the production of scientific statements, a commitment to science-based education at the annual scientific sessions, and advocacy work that is based on science.”

Clyde W. Yancy, MD (Northwestern University Feinberg School of Medicine, Chicago, IL), 2009-10:

“These 100 years [have been] journeys in discovery science, the transition from observation and anecdote to hypothesis-driven rigorous randomized trials, the evolving and now refined science of cardiovascular disease prevention, the overt inclusion of stroke as a bona fide cardiovascular disease responsive now to state-of-the-art evidence-based interventions, the paradigm shift in biology from physiology to cell and molecular biology then genomics and now data science. Most recently our focus addresses the intersectionality of disease and communities and the recalcitrant burden of health inequities on rapt display in our CVD space if only because of the ubiquity of heart disease.”

Find more from Yancy on our Off Script blog.

In a press release issued today by the AHA, Joseph C. Wu, MD, PhD (Stanford School of Medicine, CA), the current president, observed: “There is much to learn from this historic shift in the reduction of deaths from infectious diseases and the current prevalence in deaths from cardiovascular diseases.” There’s also much to celebrate, he added. “Through scientific research, technological advances, and public health policy, most of these infectious diseases have become controlled, and many have been or are nearly eradicated. . . . Although still too many people die each year, many are living longer, more productive lives while managing their cardiovascular disease and risk factors.”

TCTMD Managing Editor Shelley Wood contributed to this story.