Goal 1: Promote Human Health

THE RELEVANCE OF PREVENTION TRIALS

Prevention trials, implemented to reduce or delay progression to overt disease in a population at risk to the disease, are an important approach to health promotion. Therapies shown to reduce disease severity in patients with a specific disease are obvious, but not the only, candidates for a prevention trial in populations at high risk for prevalent diseases (such as heart failure, diabetes, COPD, asthma in children). ...more »

Submitted by (@media0)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

The impact of implementing such trials is considerable. They will clearly address an important component of NHLBI’s mission with respect to effectiveness of therapies and behavioral interventions, and it has minimal and clearly definable overlap with commercial trials of specific therapeutic products. It will also provide an important public health focus – preventing disease or reducing the impact of disease processes, thus potentially reducing chronic care costs and increasing years of useful life.

Feasibility and challenges of addressing this CQ or CC :

The biggest challenge in designing and implementing prevention trials is identifying the target, “at risk” population most likely to develop the clinical disease from known biomarkers or early signs/symptoms. Increasing availability of large, population-based registries or databases maintained for other purposes provides a very cost-efficient mechanism to electronically screen and identify “at risk” individuals. The same mechanism may also facilitate implementation of pragmatic, electronically managed, cost efficient trials.

Name of idea submitter and other team members who worked on this idea : Sonja McKinlay other Team Members: Susan Assmann and Paul Stark

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7 net votes
10 up votes
3 down votes
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Goal 2: Reduce Human Disease

Environmental induction of congenital heart defects and finding means of prevention

Congenital heart defects (CHDs) continue to be the leading cause of death among all infants with birth defects. It is reported that approximately 10% of cardiac congenital anomalies have a genetic basis. An equal percentage, or ~10%, is due to environmental factors. For ~60% the etiology is unknown and considered to have a multifactorial basis, eg, environmental agents having a role against a specific genetic background, ...more »

Submitted by (@kerstilinask)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

College drinking is up especially among young women. Women of both high and low income levels drink, may be smoking marijuana, or are exposed to other environmental toxicants. Are there gender effects, as it has been reported that in the US, more male babies undergo severe cardiac surgeries than female. Few grants are presently funded that take a teratological approach to understanding mechanisms underlying induction of congenital heart defects that can occur before a women realizes being pregnant. The embryo may already have been harmed by then and the effects last a lifetime for the child. High dose folate may be preventative of CHDs and this needs to be better defined and the effects of high folate doses on the adult and fetus need to be analyzed. A possible role for gender should be defined.

Feasibility and challenges of addressing this CQ or CC :

A recommended goal is to emphasize the submission of grants specifically addressing the etiology of congenital heart defects due to environmental factors and their prevention, using cell and molecular teratological approaches. Reinstate a study section on Teratology and Toxicology of Birth Defects made up of PIs working in those fields. There used to be four such study sections and were all removed years back. One such section should be reinstated. Current study sections lack such individuals on the panels due to this area receiving little funding. The neural field is way ahead in funding this topic and as a result the heart tends not to be mentioned in available literature that is provided to women of child-bearing age. Yet the risk for heart anomalies is equally as high and important as are effects on neural development. Similarly, both have lifelong consequences for the individual physically and psychologically and in cost to society with repeating hospitalizations and surgeries. Effects on the heart may be so severe that death occurs already in utero and may not always be counted among the epidemiological studies.

Name of idea submitter and other team members who worked on this idea : Kersti K. Linask, PhD

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-7 net votes
16 up votes
23 down votes
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Goal 1: Promote Human Health

What is the role of the environment in HLB disease etiology

It is clear that genetic sequence variation does not account for a substantial portion of disease burden. It is likely that the broad environment contributes to HLB disease via epigenomic alterations and interaction with genetic variants. There is an urgent need to understand the environmental contribution to disease as most exposures are modifiable and are targets for prevention interventions.

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Environmental exposures are clear involved in the pathogenesis of asthma, copd, CVD, and stroke. Understanding the environmental contribution may be critical for reducing disease burden for these common diseases.

Feasibility and challenges of addressing this CQ or CC :

Interventions to reduce disease burden are highly feasible in the next 5-10 years

Name of idea submitter and other team members who worked on this idea : Frank Gilliland

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4 net votes
11 up votes
7 down votes
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Goal 1: Promote Human Health

Studying Health in Addition to Disease

Why do some people stop smoking after a stroke or myocardial infarction, whereas others do not? What motivates people who adopt a healthier diet and exercise program during their lifetime or after a significant health event? How can we promote healthier lifestyle choices at all stages of life? How do we ensure equitable health promoting activities for minorities, vulnerable populations, and lower socio-economic status ...more »

Submitted by (@nhlbiforumadministrator1)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Answering this critical question would enable us to have a more complete picture both of disease and of health.

Feasibility and challenges of addressing this CQ or CC :

It is feasible to address this critical question because we need to expand our understanding of how people remain healthy or regain health, especially given the unhappy statistics concerning obesity, physical activity, blood pressure, diabetes, etc.

