National Heart, Lung, and Blood
Institute Task Force Report on Research in Prevention of Cardiovascular Disease
for Prevention Research
Utilization and Implementation of the Task Force
Task Force on
Research in Prevention of Cardiovascular Disease
During the past 30 to 40 years, tremendous advances
have been made in preventing cardiovascular disease (CVD). Since 1960,
mortality from CVD has decreased more than 50 percent in the United States.
This remarkable decline is a result of population-wide efforts to prevent CVD
and advances in treating patients with CVD. Over the past four decades, dietary
and smoking habits, treatment of hypertension and dyslipidemia, outpatient
therapy for CVD, and inpatient treatment of acute CVD events have improved
Yet, some areas of prevention research have not been
as successful. Currently in the United States, the prevalence of obesity and
diabetes continues to increase, the knowledge gained from clinical trials is
not always integrated successfully into community and clinical practice, and
health disparities have not been significantly reduced for various racial and
ethnic groups and individuals with low socioeconomic status. In addition, U.S.
mortality rates for CVD are approximately double those of many other countries,
indicating that the United States has additional opportunities for further
reducing mortality, and morbidity, from CVD.
To identify fruitful areas of research for continuing
the United States' history of success in preventing CVD, the National Heart,
Lung, and Blood Institute (NHLBI) established in January 2001 the Task Force on
Research in Prevention of Cardiovascular Disease. Its members represented
specific areas of prevention research. This report documents the deliberations
and recommendations of the Task Force.
The objective was to develop a research agenda and an
action plan for the NHLBI and the National Heart, Lung, and Blood Advisory
Council (NHLBAC). The Task Force's recommendations address the research
agenda, not a broad public health agenda. By developing specific research
priorities in the context of the research the NHLBI currently supports and
existing gaps in its portfolio, the Task Force defines a strategic prevention
research agenda for the next 2 to 5 years. The aim is to provide guidance for
allocating NHLBI resources for Institute-initiated and investigator-initiated
research on the prevention of CVD.
As requested by the NHLBI, the report is a short
document focused on identifying appropriate next steps for continued
implementation of the Institute's objectives in prevention research. The NHLBI
published a more comprehensive document, entitled the NHLBI Report of the
Task Force on Research in Epidemiology and Prevention of Cardiovascular
Disease, in August 1994.
Establishing Priorities for
Research on prevention of CVD is necessarily
multidisciplinary. It encompasses prevention activities across the disease
continuum, including research on behaviors leading to elevated risk factors for
CVD, the initiation and progression of disease, and acute events and premature
death. In its report, the Task Force emphasizes strategic clinical and
population research applicable to the prevention of CVD.
The recent National Conference on Cardiovascular
Disease Prevention highlighted national trends in risk factors, morbidity, and
mortality related to CVD. Its findings are published as a special report in
Circulation (2000;102:3137-47), entitled "Trends and Disparities in Coronary
Heart Disease, Stroke, and Other Cardiovascular Diseases in the United States"
(Cooper, R., et al.). The data reported show several disparities in the control
of risk factors and in mortality rates among groups according to race,
ethnicity, socioeconomic status, geography, age, and gender. Based on these
findings, the National Conference recommended emphasis on applied prevention
research to reduce these disparities in population subgroups and to address
adverse trends in deleterious health behaviors. The Task Force adopted this
recommendation in developing the specific research priorities presented in this
Establishing research priorities is difficult and the
process used to establish priorities has inherent limitations. The Task Force
used the following criteria to determine whether a particular area should be
considered a priority for research on prevention of CVD:
- Is the research applicable to Areal-world@ clinical
and community settings?
- Does the research area involve cutting-edge
- Is the area understudied?
- Is the opportunity timely?
- Is the potential impact large (i.e., is the burden
of disease high and/or are the risk factors or risk behaviors highly
The members of the Task Force, who represented a broad
range of prevention science, initially presented research priorities within
their areas of expertise and then collectively discussed the overall merit of
each recommendation before ranking all recommendations by priority. The Task
Force then distributed a draft report of its recommendations to leaders in
prevention research to solicit their feedback. It also encouraged input from
the global scientific community and then incorporated their responses in
developing its final recommendations.
