Addressing Heart Health Disparities
A recent 2022 paper from the Multi-Ethnic Study of Atherosclerosis (MESA) analyzed disparities in cardiovascular disease mortality across four race and ethnic groups, with adjustments for socioeconomic status, lifestyle, psychosocial factors, and immigration history. In another 2022 paper, investigators used two decades of U.S. mortality data from the Centers for Disease Control and Prevention (CDC) to evaluate demographic and regional trends in mortality from acute myocardial infarction (AMI). They report that, despite decreases in AMI mortality rates in all groups, disparities persisted. Higher mortality rates are seen in Black individuals, men, and people living in the South.
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Supporting Research to Identify Potential Therapeutic Targets
- NHLBI-supported scientists identified extensive molecular alterations in failing hearts at single-cell resolution. They did this by performing single-nucleus RNA sequencing of nearly 600,000 nuclei in left ventricle samples from 11 hearts with dilated cardiomyopathy. Understanding the landscape of genes in the human heart that are involved in health and disease may offer new potential therapeutic targets and biomarkers for heart failure.
- A recent study has identified 162 unique genes that exert their effects on up to seven disease-relevant tissues and cell types. The study was aimed at developing a comprehensive integrative genomics analysis pipeline for coronary artery disease (CAD) and to provide a prioritized list of causal CAD genes.
- Machine learning was recently used to improve patient stratification through the identification of phenotypic subtypes of dilated cardiomyopathy. These subtypes of disease have different clinical outcomes, which may reflect different underlying pathologies. This work is promising in identifying subtypes that, when further investigated, may lead to more targeted treatment approaches.
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Improving Heart Health in Women Across the Lifespan
- NHLBI’s Chronic Hypertension and Pregnancy (CHAP) trial seeks to prevent adverse pregnancy and fetal growth outcomes by focusing on interventions that safely control the cause of the problem: mild chronic hypertension during pregnancy. Recent results from this study have shown that a strategy of targeting a blood pressure of less than 140/90 mmHg in pregnant women with mild chronic hypertension leads to better pregnancy outcomes than a strategy of reserving treatment only for severe hypertension. The new strategy had no negative effect on fetal growth, a concern that had previously constrained interventions. This discovery has been so significant that it led to immediate changes in the American College of Obstetricians and Gynecologists’ clinical practice guidelines for treatment of mild chronic hypertension during pregnancy.
- IMPROVE, an NIH-wide initiative, aims to reduce preventable causes of maternal morbidity and mortality and improve health for women before, during, and after delivery. Among developed nations, the United States has the highest prevalence of maternal mortality. Pre-pregnancy factors (e.g., hypertension, obesity, diabetes), age (e.g., women over age 40 have higher rates), and disparities in rural/urban areas and among racial/ethnic groups (e.g., African Americans and American Indians bear a greater burden) contribute to the country’s high maternal mortality and morbidity rates. In addition, maternal cardiovascular health declines during the life course, a factor that underscores the need to start interventions during pre-pregnancy and early pregnancy periods. IMPROVE includes populations that have a high prevalence of maternal mortality, and its research focuses on the importance of early intervention and support, maternal mortality, disparities, and community engagement.
- The Early Intervention to Promote Cardiovascular Health of Mothers and Children (ENRICH) program will tap into existing federal home visiting programs that serve at-risk families. Its goal is to determine whether adding a cardiovascular intervention will enhance maternal and early childhood outcomes for approximately 3,000 mother-child pairs. This is especially important because adverse pregnancy outcomes — hypertensive disorders of pregnancy (HDP), preterm delivery, and low birth weight babies, for example — are associated with poor maternal and offspring cardiovascular health. Between 2007 and 2019, HDPs increased from 38.4 to 77.8 per 1,000 live births. The increase was higher in Black people and older age groups.
- A study from the Women’s Health Initiative (WHI) Memory Study (WHIMS)–Epidemiology of Cognitive Health Outcomes (WHIMS-ECHO) found an association between air pollution and cognitive decline in older women. The study also showed that improving air quality (i.e., reducing exposure) reduced the rate of cognitive decline, which is considered a strong risk factor for dementia.
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Advancing Research in Heart Failure
- In September 2022, NHLBI and the Foundation for the National Institutes of Health (FNIH) tapped into the Accelerating Medicines Partnership® (AMP®). AMP is a public-private partnership between NIH, the U.S. Food and Drug Administration (FDA), and biopharmaceutical and life science companies. It integrates the distinct resources and expertise of these entities on drug discovery and development to further support established NHLBI programs and initiatives. A new addition to this program, AMP Heart Failure, is forming working groups to systematically analyze data from HeartShare, Trans-Omics for Precision Medicine (TOPMed), and other NHLBI resources. The goal is to turn discovery of novel therapeutic targets into safe and effective treatments.
- Patients and their clinicians want to know whether they are at high risk of sudden cardiac death. A recent study showed that a simple, inexpensive test for coronary artery calcium (CAC), in combination with the use of traditional risk factors, can identify individuals with a higher risk of sudden death. Patients and clinicians will find this information useful when they are deciding what preventive strategies to use. A second study found that even a small amount of CAC detected on a scan indicates that some young adults will be at higher risk of heart attacks and other cardiovascular events into mid-life, even though doctors assume their risks are low when assessed by traditional risk equations.
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Dietary Interventions to Reduce Cardiovascular Disease
- In a study reported in November 2022, researchers compared the effects of three eating patterns on patients’ risk of experiencing a cardiovascular event within the next 10 years: the Dietary Approaches to Stop Hypertension (DASH) diet; a diet rich in fruits and vegetables; and the Western diet, which is typically low in fruits and vegetables but high in fat and sodium. The team’s findings suggest that while the DASH and fruit/vegetable diet each reduced risk scores by about 10 percent over an 8-week period, the DASH diet conferred additional benefits for women and Black adults.
- A recent NHLBI-supported study provides evidence that dietary changes — particularly replacement of margarine, butter, eggs, yogurt, cheese, or processed meats with avocado — are associated with a lower risk of cardiovascular disease.
- A study found that consuming more olive oil (versus butter, mayonnaise, dairy fat, etc.) was associated with a lower risk of mortality from cardiovascular and respiratory events. This study contributes to the body of evidence indicating the health benefits of olive oil.