Allan Struthers

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

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.