Anne Grete Semb, a pioneer at the intersection of cardiology and rheumatology

Now she is about to pass the baton on. The cardiologist paved the way for a new field of expertise when she established the Preventive Rheumatic Heart Disease Clinic at Diakonhjemmet Hospital – the world's first of its kind.

Following this clinic, 6 similar Rheumatic Heart Disease clinics have been established in the USA and Canada and a similar number in Europe.

With both a medical and doctoral degree from the University of Oslo, she has led groundbreaking research projects on the prevention of cardiovascular disease in patients with inflammatory joint diseases.

She is behind the development of the NOKAR registry, the Norwegian Cardio-Rheumatic Registry, and has led several international research networks.

She is now stepping down as a consultant and senior researcher, but continues to contribute to the development of the profession. In particular, she is working to ensure that Cardio-Rheumatology becomes a separate field.

❓What made you specialize in cardiology – and what led you into rheumatology?

I was invited to participate in basic physiology research in cardiology as a medical student and completed a PhD in this field. The path to the cardiology specialty was therefore natural.

❓ How has the field changed since you started, and what has it meant that cardiology and rheumatology have become more closely linked?

The establishment of the Preventive Rheumatic Disease Clinic has been important both from a patient perspective, but also for the development of the profession. Despite this, there is still a large unmet need for prevention of cardiovascular disease in patients with ILS.

I am very proud that the Preventive Rheumatic Heart Disease Clinic will continue as a Co-Morbidity Clinic that will continue to focus on the increased risk of cardiovascular disease. Cardiovascular disease is the most important co-morbidity in patients with ILS.

❓ What projects or results are you most proud of – both clinically and research-wise?

We have emphasized a holistic approach, so that patients at increased risk receive targeted preventive measures against their risk factors.

We have followed up with patients so that around 90 percent reach recommended levels for cholesterol and blood pressure after an average of three consultations.

In comparison, only 30–40 percent of patients in primary care, or in the general population, achieve recommended levels.

❓What do you think are the most important challenges and opportunities for preventing cardiovascular disease in patients with rheumatic diseases in the coming years?

We have documented that patients with inflammatory joint diseases have around 40 percent higher risk of cardiovascular disease than the rest of the population in Norway.

The biggest challenge is that both healthcare professionals and patients often lack knowledge about this increased risk.

In addition, far too few patients receive the preventive measures they actually need – and even fewer are followed up over time.

❓If you could give one piece of advice to health authorities, what would it be?

My clear advice to the health authorities is to strengthen the focus on prevention. Norway is far behind other European countries when it comes to resources for preventive work.
The effect of prevention is indisputable – it is both more effective and more cost-effective than treating diseases after they have occurred.

❓What will you miss most from everyday life at Diakonhjemmet – and what are you looking forward to in retirement?

What I will miss most are the patients. I have great respect for them – many live with chronic pain, fatigue and several additional illnesses, but still they face everyday life with optimism, little complaining and an impressive portion of sisu.

I am also deeply grateful to all colleagues and partners – both at Norwegian rheumatology outpatient clinics and in the 20 countries I have had the pleasure of collaborating with.

A special thank you goes to the 11 doctoral candidates I have had the opportunity to follow along the way – for their efforts, commitment and collaboration over many years.

More about Anne Grete Semb

• Position: Senior researcher and consultant in cardiology at Diakonhjemmet Hospital. Head of the Preventive Rheumatic Heart Disease Clinic.
• Education: MD and PhD from the University of Oslo.
• Professional interest: Specialist in internal medicine and heart disease with a focus on inflammatory joint diseases, vascular biomarkers, risk assessment and prevention of cardiovascular disease in rheumatology patients.
• Pioneering work: The world's first cardiologist employed in a rheumatology department. Leader of NOKAR (National campaign for the prevention of cardiovascular disease in patients with rheumatoid arthritis), founder of the Norwegian Cardio-Rheumatology Registry, which includes the entire Norwegian population over 18 years of age, and former leader of international consortia such as ATACC-RA and SURF-RA.
• International positions: Board member of the Preventive working group of the Norwegian Society of Cardiology, Board member of the European Society of Cardiology (ESC) - Cardiovascular Pharmacology working group and the European Association of Preventive Cardiology (EAPC) Preventive Section, formerly Primary care and risk factor management. Committee member of the ESC Educational board. Task force member of several ESC guideline committees. Editor of several international journals (EHJ-CVP, ECR and MJR)