Coronary Heart Disease Research

The NHLBI supports a wide range of long-term studies to understand the risk factors of coronary heart disease. These ongoing studies, among others, have led to many discoveries that have increased our understanding of the causes of cardiovascular disease among different populations, helping to shape evidence-based clinical practice guidelines.

• Risk factors that can be changed: The NHLBI Framingham Heart Study (FHS) revealed that cardiovascular disease is caused by modifiable risk factors such as smoking, high blood pressure, obesity, high cholesterol levels, and physical inactivity. It is why, in routine physicals, healthcare providers check for high blood pressure, high cholesterol, unhealthy eating patterns, smoking, physical inactivity, and unhealthy weight. The FHS found that cigarette smoking increases the risk of heart disease. Researchers also showed that cardiovascular disease can affect people differently depending on sex or race, underscoring the need to address health disparities. 
• Risk factors for Hispanic/Latino adults: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) found that heart disease risk factors are widespread among Hispanic/Latino adults in the United States, with 80% of men and 71% of women having at least one risk factor. Researchers also used HCHS/SOL genetic data to explore genes linked with central adiposity (the tendency to have excess body fat around the waist) in Hispanic/Latino adults. Before this study, genes linked with central adiposity, a risk factor for coronary heart disease, had been identified in people of European ancestry. These results showed that those genes also predict central adiposity for Hispanic/Latino communities. Some of the genes identified were more common among people with Mexican or Central/South American ancestry, while others were more common among people of Caribbean ancestry.
• Risk factors for African Americans: The Jackson Heart Study (JHS) began in 1997 and includes more than 5,300 African American men and women in Jackson, Mississippi. It has studied genetic and environmental factors that raise the risk of heart problems, especially high blood pressure, coronary heart disease, heart failure, stroke, and peripheral artery disease (PAD). Researchers discovered a gene variant in African American individuals that doubles the risk of heart disease. They also found that even small spikes in blood pressure can lead to a higher risk of death. A community engagement component of the JHS is putting 20 years of the study’s findings into action by turning traditional gathering places, such as barbershops and churches, into health information hubs.
• Risk factors for American Indians: The NHLBI actively supports the Strong Heart Study, a long-term study that began in 1988 to examine cardiovascular disease and its risk factors among American Indian men and women. The Strong Heart Study is one of the largest epidemiological studies of American Indian people ever undertaken. It involves a partnership with 12 Tribal Nations and has followed more than 8,000 participants, many of whom live in low-income rural areas of Arizona, Oklahoma, and the Dakotas. Cardiovascular disease remains the leading cause of death for American Indian people. Yet the prevalence and severity of cardiovascular disease among American Indian people has been challenging to study because of the small sizes of the communities, as well as the relatively young age, cultural diversity, and wide geographic distribution of the population. In 2019, the NHLBI renewed its commitment to the Strong Heart Study with a new study phase that includes more funding for community-driven pilot projects and a continued emphasis on training and development. Read more about the goals and key findings of the Strong Heart Study.

Within our Division of Cardiovascular Sciences, the Atherothrombosis and Coronary Artery Disease Branch of its Adult and Pediatric Cardiac Research Program and the Center for Translation Research and Implementation Science oversee much of our funded research on coronary heart disease.

Current research on preventing coronary heart disease

• Blood cholesterol and coronary heart disease: The NHLBI supports new research into lowering the risk of coronary heart disease by reducing levels of cholesterol in the blood. High levels of blood cholesterol, especially a type called low-density lipoprotein (LDL) cholesterol, raise the risk of coronary heart disease. However, even with medicine that lowers LDL cholesterol, there is still a risk of coronary heart disease due to other proteins, called triglyceride-rich ApoB-containing lipoproteins (ApoBCLs), that circulate in the blood. Researchers are working to find innovative ways to reduce the levels of ApoBCLs, which may help prevent coronary heart disease and other cardiovascular conditions.
• Pregnancy, preeclampsia, and coronary heart disease risk: NHLBI-supported researchers are investigating the link between developing preeclampsia during pregnancy and an increased risk for heart disease over the lifespan. This project uses “omics” data – such as genomics, proteomics, and other research areas – from three different cohorts of women to define and assess preeclampsia biomarkers associated with cardiovascular health outcomes. Researchers have determined that high blood pressure during pregnancy and low birth weight are predictors of atherosclerotic cardiovascular disease in women. Ultimately, these findings can inform new preventive strategies to lower the risk of coronary heart disease.
• Community-level efforts to lower heart disease risk among African American people: The NHLBI is funding initiatives to partner with churches in order to engage with African American communities and lower disparities in heart health. Studies have found that church-led interventions reduce risk factors for coronary heart disease and other cardiovascular conditions. NHLBI-supported researchers assessed data from more than 17,000 participants across multiple studies and determined that these community-based approaches are effective in lowering heart disease risk factors.

