David Goff, MD, PhD, Director, Division of Cardiovascular Sciences at the National Heart, Lung, and Blood Institute at the National Institutes of Health in the U.S., introduces the work of the organisation and his thoughts on supporting heart and vascular health research
Heart disease is the leading cause of death for men and women, despite a 71% decrease in death rates since the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health (NIH) started making long-term investments in biomedical research over 70 years ago.
Within the NHLBI, the Division of Cardiovascular Sciences (DCVS) supports research to further our understanding of and interventions for promoting heart and vascular health throughout the lifespan. In addition, it supports research that sets out to prevent and treat paediatric and adult cardiovascular diseases, such as heart attack, heart failure, stroke and congenital heart disease. We enjoyed a conversation with David Goff, MD., PhD., Director of DCVS to find out more.
Heart, lung, blood and sleep conditions
David Goff underlines the NHLBI is the lead agency in the United States (U.S.) to support research and research training related to heart, lung, blood and sleep conditions. He notes that the organisation also houses the National Center on Sleep Disorders Research and while that sleep is not in their name, it is very much a part of the NHLBI’s mission.
“The mission spans support of science from basic discovery to population science, late-stage translation, implementation science related to how to implement evidence to promote health and prevent and cure disease across the spectrum of heart, lung, blood, and sleep conditions.
“We are also responsible for workforce development in the area of science relevant to heart, lung, blood, and sleep conditions. We have a Strategic Vision document that lays out our goals and objectives. At the highest level, our goals include supporting research to understand human biology, to reduce human disease, and to advance translational research. Our fourth strategic goal is to develop the scientific workforce and resources.”
Division of Cardiovascular Sciences (DCVS)
Going into further detail about the themes covered by the DCVS, David tells us that they are responsible for nurturing research and supporting the workforce across the spectrum of cardiovascular conditions and there is a host of them. Certainly, people frequently think of heart attacks, which is, of course, the leading cause of death in the U.S. DCVS is also responsible for congenital heart disease in children, heart failure, rheumatic heart disease, hypertensive heart disease and is starting to become more involved with vascular dementia.
“We have a very wide-ranging scope of responsibility in terms of cardiovascular health and research, in addition to promoting the scientific workforce, that is, both the size and diversity in terms of race, ethnicity, gender, geography and with respect to their activities and interests related to a broad range of conditions and responsibilities that DCVS covers.”
Supporting heart and vascular health research
When it comes to how the DCVS is supporting research to advance understanding of and interventions for promoting heart and vascular health across the lifespan, David refers to the Strategic Vision. The Institute Director asked David to lead an implementation plan in this vein within the DCVS. David tells us that a vision without a plan is just a daydream, so DCVS went through a process of interacting with the scientific community and external advisors and identified six areas to focus on over the next five to 10 years in addition to areas that are already being invested in strategically.
“The first area is addressing the determinants of cardiovascular health and health equity. That first word is really important – addressing – it is not describing or understanding because we have supported a fair amount of research over the past decades. We can understand better some of the social determinants of cardiovascular health and believe it is time to start supporting research that is attempting to intervene and address this issue in a way that promotes cardiovascular health across the lifespan.
“A second area that we have identified is to understand and enhance resilience. Resilience is a concept that some individuals, despite being in relatively adverse environmental conditions, still tend to do well from the perspective of cardiovascular health, despite being exposed to adverse conditions or behaviours. If we understand more about resilience, then we might be able to leverage that knowledge to promote cardiovascular health among others across the lifespan.
“The third area identified was promoting cardiovascular health across the lifespan, from the womb to the tomb. We know from previous work, that intrauterine exposures, or exposures to the baby before birth, and the health of a mother has an important impact on the health of the child and the developing person into adulthood. These early life exposures are related to the risk of obesity and hypertension and dyslipidaemia during adult life.”
David adds that the DCVS is trying to learn more about the intergenerational transmission of risk from mother to child, and perhaps from father to child, though it appears to be a stronger transmission from mother to child. This knowledge will enable the DCVS to develop interventions that are effective to target either improving the health of women before or during pregnancy or mitigating the effects of these influences on the child during subsequent development.
“What we know today, is that children lose cardiovascular health during childhood into early adulthood. A metric developed by the American Heart Association called Life’s Simple 7 measures cardiovascular health. When we examine that in light of the population of the U.S., we see a decline in cardiovascular health from childhood into adolescence, the teen years and early adulthood to becoming middle-aged, very few adults here hit the mark for ideal cardiovascular health.”
But there are three additional areas that David notes. One is to eliminate hypertension-related cardiovascular disease – this is the leading cause of death and disability on the planet, according to the Global Burden of Disease (GBD) consortium yet it is largely preventable, he explains. David emphasises that it is, therefore, a priority to support research that improves the prevention, detection, treatment and control of hypertension.
The next to last area is reducing the burden of heart failure, a condition that is growing in importance from a public health perspective in the U.S. and many other countries. David tells us that the heart is a pump that has to relax to allow blood in and then squeeze to push the blood out. There are two types of heart failure. One is where the heart doesn’t squeeze well and the other is when it doesn’t relax well. Of the former, David says that several effective treatments are available, but it is still a bad problem to have. On the latter, there are almost no treatments available and the treatments for the other type of heart failure do not work well. The DCVS is, therefore, very keen to support the type of research that helps us to understand the form of heart failure where the heart does not relax well better. David then directs our thoughts to dementia, a public health problem we need to learn more about. DCVS is interested in supporting research that increases the understanding of vascular contributions to cognitive functioning and the interventions that they can apply to this and improve cognition and delay the onset of dementia.
Research discoveries: Fostering the next generation
David then reveals why it is important to foster the next generation of research discoveries. First, he says that tremendous progress has been made when it comes to advancing heart health. There has been an over 70% reduction in age-adjusted mortality rates in the U.S. since the mid-1960s but despite that, heart disease is still a leading cause of death globally.
“In addition, progress during the last decade has been pretty flat and we see disparities that have endured for decades by race, ethnicity, sex and geography in the U.S. The bottom line is that about one-third of Americans will die from some form of cardiovascular disease including stroke. About 60% of us are likely to have a major cardiovascular event before we die, so despite all the progress we have made in the past, this is not the time to rest on our laurels.
“We have work to do. We need to redouble our efforts to implement strategies that are known to work and support science across that translational spectrum from basic science to late-stage translation and implementation science focussed on strategies to prevent and treat. Someday, we hope to cure forms of heart disease.”
Finally, David adds that if you can meet the aforementioned Life’s Simple 7 measures and attain ideal cardiovascular health, then you can really reduce the risk of having cardiovascular disease during your life. “It is about eating a healthy diet, being physically active, not smoking and avoiding people that do, trying to stay lean and keeping your blood pressure, cholesterol, and sugar levels normal without needing medication, as well as getting a good night’s sleep. These steps will reduce your chance of getting heart disease tremendously.”