Strategic Goal: Goal 2: Reduce Human Disease

The missing ingredient in diet and cardiovascular disease prevention research

Determining the dietary patterns and dietary constituents that are most effective in preventing cardiovascular disease events. In addition to the obvious challenge of limited resources, the challenge is overcoming the tension between desire for comparable data produced from low-cost tools and need for higher quality data. Many studies continue using low-cost self-reported diet assessment instruments that produce data ...more »

Submitted by (@nhlbiforumadministrator1)

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

Details on the impact of addressing this CQ or CC :

Addressing the challenge of a dietary assessment method that harnesses recent technological advances in novel biomarker assessments and in metabolomics and microbiome research with best practices in self-reported assessment instruments would enable a giant leap forward in nutrition and cardiovascular disease prevention research. Self-reported instruments require repeated measurements which are expensive or are instruments hampered by measurement error that attenuates estimates of the diet-disease association. Progress on this critical challenge would enable research questions to be addressed using more accurate methods, including questions that ask about best overall diet pattern to prevent cardiovascular disease as well as questions targeted to specific nutrients or diet constituents. Overcoming this obstacle would enable research to move forward in population science research where knowledge of the diet of free-living individuals or community populations is needed as well as among patients in clinical research (other than expensive feeding trials where exact diet is known). There is great potential in stored specimens from epidemiology cohorts and clinical trials to be used with new biomarker assessments to associate earlier diet with hard outcomes accrued in these studies.

Feasibility and challenges of addressing this CQ or CC :

Advances in microbiome research and metabolomics technologies illustrate that progress in the field of biomarker assessments of dietary status is not only feasible but may sharpen our understanding of the relationship of dietary constituents with HLB disease pathologies. In the field of energy balance measurement there are calls for movement away from self-reported diet measures and for researchers and sponsors to focus development on objective measures (http://www.nature.com/ijo/journal/vaop/naam/abs/ijo2014199a.html ). Leadership from NHLBI in this area can move the field forward in validating tools and making them more cost effective.

“You are what you eat” is a familiar aphorism, but research progress on what dietary patterns and dietary constituents are most effective in preventing cardiovascular disease events is impeded by inadequate dietary assessment tools. This critical challenge calls for a major effort, in collaboration with other ICs, to develop methods and innovations in measures using blood, urine, feces, saliva, or other bodily fluids or tissues. These tools eventually need to be cost effective, valid, and reproducible.

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

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Strategic Goal: Goal 3: Advance Translational Research

Integrated Clinical Guideline on Comorbidities in Primary Care

The development of systematic evidence reviews (SER) that provide the evidence that partner organizations can use to develop an integrated clinical practice guideline for use by primary care providers for the treatment of patients with single and multiple conditions for the primary and secondary prevention of heart, lung, blood, and sleep (heart, lung, blood, sleep) diseases.

Submitted by (@nhlbiforumadministrator1)

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

Details on the impact of addressing this CQ or CC :

• Despite the success of single condition/disease guidelines, patients often have multiple conditions/risk factors that interact in various ways and can accelerate the development of atherosclerosis and chronic lung diseases. Effective management therefore requires a more integrated approach to assessment and treatment that spans all of relevant risk factors and conditions.

• The development of an integrated guideline has been recommended by participants in several NHLBI forums, including the NHLBI Strategic Planning process, the NHLBI Conference to Create a Cardiovascular Knowledge Network, and the Cardiovascular Disease Thought Leaders Meeting.

Feasibility and challenges of addressing this CQ or CC :

Feasibility: • NHLBI currently participates with other Institutes in funding research on comorbidities, Behavioral Interventions to Address Multiple Chronic Health Conditions in Primary Care (R01, PA-12-024).

• An increasing number of scholarly articles are addressing the magnitude and cost of the problem and calling for guidelines that address this reality.

 

Challenges: .

 

• Few studies have focused on the management of patients with multiple chronic conditions.

 

• Clinical research often excludes persons with multiple chronic conditions.

