P&S Journal: Spring 1995, Vol.15, No.2
Alumni Profile - Suzanne Oparil: It Takes Heart
By Peter Wortsman
The bad news is that cholesterol, salt, and a sedentary lifestyle have supplanted Cupid's arrows as the primary perils to the health of the human heart. The good news, thanks to decades of cardiovascular research, is that hypertension and many other previously life-threatening conditions are now treatable and, better yet, preventable.
The best news is that Suzanne Oparil'65, one of the nation's leading clinical investigators in hypertension and current president of the American Heart Association, is leading the battle against heart disease from laboratory and lectern.
For three decades and counting, Dr. Oparil has explored the biochemistry, physiology, and molecular biology of the heart and its links to the circulatory system. Her early pioneering research at Massachusetts General Hospital on the role of ACE (angiotensin converting enzyme) inhibitors led to the development of one of the most important pharmaceutical agents for the treatment of high blood pressure and heart failure. In later work at the University of Chicago and at the University of Alabama at Birmingham, where she is director of the Vascular Biology and Hypertension Program and professor of medicine, physiology, and biophysics, she has focused on the neural control of the circulation and role of electrolytes in regulating blood pressure, among other areas. She was the first woman president of the American Federation for Clinical Research, the largest clinical research organization in the world, and is a member of the Institute of Medicine of the National Academy of Sciences. She is the author of more than 285 peer-reviewed papers in clinical cardiology and hypertension.
A vocal and committed advocate of heart health, Dr. Oparil has been equally active outside the laboratory.
As a longtime affiliate of the American Heart Association, the world's largest voluntary organization dedicated to the prevention of and research in cardiovascular diseases and stroke, she held various offices and served on numerous committees at the local and national level before ascending to the presidency.
From Farm Field to Laboratory
"The scientific seed was planted early in my life," says Dr. Oparil, who grew up on a farm in upstate New York, where she "learned to appreciate the link with life and nature and a respect for circumstances that you can't control." She still retains all the vigor of her rural childhood, as if she's only just come in from the cold. Her farm background, she insists, also cultivated an independent streak and a stubborn endurance that she put to good use as a clinical investigator. An undergraduate sojourn at Cornell (which she attended as a National Merit Scholar, graduating in the top 2 percent with distinction in all subjects) helped sharpen an already formidable intellect and broaden the scope of her tireless curiosity. "People who function in my way are natural researchers," she says. "We're in the business of generating new knowledge."
At P&S, where she graduated first in her class, she enjoyed "the personal aspect of my medical education, a closeness between faculty and students, the like of which I haven't seen since, in any other place I've been." Lecture classes with distinguished scientist-teachers like Elvin Kabat, the Higgins Professor Emeritus of Microbiology, and the late Harry Rose were "both terrifying and electrifying." Another favorite professor was the late Yale Kneeland'26, who "could keep us absolutely on the edge of our chairs while inculcating the principles of physical diagnosis."
Following a medical residency at Presbyterian Hospital, she went on to pursue a fellowship in cardiology at Massachusetts General Hospital with another illustrious P&S alumnus, Edgar Haber'56, the individual she insists "really changed my professional life." Impressed by his "intellectual forcefulness, rigor, and clarity," she welcomed his ability to "take the emotion out of the medical equation." It was in Dr. Haber's laboratory that she made her seminal contributions to understanding the role of the ACE inhibitor in high blood pressure.
Dr. Haber, who has followed her subsequent work with great interest, delivered the keynote address at a March celebration at the University of Alabama marking her presidency of the American Heart Association. "She was innovative and highly imaginative in the lab," he recalls of his former protˇgˇ, "and I don't expect she's gotten any worse since!" Dr. Haber credits Dr. Oparil's success to her scientific sense of adventure. "She was very willing to take on problems that were uncertain in their outcome, difficult in their solutions yet, if brought to fruition, able to make a truly important impact on our knowledge."
Hypertension, a condition of elevated intravascular pressure in the arteries, appealed to her as a field of inquiry because "you can really practice preventive medicine, preventing clinical heart disease, and the practice goes hand-in-glove with research."
