NEWS FROM THE NHLBI
The Extramural Division of Cardiovascular Sciences of the National Heart, Lung, and Blood Institute
Michael S. Lauer, MD*,
Sonia I. Skarlatos, MS, PhD and
Diane E. Bild, MD, MPH
Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
Manuscript received January 15, 2009;
accepted April 13, 2009.
* Reprint requests and correspondence: Dr. Michael S. Lauer, National Heart, Lung, and Blood Institute, 6701 Rockledge Drive, Room 10122, Bethesda, Maryland 20892 (Email: lauerm{at}nhlbi.nih.gov).
The National Heart, Lung, and Blood Institute (NHLBI) Strategic Plan describes an ambitious agenda in cardiovascular disease research, with most of it implemented via grants and contracts to extramural scientists. There are over 85 NHLBI program scientists, who work to initiate, catalyze, evaluate, and oversee cardiovascular research efforts. These scientists are divided into 8 branches within an overarching Division of Cardiovascular Sciences (DCVS). The DCVS represents the union of 2 previously existing divisions, the Division of Cardiovascular Disease and the Division of Prevention and Population Sciences; both divisions recently prepared detailed strategic plans (1,2).
DCVS provides leadership and supports basic, clinical, population, and health services research on the causes, prevention, and treatment of cardiovascular diseases. The Division fosters research in disease areas, such as atherothrombosis, heart attack and heart failure, high blood pressure, stroke, atrial and ventricular arrhythmias, sudden cardiac death, adult and pediatric congenital heart disease, cardiovascular complications of diabetes and obesity, and other cardiovascular disorders. Research also includes a number of well-known epidemiological cohort studies that describe disease and risk factor patterns in populations; clinical trials of interventions to prevent disease and to prevent or modulate risk factors; studies of genetic, behavioral, sociocultural, health systems, and environmental influences on disease risk and outcomes; and studies of the application of prevention and treatment strategies to determine how to improve clinical care and public health. The Division supports training and career development for these areas of research.
DCVS is organized operationally into 8 scientific branches, a career development office, and an Office of Biostatistics Research.
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Advanced Technologies and Surgery Branch
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This branch conducts and manages an integrated basic and clinical research program to study innovative and developing technologies for the diagnosis, prevention, and treatment of cardiovascular disease. The branch is also a focal point for cardiovascular device development, and is currently funding developmental research of ventricular assist devices for the pediatric population. Other important areas that the branch oversees include dedicated programs in nanotechnology, systems biology, and progenitor cells. See Table 1
for specific examples of major programs.
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Atherothrombosis and Coronary Artery Disease Branch
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This branch conducts and manages an integrated basic and clinical research program to study the etiology, pathogenesis, prevention, diagnosis, and treatment of coronary artery disease and atherothrombosis. The branch's portfolio includes funded studies related to the entire spectrum of the atherothrombotic process. The branch is also engaged in a series of clinical trials related to coronary disease and atherothrombosis. Examples of 3 major trials are provided in Table 1.
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Heart Development and Structural Disease Branch
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This branch conducts and manages an integrated basic and clinical research program to study heart development, congenital heart disease, and valvular heart disease. The Pediatric Heart Network (3) provides an effective, flexible infrastructure to study congenital heart disease in children and young adults. In late 2009, a comprehensive Pediatric Cardiovascular Translation Consortium will join the Pediatric Heart Network. Details about these 2 programs will appear in future columns. This branch is also the focal point for coordination of many activities related to pediatric clinical research within the NHLBI and the National Institutes of Health.
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Heart Failure and Arrhythmias Branch
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This branch conducts and manages an integrated basic and clinical research program to study normal cardiac function and pathogenesis to improve diagnosis, treatment, and prevention of heart failure and arrhythmias. In 2007, the Heart Failure Network was initiated to accelerate research in the diagnosis and management of heart failure and to improve outcomes through evaluation of novel therapies and optimal application of existing therapies. The branch is also responsible for overseeing resuscitation science through support of fundamental resuscitation research studies and the Resuscitation Outcomes Consortium, which provides support for clinical trials in the areas of cardiopulmonary arrest and severe traumatic injury. Other supported clinical trials are shown in Table 1.
