Coronary Heart Disease Research

Over the years, the NHLBI has supported 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 like 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 cigarette smoking increases the risk of heart disease. Framingham Heart Study 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. Read more about the study findings.
• Risk factors for African Americans: The Jackson Heart Study (JHS), which began in 1997, includes more than 5,300 African American men and women in Jackson, Mississippi, and 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). The JHS 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.
• Risk factors for American Indians: The NHLBI actively supports the Strong Heart Study, a long-term study that began in 1988 to study 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 Indians ever undertaken. Cardiovascular disease remains the leading cause of death for American Indians overall. Yet, the prevalence and severity of cardiovascular disease among American Indians has been challenging to study due to the small community sizes, as well as the relatively young age, cultural diversity, and wide geographic distribution of the population. Read about the goals and key findings of the Strong Heart Study.

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 the research on coronary heart disease we fund.

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, called LDL cholesterol, raise the risk of coronary heart disease. However, even with medicine that lowers LDL cholesterol, there is still a risk of heart disease due to other proteins that circulate in the blood called triglyceride-rich ApoB-containing lipoproteins (ApoBCLs). A team of researchers is working to find innovative ways to reduce the levels of ApoBCLs, which may help prevent coronary heart disease and other cardiovascular conditions.

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

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) to study the relationship between pregnancy-related problems, such as gestational hypertension, and heart problems. The study also looks at how pregnancy problems might increase risk factors for heart disease later in life. NuMoM2B launched in 2010 and long-term studies are ongoing, with the goal to collect high-quality data and understand how heart disease develops in women after pregnancy.
• How coronary artery disease impacts 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, they do not know why some people develop high-risk coronary plaques while others do not. Researchers hope 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 researchers studying the genetic causes of coronary heart disease in a variety of populations. Other NHLBI-funded scientists are identifying genes that may raise the risk of coronary heart disease specifically in individuals of African ancestry. Based on their findings, other studies are underway to try and identify drug targets that can be used to treat people with coronary heart disease caused by specific genetic mutations.

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

RESEARCH FEATURE

Read recent findings from the NuMoM2B study: Pregnant women with sleep problems could face a lifetime of cardiovascular woes.

Current research on treatments for coronary heart disease

ISCHEMIA and related research

• Procedures or medicines to treat coronary heart disease: The NHLBI-supported International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) is a game-changer for the 18 million Americans living with coronary heart disease. More than 5,000 people in 37 countries participated in the study to identify the best treatment courses for people who have coronary heart disease. Researchers followed people for more than 5 years to determine whether an initial invasive strategy involving cardiac catheterization and coronary revascularization reduces mortality and non-fatal coronary events more than an initial conservative strategy consisting of medicines and lifestyle changes. The early invasive strategy was more effective at reducing anginal pain (chest pain), though it did not reduce mortality or non-fatal coronary events. See the ISCHEMIA results for more information.
• How treatments impact people with chronic kidney disease: The NHLBI-supported ISCHEMIA-Chronic Kidney Disease (CKD) trial, a companion trial to ISCHEMIA, examined whether an initial invasive strategy of cardiac catheterization and coronary revascularization reduced mortality and myocardial infarction more than an initial conservative strategy of guideline-directed medical treatment in people who have both coronary heart disease and advanced chronic kidney disease. During an average follow-up period of more than 2 years, the initial invasive strategy did not improve mortality or the rate of myocardial infarction.   
• Long-term studies of treatment effectiveness: ISCHEMIA-EXTEND is a follow-up with the surviving ISCHEMIA participants that will compare the initial invasive strategy with the initial conservative strategy to see if the ISCHEMIA results change when follow up is longer. Additionally, it will examine the impact of nonfatal events on long-term heart disease and mortality. A more accurate heart disease risk score will be constructed to help doctors provide more precise care for their patients. The EXTEND results will be announced in 2025 or 2026.

More research on treatments for coronary heart disease

• Studies of different surgical treatment approaches: The Cardiothoracic Surgical Trials Network (CTSN) is an international network that studies coronary heart disease, heart valve disease, arrhythmias, heart failure, and complications of surgery. Network researchers have studied the success of treatments for atherosclerotic diseases. For example, they conducted a study in people who had atherosclerotic blockages in several coronary arteries. Researchers compared multi-vessel percutaneous coronary intervention (PCI) and a hybrid procedure that uses PCI in some affected vessels and bypass surgery in others. The strategies were equally effective at preventing serious complications, including death, stroke, heart attack, and repeat surgeries in the year following the procedures. The results suggest that the hybrid procedure may be a treatment option for some patients, but further study with a longer follow up is needed.
• How mental health impacts coronary artery disease: NHLBI-supported researchers are investigating ways to reduce anxiety in people who have coronary heart disease. Anxiety is common in these patients and may raise the risk of serious cardiac events, like heart attacks. Researchers are conducting a long-term study to determine if medicines that reduce anxiety, combined with exercise, can lower the risk of complications and rates of hospitalization related to coronary heart disease. Other NHLBI-funded researchers are investigating new ways to treat depression in patients with coronary heart disease.

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

• 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.
• 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 Branch takes a comprehensive approach to understanding these disorders, combining classical epidemiology and longitudinal studies with state-of-the-art genetic and -omics technologies.

• In 2002, 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. Among other initiatives, the NHLBI and The Heart Truth® supported the creation of The Red Dress® 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. This website serves to coordinate searches across data and biospecimen collections and to provide an electronic means for requests for additional information and the submission of requests for collections. Researchers wanting to submit biospecimen collections to the NHLBI Biorepository to share with qualified investigators may also use this 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 the complications of surgery. The trials span all phases of development, from early translation to completion, and have more than 14,000 participants. They include six completed randomized clinical trials, three large observational studies, and many other smaller studies.