The study of hypertension, she is quick to point out, is very much linked to P&S. Early work in the field was done by two distinguished members of the faculty. Dr. Howard Bruen, a retired professor of medicine, was President Franklin Delano Roosevelt's personal physician toward the end of the president's life, when he was suffering from complications of the malignant hypertension that led to his death. The condition had gone untreated because of his previous physician's mistaken notion that hypertension was benign. Dr. Bruen established an aggressive regimen, restricting salt and prescribing the rudimentary drugs available at the time. And a few years later, Dr. George Perera'37, a retired professor and former associate dean at P&S, published a milestone study, showing the seriousness of hypertension.
Following her seminal work with the converting enzyme, Dr. Oparil became interested in the way the brain regulates blood pressure, a completely different area of investigation. "That's one of the nice things about academic research," she says. "If you can support yourself with grants you can change directions and work on anything you want." She discovered the importance of the brain's neuroadrenaline pathways in the pathogenesis of hypertension and the connections between the kidney and the brain that affected how blood pressure is generated. "This is a big issue in humans," she says, "although it's very hard to actually study the process in the living human brain." MRI and PET hold promise as non-invasive research tools. Other recent studies have involved the study of the effect of vasoactive peptides on the pulmonary arteries. She credits the important work done by two P&S- associated professors and friends, Dr. Al Fishman (formerly at P&S) and Gerard Turino'48.
At the Helm of the American Heart Association
At the American Heart Association, she followed in the footsteps of Dr. Myron Weisfeldt, the Samuel Bard Professor and Chairman of Medicine and a friend, fellow resident at Presbyterian Hospital, and fellow cardiology fellow in Dr. Haber's lab at Mass General. Dr. Weisfeldt credits Dr. Oparil for "a remarkable job of steering the association, capitalizing on molecular biology, molecular medicine, and, at the same time, leading the field toward concern about quality issues in the area of health care."
Dr. Oparil is staunchly committed to the public health and public policy aspect of her role as president of the AHA. "My No. 1 priority is to try to raise the public awareness. If we could get everyone to stop smoking, control their blood pressure, lower cholesterol, control their weight, and exercise more," she insists, "we could probably prevent half of the heart attacks in this country."
Prevention alone, however, is not enough.
Hypertension, if unchecked, can be fatal and affects some 50 million Americans. Diseases of the heart and blood vessels continue to kill more Americans than any other cause-particularly in her neck of the woods, the Southeast, a region also known as "The Stroke Belt." It is a cause, she urges, not for despair but for tireless research and public education. Diet and a predisposition to hypertension and stroke among African-Americans are significant factors in the South, and Dr. Oparil has directed part of her effort to advancing clinical investigation and treatment in cardiovascular medicine for minorities and women, two groups previously neglected in clinical studies.
Effective treatment calls for continuing study of the basic scientific and behavioral aspects of the problem, and study demands funding.
In this era of growing fiscal austerity, she insists, Congress has to be convinced of the economic necessity of research. "The cost of cardiovascular health care was $128 billion in 1994," she estimates, "the lion's share of which went to nursing homes, hospital care for the very ill, and disability and insurance payments for people who can't work anymore. Only $868 million went to government-funded research in heart disease and stroke." Yet it is only research, she argues, that can in the long run dramatically cut the cost of health care.
Under her leadership and that of such distinguished recent past presidents as Drs. Weisfeldt, Harriet Dustan, and others, the American Heart Association has done its best to help foster a research-friendly climate. The association funds about $93 million annually in direct support of research, a large part of which is parceled out in seed grants to young investigators. As a young cardiology fellow at the University of Chicago, Dr. Oparil received a five-year AHA grant that helped establish her research career. And she has been active in the AHA granting peer review process ever since.
Dr. Oparil and the AHA are adamant about the need to revise and update the influential Comroe-Dripps Report (first published in Science in 1976). The report presented convincing evidence, she says, "to show just how basic research-which seems to be tied to no immediate end-is necessary for major clinical advances."
"Government and the public need to understand and be more sympathetic to research." To that end, she adds, "I'll probably do a little jogging with the president."
Exercise is nothing new to Dr. Oparil.
As a farmer's daughter, she was always running around with the livestock. And as an avid horsewoman until a serious accident took her out of the saddle a few years ago, she ranked second in adult show hunting in Alabama and fifth in open hunter-no small feat, she points out, "competing with a bunch of 17-year-olds in 95-degree heat!"
Her rural upbringing continues to inspire her. "Research is like farming," she says. "It's a 24-hour-a-day, seven-days-a-week job. The cells grow and you have to be there to tend them and, when the time is right, to harvest the results. It's like bringing in the hay!"