The research priorities
presented in this report are not intended to be restrictive to the NHLBI or
investigators, nor are they intended to preclude or discourage the submission
of creative proposals in other areas of prevention research for consideration
in the peer review process. Two areas, for example, which the Task Force chose
not to address are research on surveillance and international studies.
The Task Force recognizes that ongoing surveillance of
trends in CVD is vital for adapting current research strategies to current
trends. The initiation of creative strategies for ongoing surveillance of CVD,
similar to the Surveillance, Epidemiology, and End Results (SEER) registry
system, is important, but the Task Force considers this research area to be
outside the scope of its charge.
Similarly, the Task Force recognizes that
international efforts are needed to reduce the global burden of CVD. Within the
scope of this report, the Task Force limits its recommendations to the many
opportunities for reducing the burden of CVD in the United States.
The Task Force presents its recommendations in two
categories based on priority. Although all the recommendations have substantial
merit, the Task Force's priority-ranking process yielded two distinct groups:
top-tier priorities and high-priority research. To clarify the specific
recommendations, the Task Force provides examples of specific research studies.
These examples should not be viewed as the only areas of research pertinent to
the specific recommendation.
Evaluate approaches to enhance implementation of
efficacious preventive interventions in medical systems at all stages of
Substantial evidence shows that established therapies
for preventing CVD are not being adequately applied in practice. Models of
health systems are needed to encourage and expand adoption of national
standards for screening and management of behavioral and pharmacological risk
factors for both primary and secondary prevention. The utility of novel
methods for increasing adherence to national guidelines for prevention needs to
be evaluated, and the cost-effectiveness and acceptability of these methods
need to be determined. Both activities are critical for reducing the burden of
CVD, especially among subpopulations that are not currently benefiting from
uniformly applied guidelines.
Examples of research in this area include the testing
of certain tools or specific organizational changes to encourage adherence to a
national guideline. For example, studies may evaluate the effectiveness of
intervention methods in coronary care unitsCto increase the proportion of
patients who meet national goals for secondary prevention at the time of
hospital dischargeCand systemic approaches to improve prevention in primary
Support studies to facilitate reduction of the
epidemic of obesity in American children and adults
Current trends for obesity in American children and
adults are alarming, and the incidence of Type 2 diabetes mellitus, a risk
factor associated with obesity, has increased dramatically. Morbidity and
mortality rates of ischemic heart disease attributable to obesity are likely to
rise because of increased rates of diabetes, hypertension, and dyslipidemia.
Effective interventions to prevent obesity are urgently needed, through dietary
and exercise approaches for multiple population subgroups and particularly for
prediabetic individuals and ethnic minorities. Although efficacy studies
demonstrate that individuals lose weight when calories are restricted,
regardless of the macronutrient content of the diet, the different levels of
fat content or the glycemic index have rarely been compared in effectiveness
studies or settings that are generalizable. Studies of the effects of other
dietary components (e.g., the effect of fiber on weight loss), the treatment of
obesity in both adults and children, and the maintenance of weight loss are
also needed. Importantly, effective diet and exercise interventions would also
benefit cardiovascular health in ways other than weight loss.
Examples of research in this area include studies to
compare the effects on weight loss of self-selected high-fat versus low-fat
diets or diets containing similar nutrient content but with a high versus low
proportion of vegetables. Studying the effects of such dietary interventions in
different populations (e.g., prediabetic, diabetic, ethnic minorities) also may
be important. Studies of the effects of dietary components other than fat and
of exercise, to treat and prevent obesity and maintain weight loss, are
important. Research to improve measurements of exercise and diet would also be
Initiate studies to understand the effects of
preventive strategies on the early natural history of atherosclerosis, and
integrate subclinical measures as appropriate
Strategies of primary prevention need to be focused on
the prevention of disease as early as possible in the natural history of CVD.
Using measures of subclinical disease as outcomes will enable investigators to
evaluate the efficacy of interventions on early disease (i.e., clinically
silent atherosclerosis or left ventricular hypertrophy). A number of
noninvasive diagnostic tools (e.g., ultrasound, ultrafast computerized
tomography, magnetic resonance imaging, electrocardiography, Doppler) are
available for detecting the onset of CVD. However, subclinical measures should
not be viewed as direct replacements for Ahard," CVD endpoints, but as
endpoints for interventions to reduce the early burden of disease (e.g.,
atherosclerosis). Because many markers of subclinical disease are available,
the selection of marker(s) to be used should be based on the design of the
study and the demographics of the population to be studied (i.e., children,
young adults, middle-aged populations, and higher-risk groups).
