Allan Struthers

+44 (0)1382 383013
Emeritus Professor

Biography

Allan Struthers graduated MB (Hons) from Glasgow University UK in 1977. After junior hospital posts, he was Senior Registrar at the Royal Postgraduate Medical School and Hammersmith Hospital in London in 1982 – 1985.

He was then appointed Wellcome Senior Lecturer/Consultant Physician in Dundee and is currently Professor of Cardiovascular Medicine and runs the Heart Failure service at Ninewells Hospital in Dundee. He is also an Honorary Professor at St Andrews University Medical School. He was Chairman of the SIGN Guidelines in Heart Failure twice (2007 and 2016) and Chairman of NHS-QIS Standards (2010) for Heart Failure. In addition, he is also Chairman of Tenovus NSAC, Senior Regional Advisor for SACDA and Council member of Chest, Heart and Stroke Scotland.

He is currently Co-Head of the Division of Molecular and Clinical Medicine at the Medical School in the University of Dundee. Professor Struthers runs a large clinical research programme and has supervised 50 MD/PhDs.

He helped pioneer the use of plasma BNP to identify heart failure patients and the use of aldosterone blockers to reduce their mortality. More recently, he is exploring the use of plasma BNP (and troponin) in primary prevention patients to identify silent but treatable heart disease.

Another research interest is in allopurinol and he has recently shown it to delay chest pain on exercise in angina patients and to regress LV Hypertrophy. Ongoing studies are exploring allopurinol in dialysis patients, in COPD patients and in sarcopenic patients.

In total he has held 38 different British Heart Foundation (BHF) grants along with grants from CSO, MRC, Wellcome, HTA and CHSS. He has published 508 papers which are cited around 600 times every year. His research “h” factor is high at 60. He is a Fellow of the European Society of Cardiology (FESC), the Royal Society of Edinburgh (FRSE) and the Academy of Medical Sciences (FMed Sci).

Research

Professor Struthers has repeatedly spotted new therapeutic opportunities and conducted the initial “proof of concept” studies which, led to confirmation in larger trials. For example, he was the first to ever show that aldosterone blockade had beneficial cardiac effects in man on top of ACE inhibitors (Am J Card 1995, 76: 1259): those effects were to reduce both ventricular arrhythmias and cardiac sympathetic activity. This discovery helped lead to the RALES trial where spironolactone reduced mortality in heart failure (HF) by 30%. He also discovered other mechanisms contributing to aldosterone’s ability to increase cardiac deaths, i.e. it decreases endothelial nitric oxide, it decreases cardiac autonomic function and it increases plasma collagen markers (which are a good surrogate for myocardial fibrosis).

A second area where he made important original discoveries is B-type natriuretic peptide (BNP). He wrote one of the two original studies published together in the Lancet (1993) which led to the use of plasma BNP levels to identify heart failure (HF). A later paper by him, also in the Lancet, confirmed this. BNP is now an integral part of all HF guidelines. Professor Struthers has now moved on to make original observations about BNP in a completely new (non HF) area. He has recently discovered that if an apparently healthy individual has a high BNP level, this often signifies that they have silent coronary artery disease (Heart 2006, 92: 487 and 916). This is a major finding as BNP screening could now be used to help identify those many apparently healthy middle aged individuals whose first ever manifestation of their previously silent coronary disease is sudden cardiac death. He has now developed the new concept that primary prevention could be improved by 3P Screening whereby BNP is used to select individuals for detailed cardiac phenotyping followed by personalised medicine against any abnormalities seen on cardiac phenotyping. (JACC 2012, 60, 960-8; Hypertension 2013, 62, 236-9).

