This year, the National Heart, Lung, and Blood Institute (NHLBI) celebrates its 75th anniversary. Over the decades, NHLBI has supported groundbreaking research that has pushed the frontiers of fundamental science, epidemiological (population) studies, clinical research, and implementation science. It has also been bold and innovative in its health education and dissemination efforts. In a word, the Institute has been active. It launched initiatives in emergent fields such as community-engaged research, artificial intelligence (AI)/ machine learning, and data science, and it has supported the development of new and curative therapies for common and rare diseases and conditions. NHLBI’s research programs have helped improve longevity and quality of life for people in the United States and around the world, while increasing the focus on communities bearing a disproportionate burden of heart, lung, blood, and sleep disorders.
In observance of this anniversary, we reflect on NHLBI’s long history of research accomplishments in improving public health. We renew our commitment to supporting cutting-edge basic and applied research aimed at finding effective ways to prevent, diagnose, and treat the diseases and disorders within NHLBI’s purview.
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Community-Engaged Research to Advance Public Health
NHLBI continues to increase its commitment to community-based research that successfully addresses public health problems. NHLBI’s investments in this area have continued to grow, from population health studies that seek to identify the causes of disparities, to intervention studies seeking to reduce them. Many of the diseases in NHLBI’s portfolio have a disproportionate impact on people of color, people living in rural communities, and other underserved populations. Clinical researchers are now acknowledging the need to address the complex network of factors that influence health and disease, such as where people live; how they interact with their community, family, and friends; and what kind of health behaviors they have adopted. The road to discovery depends upon the trusting participation of these communities in the research enterprise. This requires re-envisioning the composition of a research team.
- In July 2020, NHLBI partnered with the National Institute on Minority Health and Health Disparities (NIMHD) to launch Community Engagement Alliance (CEAL) Against COVID-19 Disparities. CEAL brings together multidisciplinary teams of researchers and trusted community partners, including community- and faith-based organizations, minority professional societies, and others in communities affected by COVID-19.
- NHLBI is now leveraging the CEAL community engagement platform for other initiatives, including the NHLBI Maternal Morbidity and Mortality Community Implementation Program (MH-CIP), the NIH Implementing a Maternal health and PRegnancy Outcomes Vision for Everyone (IMPROVE) initiative, and the NIH Climate Change and Health Initiative.
- NHLBI also co-leads the NIH RECOVER (Researching COVID to Enhance Recovery) initiative, launched in 2021, to better understand why some people develop long term symptoms of SARS-CoV-2 infection, or long COVID. Since its inception in 2021, RECOVER has depended on the input, support, and participation of those most affected by long COVID: the people living with the condition. Having this large-scale, diverse cohort ensures that the voices of those disproportionately affected by the disease are meaningfully represented in the research endeavor.
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Responding to the Public Health Challenges of Climate Change
The World Health Organization describes climate change as the biggest threat to human health and well-being moving into the future. Both short- and long-term impacts will lead to increases in, and worsening of, chronic diseases such as cardiovascular disease, respiratory conditions, and sleep disorders. At every level, everyone will be affected, though in different ways, and public health strategies will have to be developed to take these differences into account. Community-engaged research will be center stage in these efforts.
- NHLBI understands the important role it has to play in this massive challenge and has provided significant funding to NIH’s Alliance for Community Engagement-Climate and Health (ACE-CH) initiative.
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Cardiovascular Disease and Maternal Health
Each year, an estimated 700 women in the United States die from complications related to pregnancy, and more than 50,000 experience severe morbidity. Most cases of maternal morbidity and mortality (MMM) are related to underlying heart, lung, blood, and sleep conditions. Cardiovascular disease (CVD) is the leading cause of pregnancy-related deaths, accounting for more than one-third of these deaths annually. NHLBI supports research aimed at preventing or managing cardiovascular risk factors and CVD across a woman’s entire lifespan.
- The nuMoM2b Heart Health Study, funded by NHLBI with co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), is studying the effects of pregnancy complications on future cardiovascular health, including social factors that correlate with the future heart health of new parents, especially in communities of color.
- Results from the Chronic Hypertension and Pregnancy trial (discussed below) showed that targeting a blood pressure of less than 140/90 mmHg in pregnant women with mild chronic hypertension leads to better pregnancy outcomes.
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Supporting Diversity, Equity, Inclusion, and Access Across the Research Enterprise
Studies show teams that embrace diversity at every level of the research endeavor produce more — and more significant — scientific breakthroughs. NHLBI firmly believes this, which is why the Institute is working to fundamentally change the meaning of a multidisciplinary research team in all its work. This kind of diversity requires not only including people with different scientific expertise and skills but
also collaborating with communities and affected populations at every phase of the research enterprise — from the formulation of research questions; through the planning, design, and implementation of research protocols; to the eventual interpretation and dissemination of findings. Exposing more communities to the research endeavor means opening doors to young people who might never have considered a career in biomedical research and inviting them to share their unique perspectives and knowledge.
By actively engaging communities, supporting diversity at all levels of the research enterprise, and fostering new and diverse types of partnerships — all while continuing to invest in critical research — the Institute continues to do its part to accelerate discoveries that enhance public health.