Examples of research in this area include studies to
improve behavioral factors and pharmacological interventions in youth and
asymptomatic middle-aged adults. Rather than designing a study focused
primarily on process indicators, investigators also could integrate markers of
subclinical disease as outcomes.
Identify determinants of disparities and barriers
to optimal prevention of CVD according to age, gender, and ethnicity
Health disparities across racial, ethnic, age, and
gender groups are well documented. To eliminate these disparities, optimal
strategies are needed for delivering preventive care to all population
subgroups. Significant barriers to optimal prevention of CVD have been
identified and include level of income, access to care, and treatment. Existing
systems for primary and secondary prevention of CVD have not eliminated health
disparities. New strategies must be developed to overcome the known barriers to
Examples of research in this area include the
development of procedures for use in real-world settings to increase the
treatment of, and adherence to, interventions for lowering blood pressure among
individuals in low socioeconomic and African American populations. Other
strategies involve development of better methods of primary prevention of CVD
targeted to underserved populations. Techniques for accurately monitoring
health outcomes are also needed to track changes in health disparities.
Test approaches using subclinical measures or other
markers of CVD risk in clinical practice, to enhance effectiveness of
Clinical populations are increasingly aware of the
availability of subclinical measures, risk equations, and genetic markers for
risk of CVD. Yet, adherence to primary and secondary CVD prevention measures is
relatively low. Subclinical measures or other markers could be used as
motivational tools to enhance adherence to pharmacological and lifestyle
interventions. They could also be used to stratify individuals according to
their risk of CVD and appropriate levels of intervention (initiation and
intensity). Unfortunately, the utility of using subclinical measures or other
markers in high-risk populations or in the general population has not been
established. Although some measures have been shown to be independent
predictors of CVD events, methods to integrate them into clinical practice and
clinical prevention have not been delineated. Additional research is needed to
describe more clearly the cost- and risk-benefit of using these measures and
markers in nonresearch settings.
Examples of research in this area are efforts to
determine appropriate uses for subclinical disease or risk markers in clinical
practice. The clinical use of many subclinical markers depends on the results
of ongoing studies (e.g., of the predictive power of calcium in the coronary
artery, of many genetic markers). However, clinical guidelines for the
application of other measures (e.g., Framingham risk scores, selected genetic
markers, carotid ultrasound for atherosclerosis, Doppler studies of peripheral
artery disease) could be developed now. Some potentially important areas of
investigation include determining whether a high-risk or general-population
approach is cost effective and warranted, whether abbreviated study protocols
are possible and as effective for detecting disease as more elaborate research
protocols, and which actions should be recommended when patients present the
results of for-profit screening (e.g., ultrafast computerized tomography data)
to their regular physician.
Identify persons more susceptible to environmental
change by designing studies to determine the effects of preventive
interventions in persons with a variation in the candidate genes for CVD risk
The draft sequence of the human genome is now
available, and an enormous effort is under way to identify variations in
genetic sequences across individuals. Information is needed to better
characterize variation in disease, modifier, and susceptibility genes across
different environments so that the influence of environmental factors on levels
of risk factors and disease can be evaluated in different populations. Two
important areas to be explored are genetic effects on age-related changes in
measures of subclinical disease and the effect of age on specific genes (i.e.,
genotypeBage interaction). Determining whether responses to differing
environments and/or treatments depend on genetic variation is also fundamental.
Examples of research in this area include studies that
incorporate genetics related to lipids. Areas of inquiry could include
identifying genes, genetic variants, and environmental factors that contribute
to the variation in lipids among populations; assessing geneBenvironment
interactions related to the development of hyperlipidemia; determining the
efficacy of lifestyle or pharmacological interventions according to individual
genetic variations; and evaluating the utility of genetic screening tests for
predicting the efficacy of treatment.
Incorporate psychosocial factors into intervention
trials, for research on the prevention of CVD
Psychosocial risk factors for CVD (e.g., hostility,
depression, social isolation) and physical risk factors for CVD (e.g., abnormal
lipid and lipoprotein levels, high blood pressure, smoking) tend to cluster in
individuals and in groups of individuals (e.g., with low socioeconomic status).
