Maintaining Momentum for Pediatric Heart Disease Research
The NHLBI continues to support research on the causes of and treatments for congenital heart disease (CHD), the most common birth defect in the United States. The Pediatric Heart Network (PHN), established in 2001 and encompassing more than 30 children’s hospitals, has been working to improve evidence-based treatment for CHD. In a recent PHN study, known as the Fontan Udenafil Exercise Longitudinal (FUEL) Trial, teenagers born with a single working ventricle of the heart—a rare defect that cannot be completely corrected—showed a significant improvement in their ability to sustain moderate exercise after treatment with udenafil, a drug that helps improve blood flow.
The NHLBI is leveraging the PHN and other resources, including the Institute’s Pediatric Cardiac Genomics Consortium (PCGC), as part of the trans-NIH project known as Investigation of Co-occurring Conditions Across the Lifespan to Understand Down syndrome (INCLUDE). Through INCLUDE, NHLBI-funded researchers are investigating the genetic factors that could link Down syndrome with CHD. In 2019, the PHN provided career development awards to four emerging clinician-scientists to help them gain expertise in treating patients with CHD and Down syndrome.
Linking Heart Health and Brain Health
The NHLBI is increasing its investment to explore and better understand how heart health affects brain health. In 2020, the NHLBI’s Jackson Heart Study, the largest longitudinal study of heart disease in African Americans, will begin to include detailed assessments of participants’ cognitive function.
The Atherosclerosis Risk in Communities Study (ARIC) is also expanding to learn more about vascular dementia and other cognitive issues through the ARIC Neurocognitive Study. ARIC researchers found that after 17 years of follow-up, participants who engaged in regular moderate-to-high levels of physical activity in midlife had about a 40 percent reduced incidence of dementia than their less physically active peers.
In 2019, the Systolic Blood Pressure Intervention Trial Memory and Cognition in Decreased Hypertension (SPRINT MIND) found that aggressive treatment in midlife for high blood pressure—rather than standard treatment—may reduce the risk of vascular-related cognitive decline later in life. Magnetic resonance imaging (MRI) studies among a subgroup of SPRINT MIND participants found that the treatment helped slow the accumulation of white matter lesions in the brain, which are associated with cognitive decline. The NHLBI co-funds SPRINT MIND with the National Institute of Neurological Disorders and Stroke and the National Institute on Aging.
Addressing Rural Health Disparities
In 2019, the NHLBI stepped up its efforts to address health disparities experienced by people living in rural communities. For example, the newly funded RURAL Cohort Study aims to identify why cardiovascular, lung, and other chronic diseases occur in Southern rural communities at higher rates than in other areas. The NHLBI is also supporting increased enrollment of rural patients in northern New England into the Cardiothoracic Surgical Trials Network, as well as efforts to implement research findings in rural communities.
People who live in rural areas can also have difficulty accessing care. To address this issue, the NHLBI-supported Improved Cardiovascular Risk Reduction to Enhance Rural Primary Care (ICARE) study is testing whether telemedicine-based access to pharmacists can improve medication adherence and outcomes for patients in rural areas.
Implementing the Strategic Vision
Addressing health disparities in American Indians
The NHLBI is expanding its commitment to address the high burden of chronic disease among American Indians and other underserved populations. In February 2019, the NHLBI renewed its funding for the Strong Heart Study, which is the largest study of cardiovascular risk factors ever undertaken in American Indian communities and is conducted in partnership with 12 Tribal Nations in Arizona, Oklahoma, and the Dakotas. In the following months, NHLBI Director Gary Gibbons embarked on a listening tour with Tribal leaders to reaffirm and strengthen these partnerships.
A recent analysis from the Strong Heart Study found that across two generations, cardiovascular disease incidence rates dropped among the participants, with decreased mortality for men, although not for women.
In the next few years, funding will be made available for community-based projects driven by Tribal leaders and health officials. The study also continues to support biomedical training and career development for American Indian students and early-career investigators.
This work addresses Strategic Vision Objectives 3 and 8.
Addressing women's heart health before, during, and after pregnancy
Pregnancy can increase a woman’s risk for future cardiovascular disease—and each year, hundreds of American women die from pregnancy- or delivery-related cardiovascular complications. In addition, with rising rates of obesity, diabetes, and high blood pressure among young people, many women come into their pregnancies already at higher risk for cardiovascular disease. The NHLBI supports research to understand and reduce women’s risk of cardiovascular disease throughout their lifespan, including before, during, and after pregnancy.
One ongoing trial is examining whether pregnant women with mild chronic high blood pressure will benefit from lowering their blood pressure to a target often used for nonpregnant adults (<140/90 mmHg) without affecting blood flow to the womb.
The nuMoM2b Heart Health Study is looking at how sleep apnea and other pregnancy complications, such as preeclampsia and high blood pressure, affect a woman’s long-term health.
New studies are working to improve understanding and treatment of blood clots (thrombosis) in reproductive-age women. These studies will shed new light on long-standing data showing a higher risk of thrombosis during use of oral contraceptives, during pregnancy, and within the first several weeks after delivery.
Researchers are also working to determine the most effective ways to improve pregnancy-related outcomes in obese and overweight pregnant women. A recent study found that lifestyle interventions can help.
This work addresses Strategic Vision Objectives 2, 4, and 5.
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Heart Disease Research