Dr Eugen Brauwald
Few physicians have left a larger imprint on modern cardiology than Dr Eugene Braunwald.
Over a career spanning more than seven decades, the Austrian-born cardiologist contributed to advances in hypertrophic cardiomyopathy, myocardial infarction, heart failure and acute coronary syndromes, while founding the TIMI Study Group and helping generate evidence that shaped contemporary cardiovascular practice.
Dr Braunwald died on April 22, aged 96.
In a tribute shared by the American College of Cardiology [link here], president Dr Roxana Mehran described Dr Braunwald as “the father of modern cardiology” and “a legend of all legends”, reflecting the esteem in which he was held across the specialty.
Among the tributes published in the Journal of the American College of Cardiology [link here] this month, colleagues focused as much on his influence as a teacher and mentor as on his scientific achievements.
Born in Vienna in 1929, Dr Braunwald fled Nazi-occupied Europe with his family as a child before emigrating to the United States, where he would help shape the modern era of cardiovascular medicine.
His work touched many of the specialty’s defining developments.
In 1959, Dr Braunwald and cardiac surgeon Dr Andrew Morrow published one of the first descriptions of the condition now known as hypertrophic cardiomyopathy, helping establish understanding of a disease that remains a major focus of cardiovascular practice.
He later advanced understanding of cardiac function, ventricular performance and heart failure, but colleagues often pointed to his work in myocardial infarction as among his most influential contributions.
At a time when heart attacks were widely viewed as discrete events with damage largely complete by the time patients reached hospital, Dr Braunwald’s research helped establish that myocardial infarction was a dynamic process.
The concept that infarct size could be limited if blood flow was restored quickly enough would later underpin modern reperfusion strategies and the principle that “time is muscle”.
Dr Braunwald’s career spanned one of the most consequential periods in the history of cardiovascular medicine.
When he arrived at the National Institutes of Health in the mid-1950s and later trained at Johns Hopkins, coronary care units did not exist.
Cardiopulmonary resuscitation and defibrillation had yet to enter clinical practice, while coronary angiography and cardiac surgery remained largely experimental. Many physicians considered the heart too delicate to intervene on directly.
Much of that changed during Dr Braunwald’s lifetime.
Writing in JACC, physician, author and Dr Braunwald’s biographer Dr Thomas Lee described his career as coinciding with cardiology’s transition from a specialty focused largely on diagnosis and prognosis to one increasingly capable of altering the course of disease itself.
“Medicine moved from the Oslerian perspective … to believing that nothing is impossible,” he wrote.
He married his NYU classmate Dr Nina Starr Braunwald, who became the first woman cardiac surgeon and performed the world’s first prosthetic mitral valve replacement.
In 1984, Dr Braunwald founded the TIMI Study Group, which went on to become one of the most important cardiovascular clinical trial organisations in the world.
Through TIMI, Dr Braunwald helped lead large-scale studies that informed treatment of acute coronary syndromes, lipid disorders, heart failure and diabetes, contributing to evidence that continues to shape contemporary cardiovascular practice.
Writing in tribute, cardiologist and former Columbia University dean Dr Lee Goldman said, “the breadth and depth of these contributions represent more than any one person could possibly be expected to accomplish”.
Dr Harlan Krumholz, Editor-in-Chief of JACC and Harold H. Hines Jr Professor of Medicine at Yale University, argued that Dr Braunwald’s influence extended beyond any single discovery or research program.
“It is rare to see anyone guide a field from its infancy to its full maturity and remain relevant into their 90s,” he wrote.
A social network analysis included in Dr Braunwald’s 2013 biography found he was within three degrees of separation of 94% of productive cardiovascular investigators over a 50-year period.
Dr Goldman credited Dr Braunwald with recognising potential in both people and emerging disciplines building departments, research programs and training pathways that produced generations of cardiovascular leaders.
Dr Lee argued that Dr Braunwald’s own experience as a refugee shaped the opportunities he later created for others.
Having benefited from institutions that welcomed talented immigrants and young researchers, Dr Braunwald sought to build a similar culture at the Brigham.
Dr Victor Dzau, President Emeritus of the US National Academy of Medicine and a former chief resident under Dr Braunwald, recalled the institution as one of the closest things to a meritocracy he had encountered.
“The reason is Dr Braunwald,” Dr Dzau said.
“He wouldn’t care if you were purple. If you are smart and you work hard, things generally work out here.”
Dr Krumholz recalled watching Dr Braunwald simultaneously lead the departments of medicine at both Brigham and Women’s Hospital and Beth Israel Hospital, walking between the two institutions each day while overseeing research programs, clinical trials, textbooks and an international speaking schedule.
“He was somehow everywhere, and yet, no one felt neglected,” Dr Krumholz wrote.
For many cardiologists, however, Dr Braunwald’s influence began long before they met him.
First published in 1980, Braunwald’s Heart Disease became one of the most widely used cardiology textbooks in the world and helped educate generations of physicians.
Dr Peter Libby, Mallinckrodt Professor of Medicine at Harvard Medical School and a longtime collaborator on Braunwald’s Heart Disease, recalled that when Dr Braunwald stepped down as chair of medicine at Brigham and Women’s Hospital, he explained that colleagues rarely approached him to discuss his administrative achievements.
Instead, they would tell him: “I learned cardiology from your textbook.”
Even after stepping back from formal editorship, Dr Braunwald continued writing chapters, reviewing content and participating in planning discussions. Up until his final weeks, Dr Libby wrote, he was contributing ideas for future editions and helping develop electronic updates.
“A lesson for us all was his unswerving commitment to excellence, attention to detail, and incredible work ethic,” Dr Libby wrote.
“He labored in his study until days before his death.”
“He did not demand respect; he accumulated it,” Dr Krumholz wrote.
Reflecting on Dr Braunwald’s place in the specialty, Dr Krumholz added, “cardiology, as a field, is what it is in large part because of him.”