Dr Harriette Van Spall: I'm Harriette Van Spall, a clinical trialist from McMaster University, and it is my honour to welcome Professor Faiez Zannad, Professor Emeritus from Lorraine in France, to discuss his career journey and transformative impact on heart failure care. Professor Zannad, could you start by sharing your childhood in Tunisia and what led you to a career in science?

Professor Faiez Zannad: It started more than 70 years ago with my mother, who suffered from hypertension and died young from a stroke; she wanted me to be a cardiologist, so I was predestined for this path. I grew up in Tunisia and decided at age 20 to study medicine in France. I trained as both a cardiologist and a pharmacologist, completing a PhD in clinical pharmacology with a year at Oxford, which allowed me to view cardiology through both scientific and clinical lenses.

Dr Harriette Van Spall: How did your family life in Tunisia and your mother’s illness shape your understanding of cardiovascular disease?

Professor Faiez Zannad: I am the 10th of 13 children, and I have always been involved in my family's health. My obsession is bringing evidence-based medicine to Tunisia and similar regions. For example, three of my siblings are on rivaroxaban and suffer from profound anaemia, yet no patients from Tunisia or Africa were enrolled in those trials. We must perform trials in these regions to ensure safety and generalisability for the “most of the world” — Asia, Africa, and the Middle East.

Dr Harriette Van Spall: There is a significant gap in the clinical trial landscape in the MENA regions despite the rise of cardiometabolic disease. You have worked to establish sites there; what are the hurdles?

Professor Faiez Zannad: Sponsors often hesitate to run trials in countries where they won't sell the drug, and many funding bodies focus on communicable diseases. However, non-communicable diseases like obesity and diabetes are a “ticking bomb” in Africa and the Middle East. We need mechanisms to generate evidence and provide access to treatments in these regions.

Dr Harriette Van Spall: You built a career as an “outsider” moving from Tunisia to France. Tell us about the journey that led to you chairing major trials.

Professor Faiez Zannad: It began with an encounter with a friend who had a vision for spironolactone beyond the kidney. After the CONSENSUS trial, we drafted a protocol. I then met Bertram Pitt at an ESC meeting; he was using my published research but didn't know me. We merged our ideas and lobbied together, leading to the RALES trial, which showed a 30% decrease in mortality. This was the bit of luck I needed in my career.

Dr Harriette Van Spall: You and Professor Pitt have built a global network called CVCT. How did that come about?

Professor Faiez Zannad: We wanted to promote evidence-based therapy worldwide through a non-commercial think tank focused on science rather than promotion. The FDA and EMA became involved early on, and eventually, we moved the meeting to Washington because FDA staff had travel restrictions.

Dr Harriette Van Spall: What are the current unmet needs in the clinical trial landscape?

Professor Faiez Zannad: First, we need to ensure trialists are no longer just “white old men” by training a diverse future generation to fill evidence gaps for women and people in low- and middle-income countries. Second, we must adopt modern technology, such as AI, digital tools, and e-consent, to make trials faster and less expensive. We also want to facilitate speed dating between biotech and big companies to accelerate innovation. Finally, we need evidence-based patient engagement rather than just advocacy.

Dr Harriette Van Spall: What work are you most proud of?

Professor Faiez Zannad: Making cardiology more evidence-based and striving to take evidence generation to low- and middle-income countries. Even in high-income countries like the US, there are underserved populations who need to be included in trials.

Dr Harriette Van Spall: What is your advice for early career investigators?

Professor Faiez Zannad: As Louis Pasteur said, “Chance favours the prepared mind.” Get trained in clinical trials, evidence generation, and statistics. Also, do not wait for opportunities — create them.

Dr Harriette Van Spall: Thank you for your work in shaping cardiovascular knowledge; it is a wonderful homage to your mother.

Professor Faiez Zannad: Thank you, Harriette.