A whole other area pioneers by him is allopurinol. He developed the novel idea that allopurinol could be "oxygen in a pill" because it inhibits an oxidase enzyme which normally "wastes" oxygen in ischaemic tissue. A recent Lancet paper (2010, 375: 2161 – 7) showing this could lead eventually to the use of allopurinol as an oxygen sparing agent in all ischaemic diseases. He had already unravelled the exact mechanism whereby allopurinol improves endothelial function by profoundly reducing vascular oxidative stress and not at all by decreasing uric acid. This was a much debated issue before his elegant paper in Circulation settled the issue. His recent work has also shown that allopurinol regresses LV mass in patients with LV hypertrophy. The above work has now led to an HTA grant to examine the effect of allopurinol on CV events/mortality in ischaemic heart disease (the ALL-HEART study).

Lastly, he had the original idea behind another paper of major therapeutic importance. In conjunction with Professor McMurdo, he showed that ACE inhibitors improve mobility in elderly, disabled, immobile patients, which should greatly improve the quality of life of many elderly patients. In fact, this paper won the Bruce P. Squires award as one of the best in the year. If confirmed, ACE inhibitors could become the equivalent of "exercise in a pill" to the many elderly with limited mobility.

PhD supervision

Supervision of Postgraduate Researchers

1986-1988 Dr Peter Seidelin, MD, Scottish Office

1986-1988 Dr John McMurray, MD, ICI

1988-1990 Dr Chim Lang, MD, British Heart Foundation

1989-1992 Mr Robert Moran, PhD, Nuffield (joint supervision)

1989-1991 Dr Joseph Motwani, MD, Scottish Office

1989-1992 Dr Abdul Rahman, PhD, Malaysian Government

1989-1991 Mr Michael Arnott, PhD, Tenovus

1990-1992 Dr Nigel Sturrock, MD, Wellcome Trust

1991-1994 Miss Jenny Grant, PhD, DDS Trust (joint)

1991-1994 Mr Stuart Donald, PhD, SHEFC (joint)

1992-1994 Dr Craig Barr, MD, SHERT

1992-1994 Dr Peter Rhodes, MD, British Heart Foundation

1993-1995 Dr Dawood Darbar, MD, NHS

1994-1996 Dr Neil Davidson, MD, British Heart Foundation

1994-1999 Dr Bob MacFadyen, MD, SHEFC

1995-1997 Dr Alison Lee, MD, Scottish Office

1995-1998 Dr Abdul Naas, PhD, Libyan Government

1995-1997 Dr Rob Butler, MD, British Heart Foundation

1996-1998 Dr Meng Yee, MD, Scottish Office

1996-1999 Mr Jun Zhou, PhD, Tenovus

1996-1999 Dr Clare Bonnar, MD, Northwood Trust

1997-2000 Dr Colin Farquharson, MD, British Heart Foundation

1998-2000 Dr Rob Kelly , MD, Scottish Office

1998-2000 Dr Justein Sim, MD, British Heart Foundation

1999-2001 Dr Bushra Rana, MD, Scottish Office

2000-2002 Dr John MacDonald, MD, Northwood Trust

1999-2002 Dr Abdullah Shehab, MD, UAE Government

2000-2002 Dr Ken Wong, MD, British Heart Foundation

2000-2003 Dr Justine Davies, MD, British Heart Foundation

2001-2003 Dr Andrew Gavin, MD, British Heart Foundation

2002-2004 Dr Sanjay Jeyaseelan, MD, British Heart Foundation

2001-2004 Dr Adelle Dawson, MD, British Heart Foundation

2001-2004 Dr David Hogg, MD, British Heart Foundation

2001-2004 Dr Gary Wright, MD, European Commission

2002-2005 Dr Miles Witham, PhD, PP Healthcare (joint)

2004-2007 Dr Jacob George, MD, British Heart Foundation

2005-2007 Dr Helen Simpson, MD, Scottish Office

2005-2007 Dr Nimit Shah, MD, British Heart Foundation

2005-2007 Dr K Swaminathan, MD, Tenovus

2005-2007 Dr Donald Ang, MD, British Heart Foundation

2005-2008 Dr N Rajendra, MD, British Heart Foundation

2006-2008 Dr A Noman, MD, British Heart Foundation

2007-2009 Dr M Kao, MD, British Heart Foundation

2008-2011 Dr A Nadir, MD, British Heart Foundation

2009-2011 Dr S Rekhraj, MD, Medical Research Council

2009-2011 Dr B Szwejkowski, MD, Diabetes UK

2010-2012 Dr A Goudie, MD, Scottish Office

2010-2012 Dr A Robertson, MD, British Heart Foundation

2012-2014 Dr F Shearer, MD, British Heart Foundation

2013-2016 Dr E Rutherford, PhD, British Heart Foundation

2013-2016 Dr J. Weir-McCall, PhD, Wellcome Trust (joint)

