In January 2025 we were honored and thrilled to welcome Valentin Fuster MD PhD as our guest lecturer and Pioneer in Cardiology. Over his illustrious career he has made countless contributions to our knowledge of cardiovascular disease. Dr Fuster’s career began in Barcelona, Spain where he completed medical school at the University of Barcelona and his medical internship at the Hospital Clínico. He then moved to Scotland, where he completed his PhD at the University of Edinburgh in the role of platelet function in myocardial infarction. After completing his residency at the Mayo clinic in Rochester, he rose to the ranks of professor in Medicine. He later moved to New York to lead the Cardiology division at Mt Sinai Hospital, before moving to Boston to lead Cardiology division at Massachusetts General Hospital. Upon his return to New York, he returned to Mt Sinai Hospital where he serves as president of the Mount Sinai Hospital renamed in his honor. He simultaneously id the General Director of the National Center for Cardiovascular investigation or CNIC (equivalent to NHLBI) in Madrid, Spain. Dr. Fuster has served as editor-in-chief of the Journal of the American College of Cardiology, and past President of the American Heart Association.
Dr. Fuster has published more than 1,000 publications and his role has been instrumental in understanding cardiovascular disease, including the role of platelets in coronary disease and thrombosis, the fundamentals of acute coronary syndrome, the development of drug eluting stents, and the development of polypills for treatment. In addition to his impact on secondary prevention, he is committed to improving the primary prevention of cardiovascular disease on a global scale. As past president of the World Health Federation he has had an immense impact on global cardiovascular health, empowering communities throughout the world. He has promoted healthy habits in children through his work and beloved character on Sesame Street, Dr. Ruster. For his work he has received countless awards and accolades including lifetime achievement awards, recently in December 2024 he received the Antonio M. Gotto Jr. Prize in Atherosclerosis Research from the International Atherosclerosis Society (IAS) and now we honor him as a true Pioneer in Cardiology.
Our cardiology Chief Fellows Dr. Rahul Sheth and Dr. Louis Vincent at the University of Miami / Jackson Memorial Hospital sat down for a 1:1 discussion and interviewed Dr. Valentin Fuster:
Q: This is Louis Vincent and Rahul Sheth, Chief Cardiology Fellows at the University of Miami’s Cardiovascular Diseases Fellowship Program. We are so honored to have our Pioneer in Cardiology Dr. Valentin Fuster sitting with us today for this interview. Dr. Fuster, thank you for joining us today. For our first question, what early experiences shaped your path and helped you find your research interests? Have your professional interests changed over the years?
A: I think that we are all born with a path. In my case I would say that [my path] was curiosity and creativity, and this continues to be the case. However, in life there are many kinds of influences that you go through, and perhaps a very important influence is one that mentors and tutors have on you. I have to say that I was born with curiosity and creativity, but that my mentors made my life quite exciting. In talking about mentorship, I can tell you that I wanted to be a tennis player when I was young. I flunked a subject in school, I cannot remember what it was, and my father told me that in the summer I would not train. At the time, I had been playing 5 hours/day, I was 16 years old. I had previously been selected to represent Spain for the Junior Davis Cup, in Miami in the Orange Bowl. However, since I had failed the subject and didn’t play much or train hard, the trainer told me that I would need to win against the others [in order] to go to Miami. The fact is that I lost, and that same day I stopped playing tennis! And then what happened is that one of the most known physicians in Latin America, Dr. Farias Valentino, saw me in the blues with my head down, and told me out of the blue that [I] “will be a great physician”. I didn’t understand why he said that, but I decided then to be a physician. He was very well-known individual, so I trusted him. Soon afterwards, he had a heart attack at his 40s, and told me “You have to be a Cardiologist” -so I became a cardiologist. So as you can see, a LOT of my life has been portrayed or focused on what people told me i could do well. These are several examples in which i made my career based on the advice and support of other people.
Q: What is the best advice that you have ever received?
A: The best advice i have had was probably from my parents. My father was a psychiatrist, and a very strict person, very methodic. My mother was a very empathetic person and very positive towards society. My father gave me the methods to success and a strict approach to life, while my mother gave me the sense that one has to be supportive of society -particularly those of us that have the luck to be where we are. I have tried to transmit this message to fellows from day one, that you have to give thanks to society and be creative. Creation is not necessarily research but can be through many other aspects whether educational, or administrative etc..
Q: How do you identify and select mentors in your career?
A: Mentors are not easy to select, but certainly are important. These are people that you not only trust, but who would do anything for you. But, mentors need to be up to date. Let me explain. You cannot just choose someone based on seniority or position. Your mentor must live in the world you are in. This is critical; the person must be very knowledgeable. There must also be chemistry there. Last, I would say to you that perhaps the most important approach that a mentor can have on you is to tell you not only what to do, but what NOT to do and be a critical. Paternalism does not work. My mentors that I have or have had were very critical of me, and I will always be thankful for that.
Q: Do you have any reflections to share regarding any difficult decisions in your career and advice for fellows in making big decisions?