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

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Strategic Goal: Goal 2: Reduce Human Disease

Targeting Preclinical Diastolic Dysfunction to Prevent Heart Failure

Heart failure (HF) affects over 5 million American adults, and projected estimates show growth of this epidemic by 25% over the next 15 years as the population of the United States continues to age. Heart failure with preserved EF (HFpEF) encompasses 50% of all heart failure cases. Preclinical diastolic dysfunction (PDD) is defined as normal systolic function, moderate or severe diastolic dysfunction determined by Doppler ...more »

Submitted by (@chen.horng)

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

Details on the impact of addressing this CQ or CC :

There is currently no FDA approved therapy for HFpEF and yet HFpEF makes up 50% of all HF population. The prevalence of PDD (ACC/AHA Stage B HF) is abt 28% of the general population and these patients do not have symptoms of HF. Understanding the pathophysiology of PDD may leady to the development of therapeutic strategies to prevent the development of HFpEF. This would decrease the burden of HF impact public health and be cost-effective, similar to the use of vaccine to prevent infectious diseases.

Feasibility and challenges of addressing this CQ or CC :

With echocardiography, we are able to identify PDD patients before they develop symptomatic HF. Hence with research funding, we can better characterize preclinical diastolic dysfunction, and to discover further targets for this entity to prevent development of HFpEF

Name of idea submitter and other team members who worked on this idea : Horng H Chen

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Strategic Goal: Goal 2: Reduce Human Disease

Primary prevention statin trial in indivduals >75 years of age

Compelling question: There is insufficient randomized trial evidence for statins for primary prevention after age 75 years, as summarized in the recent 2013 ACC/AHA cholesterol guideline. T

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 paradigm of "net benefit" introduced in this guideline cannot be applied in the absence of evidence that statins reduce ASCVD events and the adverse event rate of statins in this age group. There are likely significant differences in net benefit in subgroups of older adults as well due to competing causes of morality, comorbidities, and increase potential adverse effects on muscle function and quality of life.

Feasibility and challenges of addressing this CQ or CC :

This can be addressed in pragmatic trial design, but must include individual level randomization and placebo control to accurately assess treatment effects

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

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Strategic Goal: Goal 1: Promote Human Health

Prevention of Obesity

What are the behavioral factors that predispose to excessive weight gain and development of obesity? And, which intervention strategies can effectively prevent excessive weight gain and obesity? NHLBI, other NIH institutes and the society at-large have invested heavily in research and clinical practice aimed at treatment of obesity (i.e, weight loss in those who are already overweight). However, much less research ...more »

Submitted by (@rpate0)

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

Details on the impact of addressing this CQ or CC :

Reducing the prevalence of obesity is one of the great public health challenges of the 21st century. Research should be focused, first and foremost, on prevention, not treatment, of this problem. It seems highly likely that improving the behaviors that can prevent obesity would produce a wide range of important public health benefits.

Feasibility and challenges of addressing this CQ or CC :

Two generations ago the prevalence of obesity was much lower than it is today. The prevalence was lower then, not because overweight people were better at losing weight; rather rates were lower because far fewer people became overweight in the first place. It is high time that the scientific community, clinicians, and public health practitioners invested their efforts in prevention first, where there is every reason to believe we could be successful. These efforts should be informed by a robust body of knowledge, and it is recommended that NHLBI lead the effort to expand the body of knowledge on primary prevention of obesity.

Name of idea submitter and other team members who worked on this idea : Russell Pate

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8 up votes
2 down votes
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Strategic Goal: Goal 3: Advance Translational Research

Using Social Media to Promote Healthy Behaviors

Since most people know that there are behaviors that they need to do to be healthy, can we leverage peer or family pressure or use social media to create a “grass roots” groundswell of health-promoting behaviors?

How might social media platforms such as Facebook and Meetup.com be leveraged for designing low-cost research studies and interventions that promote sustainable healthy lifestyle and behaviors?

Submitted by (@nhlbiforumadministrator1)

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

Details on the impact of addressing this CQ or CC :

Given the massive use of mobile devices and social media in our society, engaging this critical challenge would have a significant impact on our understanding how this technology can be used in disease prevention and health promotion.

Feasibility and challenges of addressing this CQ or CC :

It is feasible, timely, and cost-effective to study and incorporate into our interventions the use of social media because these applications are already so widely used.