Find more NHLBI-funded studies on preventing coronary heart disease on the NIH RePORTER.

NEWS RELEASE

Learn about the impact of COVID-19 on your risk of coronary heart disease.

SARS-CoV-2 infects coronary arteries, increases plaque inflammation

Current research on understanding the causes of coronary heart disease

• Pregnancy and long-term heart disease: NHLBI researchers are continuing the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b) study to understand the relationship between pregnancy-related problems, such as gestational hypertension, and heart problems. The study also looks at how problems during pregnancy may increase risk factors for heart disease later in life. NuMoM2b launched in 2010, and long-term studies are ongoing, with the goal of collecting high-quality data and understanding how heart disease develops in women after pregnancy.
• How coronary artery disease affects heart attack risk: NHLBI-funded researchers are investigating why some people with coronary artery disease are more at risk for heart attacks than others. Researchers have found that people with coronary artery disease who have high-risk coronary plaques are more likely to have serious cardiac events, including heart attacks. However, we do not know why some people develop high-risk coronary plaques and others do not. Researchers hope that this study will help providers better identify which people are most at risk of heart attacks before they occur.
• Genetics of coronary heart disease: The NHLBI supports studies to identify genetic variants associated with coronary heart disease. Researchers are investigating how genes affect important molecular cascades involved in the development of coronary heart disease. This deeper understanding of the underlying causes for plaque buildup and damage to the blood vessels can inform prevention strategies and help healthcare providers develop personalized treatment for people with coronary heart disease caused by specific genetic mutations.

Find more NHLBI-funded studies on understanding the causes of coronary heart disease on the NIH RePORTER.

RESEARCH FEATURE

Recent findings suggest that cholesterol-lowering treatment can lower the risk of heart disease complications in people with HIV.

Daily statin reduces heart disease risk among adults living with HIV

Current research on treatments for coronary heart disease

• Insight into new molecular targets for treatment: NHLBI-supported researchers are investigating the role of high-density lipoprotein (HDL) cholesterol in coronary heart disease and other medical conditions. Understanding how the molecular pathways of cholesterol affect the disease mechanism for atherosclerosis and plaque buildup in the blood vessels of the heart can lead to new therapeutic approaches for the treatment of coronary heart disease. Researchers have found evidence that treatments that boost HDL function can lower systemic inflammation and slow down plaque buildup. This mechanism could be targeted to develop a new treatment approach for coronary heart disease.
• Long-term studies of treatment effectiveness: The NHLBI is supporting the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial EXTENDed Follow-up (EXTEND), which compares the long-term outcomes of an initial invasive versus conservative strategy for more than 5,000 surviving participants of the original ISCHEMIA trial. Researchers have found no difference in mortality outcomes between invasive and conservative management strategies for patients with chronic coronary heart disease after more than 3 years. They will continue to follow up with participants for up to 10 years. Researchers are also assessing the impact of nonfatal events on long-term heart disease and mortality. A more accurate heart disease risk score will be constructed to help healthcare providers deliver more precise care for their patients.
• Evaluating a new therapy for protecting new mothers: The NHLBI is supporting the Randomized Evaluation of Bromocriptine In Myocardial Recovery Therapy for Peripartum Cardiomyopathy (REBIRTH), for determining the role of bromocriptine as a treatment for peripartum cardiomyopathy (PPCM). Previous research suggests that prolactin, a hormone that stimulates the production of milk for breastfeeding, may contribute to the development of cardiomyopathy late in pregnancy or the first several months postpartum. Bromocriptine, once commonly used in the United States to stop milk production, has shown promising results in studies conducted in South Africa and Germany. Researchers will enroll approximately 200 women across North America who have been diagnosed with PPCM and assess their heart function after 6 months. 
• Impact of mental health on response to treatment: NHLBI-supported researchers are investigating how mental health conditions can affect treatment effectiveness for people with coronary heart disease. Studies show that depression is linked to a higher risk for negative outcomes from coronary heart disease. Researchers found that having depression is associated with poor adherence to medical treatment for coronary heart disease. This means that people with depression are less likely to follow through with their heart disease treatment plans, possibly contributing to their chances of experiencing worse outcomes. Researchers are also studying new ways to treat depression in patients with coronary heart disease.

