This festive period, Three Wise Women from the Faculty of Medicine will be giving us the gift of wisdom.
Dr Rasha Al-Lamee, Clinical Reader in the National Heart & Lung Institute and Clinical Academic Interventional Cardiology Consultant at Imperial College Healthcare NHS Trust, highlights the unique strengths of the UK’s life sciences research ecosystem, from the NHS to the invaluable contributions of patients. She reflects on her groundbreaking ORBITA trials, which challenged conventional wisdom about stenting for coronary artery disease. Dr Al-Lamee also shares how these experiences have shaped her career and passion for mentoring the next generation of cardiologists.
We are fortunate in the UK to have a well-developed infrastructure for research in life sciences. Our universal healthcare system within the NHS, world-leading academic institutions, and dedicated researchers provide a unique environment for innovation. Most importantly, it is our incredible patients—who not only understand the need for research but are willing to participate—that make groundbreaking studies possible. This unique combination allows us to lead the world in delivering research that tests novel treatments, evaluates existing practices, and paves the way for guideline-changing clinical practice.
As a clinical trialist, I have been privileged to work within this exceptional ecosystem. It has allowed me to carry out work that I do not believe could have been conducted in many other places in the world. My focus has been on treatments for ‘stable’ coronary artery disease, a condition that affects around 2.3 million people in the UK and causes chest pain, breathlessness, and sometimes pain throughout the body. Treatments often include medicines or angioplasty, a procedure where stents—wire mesh tubes—are placed into arteries to open blockages. However, since its introduction, there has been ongoing debate about whether the relief patients experience is due to the procedure itself or a placebo effect.
Breaking new ground: The ORBITA trials
To address this, I led the ORBITA trial, which analysed the effect of stenting versus placebo procedures for patients with stable angina, a type of chest pain usually caused by coronary heart disease. It was the first of its kind and our patients were remarkable; they consented to being sedated and wearing headphone during the procedure, not knowing whether they received an actual stent or a placebo. They remained blinded to the treatment for months. It was inspiring to work with patients who demonstrated such trust in the research process. Their willingness to contribute helped us gain insights that were translatable to patients worldwide.
“It is our incredible patients—who not only understand the need for research but are willing to participate—that make groundbreaking studies possible.”
The results of ORBITA, published in The Lancet, were transformative. Interestingly, they revealed that while the stents improved blood flow, they did not alleviate symptoms more effectively than drug treatments, suggesting that the placebo effect may have been larger than previously thought. This challenged longstanding assumptions and inspired further research into coronary artery disease.
Building on the foundation of ORBITA, we launched ORBITA-2 to broaden the scope of our research. This trial recruited a more diverse patient population, integrated real-world medication regimens, and emphasised patient-centred outcomes. These efforts were essential in refining our understanding of coronary artery disease.
In ORBITA-2, patients stopped their chest pain medications before receiving either a stent or a placebo procedure. The trial confirmed that stents can relieve angina symptoms for some patients, with more than a third becoming symptom-free. However, over half of patients with a stent continued to experience chest pain, highlighting that stenting isn’t universally effective.
The personal impact of research
Conducting the ORBITA trials has been a defining moment in my career. Some of the trials we conducted were initially thought to be impossible. Yet, with the right team and the right environment, we proved that innovative research can be done. This experience has reinforced my belief in the power of asking new questions and pursuing research that pushes the boundaries of what we know.
“With the right team and the right environment, we proved that innovative research can be done.”
One of the most rewarding aspects of this work is also the deep connection I develop with patients. Research allows me to spend more time understanding their experiences and needs, something that isn’t always possible in routine clinical practice.
Mentorship and shaping the future
Research has not only defined my career but has enriched it with diversity and depth. When I began my PhD at Imperial, I never imagined becoming a researcher. Since then, it has opened countless opportunities—from building my own team to mentoring the next generation of cardiologists. Teaching and inspiring others to push boundaries, just as we have done with the ORBITA trials, is a particularly fulfilling part of my journey. I feel proud to work in an institution that has supported my work and is not scared to support me in answering research questions in a new way.