2015-2017 Dr P Liu Shui Chong, British Heart Foundation

2015-2017 Dr V Heng Cheong, Chief Scientist Office

2016-2019 Dr A Brown, Astra Zeneca

Supervision of Research Nurses

1994-1996 Amanda Duncan, Scottish Office

1994-1998 Jess Robson, British Heart Foundation

1999-2000 Margaret Band, Scottish Office/British Heart Foundation

2000-2001 Janice Broomhall, Scottish Office

2000-2001 Audrey McCarthy, British Heart Foundation

2001-2002 Stephen McSwiggan, British Heart Foundation

2001 Karen Tosh, Scottish Office

2001-2002 Janice Reilly, Scottish Office

2003-2006 Elaine Carr, British Heart Foundation

2005-2016 Sheila Ireland, British Heart Foundation & Chest Heart & Stroke Scotland

2007-2010 Ruth Stanley, British Heart Foundation

 

 

Group members

  • Mrs. Sheila E Ireland

Group alumni

Total of 45 MD/PhD students. All achieved consultant status.

Two examples are Professor John McMurray and Professor Chim Lang, both now eminent Professors of Cardiology in the UK.

Lectures and conferences

He has given 217 invited lectures, half abroad.

Recent examples are:

  • Oxidative Stress, Uric Acid and Allopurinol, American Society of Hypertension, New York, USA 2011
  • Aldosterone Escape, Human and Veterinary Cross Talk symposium on Cardiology, Bordeaux, France, 2011
  • Spironolactone vs. Eplerenone: A Comparison, Cardiovascular Clinical Trialists Forum, Paris, France, 2011
  • Potassium Supplementation in Heart Failure, European Society of Cardiology. Munich, Germany. 2012
  • Can we affect CV disease by managing uric acid?, International Symposium: Uric Acid, Gout and Beyond: Is CV Risk a New Objective. Bologna, Italy, 2012

Teaching

He teaches Cardiovascular Medicine and Therapeutics at both the University of Dundee and the University of St Andrews Medical School. He is on Steering Group of the eHEART project of Chest, Heart & Stroke Scotland.