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Vascular Biology, Hypertension, and Atherothrombosis Branch
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This branch conducts and manages an integrated basic and clinical extramural research program to investigate vascular biology, and the etiology, pathogenesis, prevention, diagnosis, and treatment of hypertension and vascular diseases. Through the Specialized Centers for Clinically Oriented Research in vascular injury, repair, and remodeling, the branch supports translational studies in vascular diseases, including aortic aneurysms, coronary artery disease, and metabolic syndrome. In 2007, GenTAC (Genetically Triggered Thoracic Aneurysms and Cardiovascular Conditions), a data and biospecimen registry, was established to provide resources to the scientific community to advance the clinical management of genetically triggered thoracic aortic aneurysms. The branch also supports basic and translational research on cardiovascular complications of human immunodeficiency virus/acquired immune deficiency syndrome.
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Epidemiology Branch
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This branch oversees major population-based cohort studies that discover and describe major risk factors for cardiovascular disease. Several examples are shown in Table 1. Some cohort studies focus on specific demographic groups, such as the Jackson Heart Study of African Americans and the Strong Heart Study of Native Americans. The Epidemiology Branch oversees a number of major efforts in genetic epidemiology, such as the Framingham SHARe (SNPs and Health Association Resource) project, CARe (Candidate Gene Association Resource), and STAMPEED (SNP Typing for Association with Multiple Phenotypes from Existing Epidemiologic Data). The branch also partially supports several Centers for Disease Control-based population-based survey studies, including the National Health and Nutrition Examination Survey.
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Clinical Applications and Prevention Branch
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This branch primarily oversees interventional trials that are aimed at primary prevention of cardiovascular events or at better management of cardiovascular risk factors. Behavioral medicine and the influence of psychosocial factors are major areas of emphasis of many research efforts. Several major studies are shown in Table 1. In conjunction with the Epidemiology Branch, the branch is also interested in health services research, and as part of this effort is overseeing a major clinical epidemiology program that is based on rich electronic medical record documentation of over 10 million patients enrolled in a large Health Maintenance Organization research network.
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Women's Health Initiative Branch
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This branch oversees several major now-completed trials of hormone therapy and other interventions for primary prevention of chronic disease, as well as a parallel observational study. At this time, over 100,000 older women continue to be followed. Because of a rich bank of biological specimens, highly detailed baseline and follow-up data, and a large number of carefully adjudicated events, the Women's Health Initiative studies continue to be a highly productive source of scientific effort. As an example of a major ongoing project, there are plans to obtain detailed genotype information on over 10,000 African-American and Hispanic women.
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Office of Research Training and Career Development
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This office supports research training and career development programs for individuals at many educational levels, from high school to faculty, as well as training programs for individuals from under-represented groups. Many of these programs are designed to take emerging and promising scientific and technological advances from discovery through pre-clinical and clinical studies. A K12 institutional training program, Research Career Development in Vascular Medicine, was established in 2007 to provide comprehensive clinical research training for physicians wanting to specialize in vascular medicine. The office also collaborates with the scientific community and professional organizations to ensure that training programs meet both the current and future needs of the cardiovascular research workforce.
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Office of Biostatistics Research
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The statisticians in this office provide a valuable resource to all of the NHLBI and to the extramural scientific community by their active involvement in the planning and execution of nearly all major NHLBI-supported projects, particularly clinical trials, often from the point of conception. In addition, the office oversees its own active research agenda, with particular attention to statistical genetics and statistical challenges of modern-day clinical trials.
Although the NHLBI's extramural cardiovascular program staff is divided into multiple branches, we strive for a working atmosphere in which there is fully open communication among all program staff. Thus, it is quite common that staff from different branches work together on major efforts, including large-scale multicenter clinical trials, research based on population-based cohort studies, research policies that are relevant throughout the Institute, and conception and development of new ideas and initiatives. In the same spirit, we recognize that we must not only all work closely with one another, but also share this philosophy of open communication with the extramural scientific community, as we seek to foster the best scientific research needed to solve the public health challenges we face.
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References
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1. National Heart, Lung, and Blood Institute Division of Cardiovascular Diseases http://www.nhlbi.nih.gov/about/dcvd/index.htmAccessed June 22, 2009.2. National Heart, Lung, and Blood Institute Division of Prevention and Population Sciences Strategic Plan http://www.nhlbi.nih.gov/about/dpps/strategicplan.htmAccessed June 22, 2009. 3. National Institutes of Health Department of Health and Human Services http://www.PediatricHeartNetwork.orgAccessed June 22, 2009.
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