A: I have had many difficulties at many levels of my career, like anyone. At a research level, a project with good results may create doubts and much stress before coming out with what it was from the beginning. A number of papers that I wrote were very much on different tiers. I started with platelets in the Cardiovascular field when it was in fact a specialty of Hematology. I still remember going to meetings in which there were probably only 2 people in the room from the cardiovascular field who were listening to me. I had a number of occasions like this in other areas of research. I also had issues in which I had to take a position in moments of institutional difficulties and otherwise. Overall, I think what is most important is that you always do what is right, and try not to be defensive. I think the question you’re asking is important for everyone because life has ups and downs for everyone and the most important is how we overcome those moments. This idea comes back to what we mentioned in my talk earlier about resilience for Fellows, because you have to overcome difficulties. I don’t want to sell any book but I do have a book called the “Circle of Motivation” which i wrote a few years ago, which actually explains how sometimes when you feel you are at the top you are actually beginning to go to the bottom, and how when you are at the bottom you can make it back to the top. Again, I have another book that came out which is entitled “Moving On” which explores how exactly you must focus in overcoming difficulties. It is much more specific about how the circle of motivations goes both ways. Yes, resilience is very important. But the other aspect that is very important in life teamwork, the fact that we’re in a society and working together. Today, an individual approach to everything will not work. These are all issues that are important: being creative, finding out who you are, team efforts, investing yourself properly and resilience.
Q: Reflecting on the many successes and challenges of your career, is there something you are most proud of?
A: Yes, perhaps two things come to mind. One is perhaps my work with the young people that I train. The F society, which is fantastic group of about 200 fellows that I have trained in which I feel I have done something right. The other issue is positions or awards -that I never worked for that came spontaneously as my life has been moving on. Things happened that I didn’t necessarily go for, and happened spontaneously, whether they were awards or positions they came as part of my natural approach to life. These are 2 aspects that created a sense of (pause) not necessarily proudness but perhaps accomplishment.
Q: Much of your recent work has focused on public health and community education. What public health initiatives or changes would you make with carte blanche?
A: Yes- I think as I mentioned yesterday, the first thing needed is to create a culture from the bottom up. There are disadvantages to this approach- it takes time. People who think that the answer will come from the top down may underestimate that the problem is much more significant. Political leaders stay in power for a short time, with many pressing issues to solve. The issues of health require a common culture. My issue has been over the last 10 years to work with children from the bottom up. Children are very receptive to education, particularly of health. I am now working on the possibility of creating a 1st book for the primary school system that may be obligatory on health for children, and working with governments on this issue. While I still think efforts must come from the bottom up, from time to time things can be done from top down like creating new signs or label signatures. In considering the top down approach, much could also be done with the food industry or with tobacco. Still, much can be done via education with the culture working from bottom up.
Q: With your unique perspective, what other major changes do you imagine in the future of Cardiology?
A: First of all, I feel that we have to go for quality of life. We have struggled with QOL for many years and have reached a stage that to me is probably the limit. The question is, how can we reach those advanced ages with quality of life? This is the issue to focus on. In order to have QOL you have to prevent disease. We are getting back to the issue of how we can prevent disease. The key to this, in my view, is to really understand health using the most sophisticated technologies possible. The other key is education. In education, the route that is most fertile is children because children capture what we teach them. To answer the question, quality of life is going to be the movement of the future. To have quality of life, you must understand health with the most sophisticated technologies possible. And last education, for which the children are probably one of the most critical groups that can have implications for the future. They capture things that can come back once they are adults.
Q: If you had to predict the future of Cardiology, which innovation or technology may become important in our lifetimes?
A: There are 2 technologies that will be very important. Genetics and imaging. Imaging is becoming obvious. Imaging that is noninvasive allows us to best see the #1 killer today, which is arterial disease. The other is genetics, very soon in life one can begin to identify new issues that will need to be approached. Technically speaking, I am very convinced the future relies on these technologies. Then peripherally in the clouds are things that will be important but are difficult to predict. Artificial intelligence is one of them. The other is new therapies. On one side, medication adherence is very low today. There is the advance of the polypill which is working well today and was recently approved by the WHO as essential. The other potential is addressing disease with long acting subcutaneous medications to address conditions like hypertension, dyslipidemia, amyloidosis. This is a change that will be quite fascinating to me.
Q: What have been some keys to your academic productivity and maintaining motivation?
A: I am very methodical. In a way, you become very strict. For example, I get to work every day at 5AM. It makes for a long day, but it is all structured. I also go to Spain once a week, but in a single day, imagine that a lot can be accomplished in an institution with 400 investigators. Back home, my days are long but very structured. I don’t appear phenotypically ever like someone in a hurry, but I think of myself rather as someone whose time is very well organized. You cannot go here and there and so forth. For example trips like these may be structured up to 1 year before! You have to be very strict with your time. This is what my father provided to me -the method. Then, you have to be motivated. For me, whatever I do is because I like it. You CANNOT start doing things that you don’t like, and that’s basically the simplest way I can answer you.