Instead of acting independently, risk factors probably interact to increase an
individual's risk of disease, and psychosocial risk factors may contribute to
the risk of CVD via effects on physical risk factors. Because psychosocial risk
factors appear to cause some people to engage in behaviors (e.g., smoking, poor
dietary intake) that contribute to increased levels of physical risk factors,
studying the combined and interactive effects of both types of risk factors on
risk of CVD is important.
Examples of research in this area include studies that
use sophisticated, multivariate statistical techniques (e.g., PATH analysis,
Structural Equation Modeling) to evaluate data on psychosocial and physical
risk factors which are available from extant studies [e.g., Coronary Artery
Risk Development in Young Adults (CARDIA), Atherosclerosis Risk in Communities
(ARIC), Multiple Risk Factor Intervention Trial (MRFIT), Hypertension Detection
and Follow-up Program (HDFP), Nurses' Health Study (NHS), Health Professionals
Follow-up Study (HPFS)]. Related studies could determine whether the targeting
of psychosocial risk factors results in improved outcomes for interventions to
reduce physical risk factors (e.g., smoking).
Evaluate the efficacy of preventive strategies on
risk factors, quality of life, and functional status in elderly persons and the
effectiveness of strategies for use in clinical practice
Recent census data suggest that the oldest age group
(75 years and older) continues to increase as a proportion of the U.S.
population. Although manifesting a broad spectrum of comorbidity, functioning,
and treatment of disease, this heterogeneous group has been the focus of
relatively few intervention studies of CVD. Too little is known about the best
strategies to use in this group to compress morbidity, preserve (or enhance)
functioning, and optimize outcomes.
Examples of research in this area include randomized
trials of various combinations of strategies (e.g., management of blood
pressure and lipid levels by drugs, diet, and exercise) to reduce the risk of
CVD in representative groups of very elderly patients. Little is known about
the effectiveness of lowering patients' lipid levels using statins for those 75
years of age and older. Studies of lipid management are needed in this age
group and should include randomized trials and observational studies to assess
a spectrum of outcomes.
Obtain consent and DNA when possible from
participants in prevention studies
Using current resources, tools, and technologies,
high-throughput genotyping and re-sequencing of candidate genes are feasible.
The relevance of gene mutations and sequence variations in the onset and
progression of disease across genetically heterogeneous population groups needs
to be determined. By knowing whether and how the effectiveness of interventions
differs across different genetic subgroups, investigators will be able to
tailor interventions to individuals. To improve understanding of the potential
genetic basis of prevention, DNA should be collected whenever possible in all
prevention-oriented observational studies and trials.
Understand the origins of psychosocial factors in
childhood, including gene-environment interactions
Psychosocial and physical risk factors for CVD, and
their tendency to co-occur in individuals and groups of individuals, likely
have their origins in childhood, including the prenatal period. Some diseases
are caused by mutations of a single gene (e.g., Huntington's chorea, sickle
cell anemia), but the development of risk factors for CVD probably involves
interactions of multiple genes with environmental factors. Knowledge of the
variation (polymorphisms) in genes that are strong candidates for interacting
with environmental factors, to contribute to the development of disease, is
rapidly increasing. Identifying persons at highest risk of CVD should therefore
be possible with far greater accuracy. This knowledge would enable
investigators to target high-risk groups for more effective and efficient
Examples of research in this area are studies to
evaluate candidate polymorphisms of genes that regulate serotonergic function
among children in both positive and adverse (e.g., lower socioeconomic)
environments, as predictors of the development of CVD in individuals and groups
Determine the effects of dietary patterns and
specific nutrients on CVD risk factors other than LDL cholesterol (e.g., blood
pressure, other lipoproteins, and other risk factors) across population
Many studies address the effects of diet on
lipoproteins, especially low-density lipoproteins (LDL). However, other
lipoproteins appear to be involved in atherogenesis, including high-density
lipoproteins (HDL) and triglyceride-rich remnant particles. In addition, diet
has other, nonlipoprotein effects (e.g., on coagulation, blood pressure, and
antioxidant level), which may be important. The effects of dietary patterns and
specific nutrients on multiple lipid and nonlipid endpoints need to be studied.
The effects of dietary patterns in specific population subgroups, especially
diabetic and prediabetic patients, also should be addressed.