Few would disagree with the importance of studying the epidemiology, mechanisms, and progression of disease: research is focused on preventing or curing diseases. In addition to this disease-focused model, there are untapped opportunities to examine health and wellness. Borrowing from the field of Positive Psychology, which is the study of the aspects or characteristics of mental health (e.g., the strengths, values, behavior that contribute to well-being), we can expand this idea to study the aspects of those who remain healthy, who have retained health after disease, or who have successfully made healthy lifestyle changes. In terms of obesity, an example of this idea is Rena Wing’s National Weight Control Registry, which studies individuals who have successfully maintained long-term weight loss.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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135 net votes
176 up votes
41 down votes
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Goal 2: Reduce Human Disease

Can Psychological Science Improve Weight Loss?

Will sensitivity to the psychological aspects of obesity, including lifestyle priorities and motivations, improve the efficacy of long-term effectiveness of weight loss and obesity prevention interventions?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

A primary focus on principles of psychology may result in significantly improved control of the obesity epidemic. Effective interventions could reduce the risk of diabetes, sleep apnea, and hypertension. This research could also affect clinical practice guidelines for weight loss and obesity treatment.

Feasibility and challenges of addressing this CQ or CC :

Psychological science has been successful in developing effective treatments for a number of conditions, including sleep disorders, depressive symptoms, anxiety and phobias. Many of the behavioral principles employed in such interventions (e.g., cognitive restructuring, motivational methods) could be translated for the prevention and treatment of obesity within a reasonable time frame. Additional attention should be directed to the needs of population subgroups in which obesity is most prevalent.

In their Viewpoint article on weight loss intervention research, Pagoto and Appelhans (JAMA, 2013, see attachment) question whether a continued focus on dietary factors in research on weight loss and obesity is warranted. Their commentary raises the importance of attention to the individual psychological characteristics that influence adherence to weight loss interventions rather than dietary composition.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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51 net votes
104 up votes
53 down votes
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Goal 2: Reduce Human Disease

Cardiovascular risk and adverse event prediction & estimating net benefit in statin-treated individuals

Compelling Question: There is insufficient data to personalize the use of nonstatin or other preventive therapies in statin-treated patients. Equations could then be developed to predict CVD risk and to predict the risk of adverse events in statin-treated patients to guide intensification of therapy.

Submitted by (@jennifergrobinson)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

The 2013 ACC/AHA cholesterol guideline recommends statin therapy for the prevention of CVD events in moderate-high risk individuals. Many patients are still at increased CVD risk on statin therapy.

 

The potential for net benefit from CVD risk reduction therapies added to statin therapy depends on the absolute CVD risk in the statin-treated patient, the relative reduction in CVD risk from the added therapy, and the potential for net benefit.

Feasibility and challenges of addressing this CQ or CC :

This could be a pooling project of existing data from observational databases and clinical trials. Sophisticated pharmacoepidemiologic methods would be needed (and likely need to be developed) to draw appropriate inferences for application to clinical practice.

Name of idea submitter and other team members who worked on this idea : Jennifer Robinson MD MPH

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3 net votes
11 up votes
8 down votes
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Goal 2: Reduce Human Disease

How can we implement what we already know for ASCVD prevention?

We have a number of highly effective evidence-based interventions that have been shown to reduce ASCVD events - statins, BP drugs, aspirin, acute care. Yet large proportions of high risk population groups are not taking evidence-based treatment. Numerous interventions have been tried at multiple levels from the individual patient to the federal government payors. What are the best practices? How can we systematically ...more »

Submitted by (@jennifergrobinson)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

A starting point would be to complete the work of the Implementation Working Group convened as part of the NHLBI Cardiovascular Prevention Guidelines in 2008. Needs: (1) Collaboration of consortia involved in multilevel prevention efforts (HMOs, pharma plan managers, health systems, etc) (2) An information warehouse of best practices from consortium members. (3) Collaborate with learning healthcare systems groups to test & evaluate implementation/interventions (40 Disseminate best practices & support to broader range of groups

Feasibility and challenges of addressing this CQ or CC :

Much work has been done in this area & should be collated & assessed for efficacy and cost-benefit. Collaborative framework needed, will require infrastructure funding.

Name of idea submitter and other team members who worked on this idea : Jennifer G Robinson MD MPH

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-9 net votes
3 up votes
12 down votes
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Goal 2: Reduce Human Disease

A Program of Research in the Prevention of Chronic Heart Failure

There is a need to improve identification and surveillance of persons at risk for heart failure and pathological ventricular remodeling prior to development of clinically overt heart failure.

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Substantially reduce the age-adjusted incidence and population burden of chronic heart failure.

Feasibility and challenges of addressing this CQ or CC :

The big data and omics revolutions have made it feasible to collect and analyze a variety of data in large numbers of persons within a relatively short time. A very large sample size provides excellent statistical power. Also, the public health and economic magnitude of the problem create the urgency needed to address the critical challenge expeditiously.

