Cardiovascular & Circulation Research

Publication Analysis 2007-2013
by Kathleen Gransalke, Labtimes 02/2015

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Unsurprisingly, research on the cardiovascular system, especially its diseases, spawned a record number of publications. Guidelines and definitions on heart failure, heart attack and hypertension dominate the scientific output. One of the leading countries is The Netherlands.

In spite of growing cancer concerns, Cardiovascular Diseases or CVDs are still the number one killers in the world. According to the WHO, 17.5 million people died from CVDs in 2012 – that’s about a third of all global deaths. By comparison, 8.2 million people died of cancer in the same year. Risk factors were quickly identified in the modern lifestyle, in which smoking, an unhealthy diet and inactivity are often the order of the day. But, also several thousand years ago, people weren’t safe from diseases of the cardiovascular system. In 2009, a team of Egyptian and US-American cardiologists used computed x-ray tomography to examine 22 mummies (who had lived between 1981 BCE and 334 CE) from the Egyptian National Museum of Antiquities in Cairo, Egypt. In five of them, they saw clear signs of atherosclerosis, the narrowing of blood vessels. “The most ancient mummy with findings diagnostic of atherosclerosis was Lady Rai, nursemaid to Queen Amrose Nefertari, who died in approximately 1530 BCE,” the authors write. Whether the atherosclerosis, causing a heart attack or stroke, sent her to meet Osiris, God of the dead, couldn’t be determined but the cardiologists’ findings showed that CVDs are not a modern ailment and that “we may have to look beyond modern risk factors to fully understand the disease”.

Many national heart journals

Very clearly, research on the cardiovascular system is very close to European scientists’ hearts. This is showcased in the number of expert journals and the articles they publish, which we surveyed in the first part of our publication analysis on Cardio­vascular System and Circulation Research in Europe, and which formed the basis of our nations’ ranking. Interestingly, it seems as if almost every European country has its own specialist journal. There’s Herz, the Italian Journal of Vascular and Endovascular Surgery, Kardiologia Polska, the Netherlands Heart Journal, Sang Thrombose Vaisseaux, Revista Espanola de Cardiologia and the Scandinavian Cardiovascular Journal, to name but a few. Altogether, European cardiologists wrote a whopping number of 80,984 articles between 2007 and 2013, collecting more than a million citations. Considering the fact that, for this part of the publication analysis, we had to leave out all papers with cardiovascular content published in multidisciplinary journals such as the New England Journal of Medicine and the like, the true numbers are sure to be much more impressive.

No surprises at the top of the nations’ ranking. Germany takes the lead, followed by England and close pursuer, Italy. The Netherlands scores a good 4th place. Also in excellent positions are Greece (12th) and Poland (14th). Gazing at another figure, the citation per article ratio, brings a country into the spotlight that hasn’t even made the top 20 – Estonia (27th place according to number of citations). The 71 Estonian articles, published in cardiology expert journals, collected 2,439 citations – this yields 34.4 citations per article. Not bad for such a small country. All other countries lag far behind. The best of the rest are Iceland (26th according to citations) and Scotland with, on average, 24.1 and 23.3 citations per article, respectively.

Globally, it’s the same old story. European cardiovascular research dominates the categories, number of citations and articles but clearly loses out when comparing citations per article. Also performing strongly is Canada: the country takes 3rd place according to number of citations and even holds 1st place when it comes to citations per article.

“Magnetic” guidelines

Now, let’s look a little more closely at the papers and their authors. It’s really no surprise that the lion’s share of papers is about clinical matters, be it treatment or diagnosis of CVDs. Often, this comes in the form of guidelines and it’s exactly those guidelines that turned out to be real ‘citation magnets’. Just have a look at our top papers on p. 34. Three of the top five papers are guidelines, on arterial hypertension, acute and chronic heart failure, and myocardial revascularisation. The top five is completed by two comparative studies, one comparing drugs and the other medical procedures (non-surgical vs surgical).

Before we get to the most-cited authors in Cardiovascular and Circulation Research, a few additional remarks are necessary. Unfortunately, Web of Science, the database we use for this publication analysis, revealed a weakness that takes special effect in this ranking. It can’t pick up authors, who belong to a study group, a common practice in cardiology research with its large-scale studies. Hence, it’s possible that some authors are short of a few citations and papers. But, as this applies to all researchers, we thought it’s fair enough.

Productivity has also been a contentious issue in recent times in academic circles. But you can’t accuse several of our top authors of being unproductive. Over 500 papers in seven years – this equals 1.5 papers per week. One wonders whether the researchers have time to read all the papers they have authored.

Approaching our top 30 most-cited cardiologists in Europe, let’s next do some geography. All corners of Europe are united in the battle against CVDs. From the north, we have fighters from Norway and Sweden. The East delegates two Polish, the South sends warriors from Spain, Italy and Greece. From the west advance Dutchmen, Germans, Frenchmen, Belgians, Scots and an English combatant. At the head of the troop are two researchers from The Netherlands, Jeroen Bax (1st) and Patrick Serruys (2nd).

Sadly, our army has to do battle without a single female fighter. Silvia Priori from the University of Pavia, for instance, missed the top 30 by only 100 citations. She studies genetics of cardiac arrhythmias and is, by the way, co-author on our second most-cited cardio paper.

With his studies on non-invasive imaging techniques, including echocardiography, multi-slice computed tomography and others, Bax, on the other hand, effortlessly rose to the top of our publication analysis. The Leiden researcher is also President Elect of the European Society of Cardiology, deputy editor of the European Heart Journal and a close collaborator of Don Poldermans. The latter might be familiar to readers of the Retraction Watch blog. Poldermans resigned from Erasmus Medical Center in Rotterdam in 2011 after accusations over scientific misconduct. In several of his studies, he was a bit lax with the implementation of the study protocol. Experts listed as members of safety committees, evaluating the trial results and analysing data, had no idea they were part of the study. One article has been retracted thus far. In our time frame, 2007-2013, Bax and Poldermans co-authored 117 publications.

Stents, aspirin and stem cells

The grand majority of our top 30 researchers works in a clinical environment, trying to find or optimise treatment options for patients suffering from heart failure, heart attack or stroke. One of those treatments involves the implantation of stents: small tubes made of bare metal or covered in drugs like the anti-proliferative agent paclitaxel, to keep arteries open. In 1999, Patrick Serruys introduced the use of such drug-eluting stents, in this case covered in sirolimus, a drug inhibiting cell division, for the first time in patients. Other stent specialists among our top 30 are Stephan Windecker (11th) and Adnan Kastrati (22nd).

Heart disease and stroke can also be battled with anti-platelet therapy. In the 1990s, Lars Wallentin (6th), discovered the protective effects of low-dose aspirin on coronary artery disease. Atero­thrombosis and anti-platelet therapy is a matter of the heart for Gabriel Steg (4th) and Gilles Montalescot (28th), too.

Michal Tendera (29th), former president of the European Society of Cardiology (2004-2006), wants to take on cardiovascular disease with cardiopoietic stem cell therapy. In a study published in 2013, he and his colleagues found that “Cardiopoietic stem cell therapy was (…) feasible and safe with signs of benefit in chronic heart failure, meriting definitive clinical evaluation”.

Without a doubt, European cardiologists put their heart and soul into research that could save the lives of millions of people, slowly rendering the top killer in the world harmless. If everything goes according to plan, then WHO’s estimate of 23 million people dying from CVD in 2030 will remain just that, a preliminary estimate and not a sad but true fact.

View the Tables: Europe...and the World, Most Cited Authors...and Papers

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Last Changed: 25.03.2015