Publications

  • Struthers AD. A New Approach to Residual Risk in Treated Hypertension : 3P Screening. HYPERTENSION. 2013, 62 (2), 236-9
  • Szwejkowski BR, Gandy SJ, Rekhraj S, Houston JG, Lang CC, Morris AD, George J, Struthers AD. Allopurinol reduces Left Ventricular Mass in Patients with Type2 Diabetes and Left Ventricular Hypertrophy. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2013 07.074(e-published ahead of print)
  • Rekhraj S, Gandy SJ, Szwejkowski B, Nadir MA, Noman A, Houston JG, Lang CC, Struthers AD. High dose allopurinol reduces left ventricular mass in patients with ischaemic heart disease. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. 2013, 61 (9), 926-932
  • Anderson W, Lipworth BJ, Rekhraj S, Struthers AD, George J. Left Ventricular Hypertrophy in Chronic Obstructive Pulmonary Disease without Hypoxaemia : The Elephant in the Room? CHEST 2013, 143(1),91-97
  • Nadir MA, Rekhraj S, Wei L, Lim TK, Davidson J, MacDonald TM, Lang CC, Dow E, Struthers AD Improving the Primary Prevention of Cardiovascular events by using Biomarkers to identify Individuals with Silent Heart Disease. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2012 Sep 11;60(11):960-8. Impact Factor 14.3
  • Kao MP, Ang DS, Gandy SG, Nadir A, Houston JG, Lang C, Struthers AD. Allopurinol benefits left ventricular mass and endothelial dysfunction in chronic kidney disease. JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY 2011, 22, 1382 – 1389. (Impact Factor 8·3).
  • Nadir MA, Wei L, R, Elder D, Libianto R, Lim TK, Pauriah M, Pringle SD, Doney AD, Choy AM, Struthers AD, Lang CC. Impact of renin angiotensin system blockade therapy on outcome in aortic stenosis. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2011, 58 (6), 570 – 576. (Impact Factor 14·3).
  • Elder DH, Wei L, Szwejkowski BR, Libianto R, Nadir A, Pauriah M, Rekhraj S, Lim TK, George J, Doney A, Pringle SD, Choy AM, Struthers AD, Lang CC. The Impact of Renin Angiotensin Aldosterone System Blockade on Heart Failure Outcome and Mortality in Patients identified to have Aortic Regurgitation: A Large Population Cohort Study. J AMERICAN COLLEGE OF CARDIOLOGY 2011, 58 (20), 2084 – 2091.(Impact Factor 14·3).
  • Noman A, Ang DSC, Ogston SA, Lang CC, Struthers AD. Effect of high dose allopurinol on exercise in patients with chronic stable angina: A randomised placebo controlled crossover trial. LANCET 2010, 375: 2161-2167. (Impact Factor 34). : Also as BMJ Shortcut. BMJ 2010, 340, p1331. Also as Lancet podcast.
  • Wei L, Struthers AD, Fahey T, Watson AD, MacDonald TM. Spironolactone use and renal toxicity: a population based longitudinal analysis. BRITISH MEDICAL JOURNAL 2010, 340: C1768. (Impact factor 13·5)
  • AlZadjali MA, Godfrey V, Khan F, Choy AM, Doney AS, Wong AK, Petrie J, Struthers AD, Lang CC. Insulin resistance is highly prevalent and is associated with reduced exercise tolerance in nondiabetic patients with heart failure. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2009, 53: 747-753.
  • Struthers AD, Lang CC. The potential to improve primary prevention in the future by using BNP/N-BNP as an indicator of silent “pancardiac” target organ damage: BNP/N-BNP could become for the heart what microalbuminuria is for the kidneys. EUROPEAN HEART JOURNAL 2007, 28: 1678-1682. (Impact Factor 10)
  • Sumukadas D, Witham MD, Struthers AD, McMurdo M. Effect of perindopril on physical function in elderly people with functional impairment: a randomised controlled trial. CANADIAN MEDICAL ASSOCIATION JOURNAL 2007, 177(8): 867-874. Impact Factor of journal 9 This paper won the Bruce P Squires Award.
  • George J, Carr EA, Davies JI, Belch JJF, Struthers AD. High dose allopurinol improves endothelial function by profoundly reducing oxidative stress and not by lowering uric acid. CIRCULATION 2006, 114: 2508-2516.
  • Struthers AD, Morris AD. Screening for and treating left ventricular abnormalities in diabetes: a promising new way of reducing cardiac deaths. LANCET 2002; 359: 1430-1432 (Viewpoint article)
  • Farquharson CAJ, Struthers AD. Gradual reactivation over time of vascular tissue angiotensin I to angiotensin II conversion during chronic lisinopril therapy in chronic heart failure. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2002; 39: 767-775.
  • Farquharson C, Butler R, Hill A, Belch JJF, Struthers AD. Allopurinol improves endothelial dysfunction in chronic heart failure. CIRCULATION 2002; 106: 221-226.
  • Yee KM, Pringle SD, Struthers AD. Circadian influence of aldosterone blockade on QT dispersion and Heart Rate Variability in Chronic Heart Failure. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (2001) 37, 1800-1807.
  • Farquharson C, Struthers AD. Spironolactone increases nitric oxide bioactivity, improves endothelial vasodilator dysfunction and suppresses vascular angiotensin I/II conversion in patients with chronic heart failure. CIRCULATION (2000); 101: 594-597. Brief Rapid Communication.,