<International Circulation>:  Were you as focused on preventative cardiology in the early days?
　　Dr Smith:  When I was at medical school at Yale， we had to write a thesis and I spent my summer at NIH which had a summer program for students. Because I had a degree in chemical engineering， they put me in biomedical engineering and I was running an ultracentrifuge. As part of the NIH summer program， if the speaker (who was absolutely first class; they were the best of the best coming in and giving us a lunch talk) was from your university， you had to introduce them. Bob Levy， of the Levy-Lees-Fredrickson era of early lipoprotein analysis and its relation to disease， came and he was from Yale and I had to introduce him. Afterwards he said， “Are you happy? How is the summer going?” I told him I was having an amazing time in Georgetown; some of the best parties ever. Three of us had rented an overpriced apartment and spending everything we made on the apartment and parties， but I said I am unhappy out here. I am running an ultracentrifuge because I have a chemical engineering degree and it’s dull. He said， “Come and work with me.”At that time， they were the guys in cholesterol and lipoprotein; they were really hot and I didn’t really know what I was getting in to. I went back every summer and even took an elective down there and ended up writing my thesis on lipoproteins and got quite interested in cholesterol and heart disease. At that point in time， that was a hypothesis that had been unproven by any medical interventions. When I went up to Harvard to the Brigham for my internship/residency/fellowship， and because I have an engineering degree， I am in the cathlab. I really enjoy doing things with my hands and things of an interventional nature. Although they thought I might be doing something with lipoproteins I was completely absorbed in all kinds of things in the cathlab. My first job after that was running the cathlab at the University of Colorado in Denver. It was a great job. I did a lot of skiing at Aspen. I had a clinic in Aspen for a while. From there I went to San Diego and there we started the first heart transplant program and got into left ventricular assist devices. It annoyed me to learn that people were either interventional or preventive; I thought they should have been the total package. I always continued my interest in prevention， but I was really occupied with guidelines and intervention. In fact I was the first interventional cardiologist to be President of American Heart. For my presidential address， I had prepared a talk on the contribution of invasive and interventional cardiology to cardiovascular medicine. At that time， the 4S trial came out which showed that simvastatin actually improved survival and there were cardiologists in the early 90s and that period who were highly respected， who were saying that this cholesterol hypothesis was simply wrong. I tore that speech up and my talk ended up entitled， “Risk Reduction Therapies – The Need to Change”. My point was that we had to focus much more on the value of preventative therapies. Two years after that we published the secondary prevention guidelines; it was very short， only two pages. And so I got into guideline work. I became very good friends with Philip Pool-Wilson， who was President of the European Society and by 1997 we had set up the global cardiovascular group called the Global Forum. We were discussing how we should respond to the work that Murray and Lopez had just put out. By 2000， the WHF actually changed its name from ISFC (the International Societies and Foundations of Cardiology) which had formed from the merging of the international foundations and societies， under the presidency of Antonio Bayes de Luna and started World Heart Day and the present day World Heart Federation was founded. Meanwhile we were a group of guys wanting to get things done and we were seeing the Global Forum getting bigger and bigger and the WHF pulled us in and I chaired the Science Advisory Board and Philip Pool-Wilson was President by 2004. We had set up demonstration projects and things had really started to change. That is a little bit of the history of WHF and how I got interested in the international scene. Also by around 2000， I had been invited to come to China because they were interested in these new secondary prevention guidelines. When we first published the secondary prevention guidelines in 1996 they were two pages rather than three hundred and physicians loved it. The Chinese wanted to know about and I went over to Beijing， Shanghai and Guangzhou and I met Liu Lisheng for the first time and she is a remarkable woman. I met Zhau Dong and we started off with the whole 65 hospital project which in some ways was similar to what we had been doing in getting the guidelines together with 1600 hospitals and over a million patients in the United States. It has taken off and expanded from there. I agreed to do part-time as the Chief Science Officer for American Heart after I was President and build programs. They asked me to go full-time but I didn’t want to stop seeing patients and I didn’t want to stop working with Fellows. They asked me to chair the overall guideline effort which I did because I love that. Then the NIH asked if I could head up their program and I have been able to work with the World Heart Federation to get them more involved. What I am really interested in is how we translate science which is evolving primarily in Western Europe and North America， and how that gets into these healthcare systems that are themselves evolving and when do you introduce it. So my career has had continuity but it has really broadened.