Even if people haven’t memorized the American Heart Association’s seven factors related to heart health (get active, control cholesterol, eat better, manage blood pressure, lose weight, reduce blood sugar, stop smoking), most know that these are the behaviors that they need to do to be healthy. Despite this knowledge, heart disease is still the leading cause of death in the United States; about 1 in 3 U.S. adults has high blood pressure; diabetes affects nearly 26 million in the U.S.; and about 19% of U.S. adults are smokers. According to the CDC, in 2011 over 50% of those 18 years of age or older did not meet the recommended goal for aerobic exercise (150 minutes per week of moderate-intensity activity such as walking). Obesity is an epidemic: about one-third of American adults are obese (BMI ≥ 30 kg/m2). People know what to do, but why don’t they do it? Our built environments and culture do not intrinsically promote a healthy lifestyle. In the absence of a culture that promotes walking or biking over driving cars and that promotes fast and fattening food over more healthy food choices, can we use peer networks to promote healthy behaviors? For example, Meetup.com is a tool that people use to meet for activities that include hiking, tennis, and physical fitness boot camps.

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

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52 up votes
35 down votes
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Strategic Goal: Goal 1: Promote Human Health

Qigong and Tai Chi for Chronic Disease Prevention

Non-pharmacological interventions for pain and stress have gained tremendous momentum. Mind-Body Practice -- Qigong and Tai Chi -- are group based and inexpensive to implement. The evidence base suggests that these practices are safe and effective for a multitude of preventable chronic disorders.. THE QUESTION: Given safety and efficacy, should there be vigorous research on implementation of Qigong and Tai Chi and ...more »

Submitted by (@rogerjahnke)

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

Details on the impact of addressing this CQ or CC :

What can we do to assure that safe, effective, inexpensive non-parmacological approaches like Qigong and Tai Chi become widely diffused into communities, agencies, organizations, schools, health systems and businesses.

Feasibility and challenges of addressing this CQ or CC :

We have participated in a number of studies that have contributed to the evidence base for Mind-Body Practice as a safe and effective non-pharmacological programming.

 

The key -- group based. For the financing, group based is inexpensive. For the efficacy group based supports compliance.

Name of idea submitter and other team members who worked on this idea : Dr Roger Jahnke, http://IIQTC.org

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33 up votes
31 down votes
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Strategic Goal: Goal 2: Reduce Human Disease

Addressing the population-level determinants of CVD

Atherosclerotic CVD is an epidemic disease that is determined primarily by the social and physical environments acting in part through risk factor distributions. To date most preventive efforts have been in the clinical setting, using medications for risk factors. As useful as this is, a much better solution is to deal with the behavioral contributors to risk and their social determinants, including strong destructive ...more »

Submitted by (@stephen.fortmann)

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

Details on the impact of addressing this CQ or CC :

Atherosclerotic disease is largely preventable through behavior: physical activity, nutrition, absence of tobacco use. Achieving ideal risk factor levels would virtually eliminate ischemic CVD, even in genetically-susceptible individuals. The decline in CVD mortality has been in large part due to declines in risk factor levels. The current epidemic of obesity threatens to reverse these gains. It is a critical challenge to develop ways to counter the negative social and economic forces that prevent improvements in risk behaviors

Feasibility and challenges of addressing this CQ or CC :

The short-term nature of NHLBI research has limited its ability to address this overwhelming part of the CVD problem. This is the challenge. NHLBI needs new mechanisms and perhaps partnerships to discover ways to address these population-level issues. Research on how to build community coalitions to address public health policy and educational approaches to CVD prevention will require new funding mechanisms perhaps analogous to funding individual investigators rather than individual grants.

Name of idea submitter and other team members who worked on this idea : Stephen P. Fortmann

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22 up votes
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Strategic Goal: 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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Strategic Goal: 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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176 up votes
41 down votes
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Strategic Goal: Goal 2: Reduce Human Disease

A Program of Research in the Prevention of Chronic Heart Failure

There is a need to address chronic heart failure (HF) through improved identification of patients at risk for HF and of patients with pathological ventricular remodeling who have minimal evidence of clinical HF, and more focused and individualized pharmacologic and lifestyle treatments and monitoring of patients with HF risk. Approaches would include big data collection, omics, statistical modeling, and focused clinical ...more »

Submitted by (@nhlbiforumadministrator1)

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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28 up votes
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Strategic Goal: 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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