Chronic heart failure (HF) is easily the most common and growing cardiovascular cause of hospitalization and impaired functional status and quality of life in the U.S. and much of the world. This is the case despite improved pharmacologic and lifestyle treatment of HF, as well as improved control of blood pressure in the general population. While some HF in the very elderly may reflect the aging process, the epidemiology suggests that most incident cases could be prevented or postponed for years. Also, there are major ethnic and socioeconomic disparities in the incidence of HF.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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14 net votes
28 up votes
14 down votes
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Goal 3: Advance Translational Research

Build a National Surveillance of Chronic CV and Lung Diseases

There is a need to build a robust coordinated surveillance system on the incidence and prevalence of chronic diseases. Surveillance data are needed to: •Describe and monitor the burden, trends, and patterns of these diseases •Set parameters and metrics of research priorities •Identify where to target resources for prevention, treatment, and delivery of care •Track and monitor progress toward public health disease ...more »

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

The high prevalence of chronic cardiovascular and lung diseases has created burden in increasing healthcare costs and high mortality rates in the US compared to other developed countries. Even so, they remain among the most preventable health problems. A national surveillance system for chronic cardiovascular and lung diseases would enable data-driven decision-making about public health strategies for prevention, management, and cost containment.

Feasibility and challenges of addressing this CQ or CC :

A 2011 Institute of Medicine (IOM) report concluded that a coordinated surveillance system is needed. It proposed a framework for such a system that would integrate existing information through collective efforts of multiple stakeholders. The time is right to gain from and build upon numerous ongoing broad initiatives in biomedical Big Data, including growing health IT adoption mandated by the HITECH Act, ONCHIT efforts to achieve health IT interoperability, the NIH BD2K initiative, and the multiorganizational network participating in FDA Mini-Sentinel, HCS Collaboratory, and PCORnet, among others. The NHLBI is well-positioned to lead, develop and implement the IOM’s recommended framework and system. (IOM report - http://www.iom.edu/Reports/2011/A-Nationwide-Framework-for-Surveillance-of-Cardiovascular-and-Chronic-Lung-Diseases.aspx)

Existing data sources (i.e., population surveys, registries, cohort studies, administrative data, and vital statistics) do not individually provide nationally representative data, cannot be linked, and are not currently readily accessible to all levels of users. One potential way to build such a system is to integrate and expand existing data sources.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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5 net votes
13 up votes
8 down votes
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Goal 2: Reduce Human Disease

Understanding COPD Manifestations in Subjects without Overt Airflow Obstruction

What is the pathogenesis and appropriate treatment for subjects with chronic respiratory symptoms or imaging abnormalities who do not have overt airflow obstruction (and thus are not currently categorized as having COPD)?

Submitted by (@jdc000)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

COPD is currently diagnosed by spirometry, but many other individuals (primarily smokers) have respiratory symptoms and/or imaging abnormalities that suggest lung damage. Identifying subjects with pre-obstruction manifestations of COPD could lead to more effective treatment and prevention.

Feasibility and challenges of addressing this CQ or CC :

COPD subjects often develop ongoing inflammation that persists long after smoking cessation. It is unknown when this cycle of inflammation begins or what causes it.

Name of idea submitter and other team members who worked on this idea : Ed Silverman, James Crapo and the COPDGene Executive Committee

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32 net votes
47 up votes
15 down votes
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Goal 3: Advance Translational Research

Community Collaborative Research Targeting Populations with CVD

In what ways can researchers better collaborate with community representatives from populations with high prevalence / morbidity / mortality of cardiovascular disease (CVD) to enhance and sustain interventions and achieve improved health outcomes? How can a combination of health behaviors and risk factors be used to conduct community-engaged research to prevent and treat CVD, chronic obstructive pulmonary disease (COPD) ...more »

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Studies designed to engage target populations at high risk for diseases such as CVD, COPD and stroke would help prevent and effectively treat such diseases. Comprehensive interventions addressing health behaviors and risk factors especially in co-morbid conditions will promote the administration of suitable therapies and adherence to medication regimens. Community consultation would generate more effective interventions and accelerate the translation of research results into practice.

Feasibility and challenges of addressing this CQ or CC :

The NHLBI formed COPD working group could be enhanced to engage additional stakeholders like community representatives and community-engaged researchers. Research could be conducted to implement the AHA 2020 impact goals to reduce CVD morbidity and mortality. Cultural adaptations of proven modalities are needed to reach populations most at risk to reduce health disparities. These populations include African Americans, Hispanics (including their subpopulations), and American Indians.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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15 net votes
25 up votes
10 down votes
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Goal 2: Reduce Human Disease

Prevent the Development of COPD

What can be done to prevent the development of COPD in individuals at increased risk. Quitting smoking before the development of COPD can prevent COPD development. What can be done to prevent COPD for individuals with other identified ris factors

Submitted by (@jsullivan)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Several risk factors have been identified that identify individuals at risk for developing COPD including low birth weight, poor maximally attained lung function and the presence of asthma. Strategies to prevent COPD development in these individuals are needed.

Feasibility and challenges of addressing this CQ or CC :

The Lung Health Study demonstrated that smoking cessation prevents COPD progression. Studies of similar size and duration should be organized to address other risk factors.

Name of idea submitter and other team members who worked on this idea : COPD Foundation, COPDF MASAC

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15 net votes
18 up votes
3 down votes
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