An example of research in this area is a randomized
efficacy study to compare two low-saturated-fat diets (high total fat versus
very low total fat) for their effects on lipids, lipoproteins, and coagulation
in different groups of individuals (who are obese and nonobese, have normal or
high triglyceride levels at baseline, exhibit normal insulin sensitivity).
Evaluate behavioral strategies in adolescents,
including successful strategies from other disciplines (e.g., research on drug
Adolescence is a time when individual health behaviors
emerge from family health behaviors. It is also a time when the influence of
peers on health behaviors increases and behavioral interventions are most
difficult. Effective lifestyle and behavioral interventions for adolescents
need to be developed and assessed.
An example of research in this area is a randomized
clinical trial to determine whether behavioral strategies to build self-esteem
and self-efficacy, which have been useful in preventing drug abuse, can be used
to prevent other adverse health behaviors, such as tobacco use, poor diet, and
Understand the social and cultural antecedents of
diet and exercise behavior
The reasons for adopting, or failing to adopt, a
healthy diet and/or physical activity are complex. Providing information and
knowledge of appropriate health behaviors is important and necessary, but is
not sufficient for promoting heart-healthy behaviors at a population level. To
enhance success in promoting healthy lifestyles, the fundamental social and
cultural antecedents of healthy behaviors need to be better understood. Results
from this basic research can be incorporated into the next generation of
Examples of research in this area are studies to gain
a better understanding of the reasons for food selection (e.g., cost,
commercial media campaigns, availability, convenience) among diverse
populations. Specific studies could examine the effects of cultural traditions
and social influences on food choices by individuals of various ethnic and
Evaluate newer options for hormone replacement
therapy for prevention of CVD
The accumulation of evidence suggests that the
traditional form of hormone replacement therapy (0.625mg/day of conjugated
estrogen combined with medroxyprogesterone acetate), which is being tested in
the Women's Health Initiative (WHI), may not be optimal for preventing CVD.
While clinicians await the results of the WHI and additional ongoing studies,
other options for hormone replacement could be evaluated. Studies that compare
the efficacy of alternative compounds, such as low-dose estrogen, natural
progesterone, selective estrogen receptor modulators (SERM), and other
tissue-specific estrogens (including soy isoflavones), on surrogate markers and
intermediate CVD endpoints are needed. These studies would enable investigators
to identify the optimal therapy for testing in future large-scale, clinical
studies of CVD endpoints and to make informed choices about therapy for
An example of research in this area is a randomized
clinical trial to compare the effects of low-dose estrogen or other alternative
compounds on markers of inflammation and vascular activation and on subclinical
or clinical outcomes of CVD.
Understand community-wide and neighborhood-level
determinants of health behaviors
The major risk factors for epidemic CVD (i.e.,
incidence at the societal level) are social and include low socioeconomic
status, poor diet, physical inactivity, tobacco use, and adverse physical
environment. Major NHLBI studies in the 1980s demonstrated that community-level
risk of CVD changes over time. The determinants of these changes and the
reasons for improvement by some communities, but not others, are not clear.
Factors that indicate a community's acceptance of change also are not known.
The determinants of changes in health behaviors tend to operate in
neighborhoods and entire communities. Important variables may include
availability of recreation facilities or fast food, media and marketing,
transportation systems, and cultural factors.
Examples of research in this area include studies with
small- or large-scale objectives. Small-scale studies could focus on the
effects of in-store marketing of tobacco on initiation of smoking among youth
or the effects of television marketing of snack foods on individuals' caloric
consumption. Large-scale studies could include long-term observational studies
in several communities to document differences in social variables and changes
in risk factors for CVD. A study of exercise levels in recently constructed,
planned communities that emphasize cohesive neighborhoods and public transit
would be informative. The goal of these efforts would be to identify successful
techniques for promoting healthy behaviors at a population level.
Evaluate potentially generalizable interventions in
selected community settings (worksites, churches, schools)
A major challenge in the prevention of CVD is to
address social, community-level causes of disease. Large-scale, community-wide
intervention studies are expensive. However, studies of intervention programs
in selected community settings, such as schools, worksites, and churches, may
suggest programs that can be generalized to other settings and populations. The
NHLBI is already supporting research in this area. Additional studies on the
dissemination of interventions (e.g., incentives for schools to adopt and
implement effective curricula related to the prevention of CVD) would be
helpful. Also, because declining levels of physical activity are contributing
to the epidemic of obesity in the United States, ways to increase total daily
energy expenditures should be emphasized and extended to the worksite. Focusing
only on leisure-time exercise is not sufficient.