Find more NHLBI-funded studies on treating coronary heart disease on the NIH RePORTER. 

NHLBI IN THE PRESS

Researchers have found no clear difference in patient survival or heart attack risk between managing heart disease through medication and lifestyle changes compared with invasive procedures. 

Survival rates similar for varying coronary heart disease treatment strategies.

• Researchers from the Cardiovascular Branch of the Division of Intramural Research work on understanding the causes and risk factors of cardiovascular diseases and improving diagnostic and treatment options. Specific projects aim to answer clinically relevant questions, using methods ranging from molecular-level studies to clinical projects in diagnostics, therapeutics, and interventions.
  • Laboratory of Cardiac Physiology
  • Laboratory of Cardiovascular Biology
  • Minority Health and Health Disparities Population Laboratory
  • Social Determinants of Obesity and Cardiovascular Risk Laboratory
• The Population Sciences Branch explores the prevention and treatment of cardiovascular diseases across the population. Researchers in this branch explore heart, lung, blood, and sleep disorders, taking advantage of data from thousands of participants in the Framingham Heart Study as well as other population cohorts. The Population Sciences Branch takes a comprehensive approach to understanding these disorders, combining classical epidemiology and longitudinal studies with state-of-the-art genetic and omics technologies.
  • Laboratory for Cardiovascular Epidemiology and Genomics
  • Laboratory for Hemostasis and Platelet Biology

• In 2002, the NHLBI launched The Heart Truth®, the first federally sponsored national health education program designed to raise awareness about heart disease as the leading cause of death in women. The NHLBI and The Heart Truth® supported the creation of the Red Dress® as the national symbol for awareness about women and heart disease, and also coordinate National Wear Red Day® and American Heart Month each February. 
• The Biologic Specimen and Data Repository Information Coordinating Center (BioLINCC) facilitates access to and maximizes the scientific value of NHLBI biospecimen and data collections. A main goal is to promote the use of these scientific resources by the broader research community. BioLINCC serves to coordinate searches across data and biospecimen collections and provide an electronic means for requesting additional information and submitting requests for collections. Researchers wanting to submit biospecimen collections to the NHLBI Biorepository to share with qualified investigators may also use the website to initiate the application process. 
• Our Trans-Omics for Precision Medicine (TOPMed) Program studies the ways genetic information, along with information about health status, lifestyle, and the environment, can be used to predict the best ways to prevent and treat heart, lung, blood, and sleep disorders. TOPMed specifically supports NHLBI’s Precision Medicine Activities. 
• NHLBI population and epidemiology studies in different groups of people, including the Atherosclerosis Risk in Communities (ARIC) Study, the Multi-Ethnic Study of Atherosclerosis (MESA), and the Cardiovascular Health Study (CHS), have made major contributions to understanding the causes and prevention of heart and vascular diseases, including coronary heart disease.
• The Cardiothoracic Surgical Trials Network (CTSN) is an international clinical research enterprise that studies heart valve disease, arrhythmias, heart failure, coronary heart disease, and surgical complications. The trials span all phases of development, from early translation to completion, and have more than 14,000 participants. The trials include six completed randomized clinical trials, three large observational studies, and many other smaller studies.

FACT SHEET

The Truth About Women and Heart Disease Fact Sheet

Learn how heart disease may be different for women than for men.

View the fact sheet.