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This month’s F1000Prime Faculty Member is Jerome Fleg, a Medical Officer in the Division of Cardiovascular Diseases at the National Heart, Lung, and Blood Institute, National Institutes of Health, and an adjunct professor in the Cardiovascular Division at Johns Hopkins University School of Medicine. 

In this blog he talks to us about his career, research and experience of being an F1000Prime Faculty Member. He also tells about the new edition of Cardiovascular Disease in the Elderly, which he edited along with fellow F1000Prime Faculty Member, Wilbert Aronow, and Michael Rich, who has published on F1000Research.

How did you get into your field?

After completing my training in internal medicine and cardiovascular (CV) disease, I was an Intramural Scientist at the National Institute on Aging for nearly 25 years, where I studied the age-related changes in CV structure and function in healthy volunteers from the Baltimore Longitudinal Study of Aging. Of special interest were age differences in how the CV system responds to exercise.  We also documented an acceleration with age in the rate of decline in maximal oxygen consumption even in these healthy volunteers.  

With its major expansion in recent years, I believe F1000Prime continues to accomplish this primary mission in an unparalleled fashion.

Why did you choose to specialise in cardiology?

I have always been drawn to “quantitative” sciences and systems.  Cardiology clearly represented such an area, with the ability to measure flows, volumes, and pressures and the effects of various perturbations on them.  In addition, the high rates of CV disease in the general population guaranteed my continued employment!

Can you tell us about the sixth edition of ‘Cardiovascular Disease in the Elderly’ you recently published?

This book remains the most comprehensive text on this topic ever since the first edition was published in 1994.  It covers everything from normative CV changes with aging to the epidemiology, pathophysiology, diagnosis, and treatment of all major CV disorders that affect older adults. The new edition consists of 32 chapters written by international experts in their respective area, carefully selected by my co-editors, Wilbert Aronow and Michael Rich, and myself.  It is written for both practicing clinicians as well as researchers.

Why did you join the F1000Prime Faculty?  

I was honoured to be asked to join the F1000Prime Geriatric Cardiology Faculty nearly a decade ago.  This web-based format for disseminating important, recently published research in CV disease was a novel way to keep busy clinicians and scientists abreast of new information relevant to their areas of interest.  With its major expansion in recent years, I believe F1000Prime continues to accomplish this primary mission in an unparalleled fashion.   

I have always been drawn to “quantitative” sciences and systems.  Cardiology clearly represented such an area, with the ability to measure flows, volumes, and pressures and the effects of various perturbations on them. 

I believe the major benefit of F1000Prime to the scientific and clinical communities is to keep them abreast of new developments and their relevance.  Furthermore, the expertise of the reviewers provides a unique ability to put these new findings into perspective.

Tell us about one of the recent articles you recommended on F1000Prime?

A recent recommendation of mine was Transcatheter Aortic Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients by Mack MJ, Leon MB, Thourani VH, et al, published online in the New Engl J Med in March 2019.

This multicenter randomized trial of 1000 low-risk patients with severe aortic valve stenosis compared transcatheter aortic valve replacement (TAVR) versus traditional surgical AVR.  The trial showed that the composite endpoint of death, stroke or rehospitalization at 1 year was 46% lower with TAVR (8.5% vs 15. 1%,respectively). These findings strongly support extending the routine use of TAVR to patients with low surgical risk.  Given prior large randomized trials showing similar or better outcomes with TAVR versus surgical AVR in patients at high and intermediate surgical risk, it now appears that TAVR should be considered as first line therapy for severe aortic valve stenosis in older adults regardless of their surgical risk.