Examples of research in this area include studies of
interventions to promote increased physical activity, and particularly to
prevent obesity, among diverse population subgroups. Development of a
comprehensive health promotion curriculum for grades K through 12 in
collaboration with a school system may improve long-term adoption and
effectiveness of interventions.
Utilization and Implementation of the
Task Force Report
The recommended priorities for research in prevention
of CVD, presented in this report, reflect the consensus of the Task Force.
These recommendations may be used by the NHLBI to help guide the Institute's
decision making process, to accept investigator-initiated grants in excess of
$500,000, to stimulate and encourage submission of research project grant
applications in targeted areas of research, and to provide direction for the
development of specific NHLBI initiatives (i.e., Requests for Applications,
Requests for Proposals, Program Announcements).
The Task Force believes that research on the
prevention of CVD offers tremendous opportunities for scientific discovery. The
priorities it set forth are intended to promote further activity in high-yield,
high-priority research areas in the short-term. However, the Task Force
emphasizes that this report is not intended to constrain the Institute from
recognizing meritorious research that may lie outside the topics described
Substantial benefits will be gained from funding the
next generation of innovative research on prevention of CVD. Significant
advances to reduce the U.S. burden of CVD have been made in the past decades.
With this report, the Task Force hopes to energize continued progress in
research on prevention of CVD. Its recommendations should be viewed as an
effort to achieve a balance among many important research areas. These include
primary and secondary prevention; genetic, environmental, and combined
approaches; prevention in childhood through older adulthood; risk factors for
CVD; subclinical disease and clinical outcomes of CVD; and community, as well
as clinical, settings.
The Task Force believes that the next generation of
studies to prevent CVD will provide the foundation for future efforts to
further reduce the still-unacceptable high burden of CVD in the United States.
Task Force on Research in Prevention
of Cardiovascular Disease Task Force
Gregory Burke, M.D.
Professor and Chairman
Department of Health Sciences
Wake Forest University School of Medicine
Winston-Salem, North Carolina
Lori Mosca, M.D., Ph.D.
New York Presbyterian Hospital
Associate Professor of
Columbia University New York, New York
Donna Arnett, Ph.D.
Division of Epidemiology
University of Minnesota School of Public Health
Luther T. Clark, M.D.
Department of Medicine
SUNY Health Science Center at
Brooklyn, New York
Stephen R. Daniels, M.D., Ph.D.
Pediatrics and Environmental Health
Children's Hospital Medical Center
University of Cincinnati College of Medicine
Stephen P. Fortmann, M.D.
C. F. Rehnborg
Professor of Preventive Medicine
Stanford University School of Medicine
Palo Alto, California
Harlan M. Krumholz, M.D.
Associate Professor of
Yale University School of Medicine
New Haven, Connecticut
Redford B. Williams, Jr., M.D.
Behavioral Medicine Research Center
Department of Psychiatry &
Duke University Medical Center
Carl Roth, Ph.D., LL.M.
Associate Director for
Scientific Program Operation
Office of Science
Jeffrey Cutler, M.D., M.P.H.
Applications and Prevention Program
Division of Epidemiology and Clinical
Teri Manolio, M.D., Ph.D.
and Biometry Program
Division of Epidemiology and Clinical Applications
Peter Savage, M.D.
of Epidemiology and Clinical Applications
Denise Simons-Morton, M.D., Ph.D.
Director, Clinical Applications and Prevention Program
Epidemiology and Clinical Applications
The National Heart, Lung, and Blood
Institute (NHLBI) provides leadership for a national program in diseases of the
heart, blood vessels, lung, and blood; sleep disorders; and blood resources
management. It plans, conducts, fosters, and supports an integrated and
coordinated program of basic research, clinical investigations and trials,
observational studies, and demonstration and education projects related to the
causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and
blood diseases, and sleep disorders. Research is conducted in the Institute's
own laboratories and by other scientific institutions and individuals supported
by research grants and contracts. The Institute also supports research training
and career development for new and established researchers in basic and
clinical research relating to these topics, and oversees management of the
Women's Health Initiative.
U.S. DEPARTMENT OF HEALTH AND
Public Health Service
National Institutes of Health
For Administrative Use