John McMurray MD FESC (2024)

John McMurray of Glasgow is championing the cure of heart failure 

John McMurray MD, FRCP, FESC, FACC, FAHA, FRSE, is Professor of Medical Cardiology and Deputy Director of the Institute of Cardiovascular and Medical Sciences at the University of Glasgow, UK. He is an Honorary Consultant Cardiologist at the Queen Elizabeth University Hospital, Glasgow. His high-profile clinical trials into heart failure, coronary heart disease, atrial fibrillation, and diabetes have placed him amongst the most influential bio-medical researchers in the world.

Born in Northern Ireland, McMurray first attended university in Manchester, UK. His long-standing interest in heart failure developed during his final years as a medical student which coincided with the introduction of angiotensin-converting enzyme (ACE) inhibitors. ‘During my time as a junior doctor I was lucky to work with a physician who was willing to try this new type of treatment on very sick patients with heart failure and I was able to see the remarkable effects of that treatment. When it was subsequently shown not just to make people feel better and recover, but to live longer, that confirmed my interest in heart failure and gave me a passion that you could study treatments, gain evidence and apply that treatment in clinical practice’.

In the mid-1980s, McMurray moved to Edinburgh, Scotland to complete his clinical training. As a prelude to specializing in cardiology, he undertook research at the University of Dundee with Allan Struthers MB who was engaged in work on recently-discovered natriuretic peptides. McMurray completed his MD thesis at Dundee and keen to continue working with natriuretic peptides, he moved to Glasgow where Henry Dargie MD was starting work with what became known as neprilysin inhibitor. Although the early neprilysin inhibitors didn’t work as expected, McMurray kept on with his work on heart failure. In 1993, he was appointed to a consultant role in Edinburgh before a Medical Research Council (MRC) initiative on heart failure drew him back to Glasgow 2 years later. He has remained in Glasgow ever since.

He was the inaugural Eugene Braunwald scholar in cardiovascular disease at the Brigham and Women’s Hospital, Boston, USA, between 2010 and 2011, and visiting Professor of Medicine at Harvard University, Boston. This brought him into the orbit of Marc Pfeffer MD whom he describes as an important mentor. ‘By that stage I’d formed good relationships with Salim Yousef MD, at McMaster University in Canada, Robert Califf MD, and Christopher Granger MD, both from Duke University School of Medicine in the USA, so I was working with the people who were involved in leading clinical trial initiatives of the time, and I counted myself very lucky to be part of that team’.

Having set out to specialize in cardiology and pursue his interests in heart failure, he describes his career as a straightforward one which progressed through a combination of luck, determination, and making the most of opportunities as they presented themselves. Cardiology was, and remains, a great choice. He says: ‘I would always encourage young doctors to get involved in cardiology because it’s the best speciality I can think of. It’s a combination of wonderful interventional treatments, devices, and great drugs and has an evidence base that is virtually unrivalled’.

Although cardiology may not see the dramatic leaps forward in clinical practice typified by the introduction of therapies such as ACE inhibitors, McMurray sees innovation continuing. ‘Looking back you could argue it was easier to demonstrate progress because you could show dramatic differences with a small number of patients. I don’t think it is as easy today, but that doesn’t mean that it is any less exciting. The steps are much smaller and that’s one of the challenges, because as you get more and more effective treatment options, it becomes increasingly difficult to add to those’.

Clinical practice and research remain McMurray’s primary engagement in his working life and for him, are entirely symbiotic. ‘My clinical practice tells me what the questions that we need to ask are. I realize the problem from the patient’s side and we design research to try and get an answer that solves the problem, and that advances clinical care. It’s a never-ending circle’.

McMurray sits on the editorial boards of several leading journals and identifies scientific journals as a valuable platform to disseminate clinical knowledge and research as well as providing a forum where people can exchange ideas. He has been identified as one of the most influential biomedical researchers in the world—and is the only UK cardiovascular researcher to be recognized in this way.1 He has also been recognized by Reuters Thomson as one of the world’s most influential scientific minds. He was lead author of the World Health Organisation’s (WHO) guidelines on the management of heart failure and highlights the importance of this activity: ‘Guidelines are essentially a summary of evidence and trying to help doctors apply that evidence in everyday practice’.

He characterizes a good clinical trial as one that definitively answers a clinically relevant question. This apparently simple definition does not, however, always translate into simple, relevant outcomes. ‘Many trials don’t give definitive answers and sometimes that’s because they are not big enough or there is some problem with their conduct. Clinical trials are like any other form of research in that they evolve, you learn, problem solve, and get better. They are enormously expensive human experiments where a vast number of patients, from as many as 50 countries, are trusting you with their lives and their health. They can involve as many as 1000 investigators, so trials require a massive amount of goodwill, trust, and people working together in a collaborative way to do something good. It’s a great responsibility leading those trials properly and trying to design and conduct them in the best way possible’. Nor does McMurray believe that a neutral outcome in a trial equates to a wasted effort. He says there is something to be learned from every trial with its processes and procedures and the data gathered.

From his own work, he singles out VALIANT; the CHARM Programme; EMPHASIS and PARADIGM as important for their role in changing guidelines and making a difference to treatment options for patients. He says: ‘These clinical trials demonstrated that we had treatment that would make patients feel better and live longer and that is the goal of everything I want to do. I want to help my patients on the ward and in the outpatient clinics on a very one-to-one personal basis, but I also want to help patients on a larger scale and that’s a different type of reward’. Being able to help not only local patients but also many thousands, and possibly millions of people globally makes being a clinical academic engaged in trials the best job in the world, he says.

McMurray also points to progress made in the wider speciality of cardiology in parallel to drug development. ‘We also have interventions and devices and even surgical interventions, which are all progressing at a tremendous rate. Anything that involves the sort of mechanization or miniaturization seen in other fields such as computing and telecoms is also happening to devices in cardiology. It is an astonishing era, without even considering the ‘holy grail’ of cell therapy. If all the promise held by cell therapy ever comes to fruition, we won’t be talking about treating HF, we will be talking about curing HF’.

Looking to future developments in heart failure, he suggests the facts are superior to guess work and says that with over 10 active clinical trials looking at drugs and a new molecule on the go, there is huge potential for innovation. ‘We have never seen this level of activity before and the law of averages suggests as least one of these trials is going to come out positive. I am very confident that at least in the next 5 years we are going to see another significant breakthrough in the treatment of HF and if you can do that every 10 years in medicine, you are doing well’.

Conflict of interest: none declared.

Reference

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