Goal 2: Reduce Human Disease

Genetic risk factors for sudden cardiac death

What are the genetic risk factors for sudden cardiac death and failure to respond to CPR and defibrillation?

Submitted by (@rebecca.lehotzky)

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

Name of idea submitter and other team members who worked on this idea : AHA Staff & Volunteers

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-2 net votes
2 up votes
4 down votes
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Goal 2: Reduce Human Disease

Reducing CV events in breast cancer survivors -knowledge gaps

Identifying breast cancer survivors at high risk for CV morbidity and mortality to allow targeting of management strategies to reduce CV events and thereby improve overall cancer-related survival.

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 :

Chemotherapy for breast cancer stages I-III is known to be associated with or induce cardiotoxicity. Over 35% of these women develop progressive fatigue and exercise intolerance, and heart failure limiting their daily activities and frequently interfering with their ability to return to work. CV disease are the leading cause of morbidity and mortality for those surviving beyond 5 to 8 years from their breast cancer diagnosis. The excess of CV morbidity and mortality in these patients threatens to offset reductions in cancer-related survival. Identifying breast cancer survivors at high risk for CV morbidity and mortality could allow targeting of cardiovascular disease reducing therapeutic interventions.

Feasibility and challenges of addressing this CQ or CC :

creating a multisite registry of women with Stage 1-3 breast cancer scheduled to receive chemotherapy and a control population women of similar demographic and CV risk profile without neoplasia, would allow to collect data at baseline and during/after cancer treatment related modern therapy, pre/post treatment functional status, including fatigue, behavioral and psychosocial risk factors and quality of life, and serum biomarkers indicative of myocardial injury, fibrosis, and heart failure.

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

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-1 net votes
5 up votes
6 down votes
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Goal 3: Advance Translational Research

COPD risk categories and resource utilization

Can a tool be developed to group patients into risk categories for resource utilization?

Submitted by (@jimandmarynelson)

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 usually blamed on smoking - first-hand smoke, second-hand smoke, and third-hand smoke. In reality, smoking is a major contributing factor. However, many other factors may lead to destruction of the breathing mechanisms in human lungs. Premature birth, exposure to industrial or agricultural chemicals, breathing dirty air, and a genetic factor known as Alpha-1 Antitrypsin Deficiency, as well as other factors may lead to COPD. In addition, COPD encompasses emphysema, chronic bronchitis, and certain types of incurable asthma, normally a combination of two or more of these disorders.

Each category of COPD requires its individual research approach.

Name of idea submitter and other team members who worked on this idea : Mary E. Nelson, caregiver, Arizona State Advocacy Captain, Copd Foundation

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19 net votes
21 up votes
2 down votes
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Goal 3: Advance Translational Research

Develop biomarker panel to predict CVD risk in -omics era

There is a need to utilize the vast data generated in -omics research to develop biomarker panels for better prediction of cardiovascular disease (CVD) risks. •Cardiovascular diseases develop over decades and different panels of markers may be required for different stages •Lead molecules as potential biomarkers need to be selected by a panel of experts •Standard procedures about sample preparation, data acquisition, ...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 :

•Develop specific and sensitive markers for early prevention with more predictive power. Biomarkers that can detect specific perturbations in the system, such as metabolic status and vascular integrity prior to the occurrence of the diseases can be used for early preventive treatment of cardiovascular diseases.

 

•Identify vulnerable population who cannot be identified by the current LDL-HDL profiling

 

•Allow for more personalized treatment

Feasibility and challenges of addressing this CQ or CC :

•An increase in system biology studies using –omic approaches have provided huge data to mine through and find potential biomarkers, such as microRNA, DNA, lipids, proteins, and other metabolites, which can be used to assess changes proceeding cardiovascular diseases occurrence.

 

•The NIH-wide Big Data to Knowledge (BD2K) initiative launched in 2012 may have laid out some framework.

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

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7 net votes
14 up votes
7 down votes
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Goal 1: Promote Human Health

Venous Thromboembolism

How can individual VTE risk-assessment scoring be combined with promising biomarker candidates in order to help predict risk in the general patient population and prevent unprovoked low-risk VTE cases?

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 VTE field is approaching a new era of therapy in which predictive measures at the primary care level will identify those patients most at risk for VTE. With the identification of predictive biomarkers for VTE occurrence, efforts will be necessary to develop point-of-care or in-home biomarker testing devices to improve risk-assessment scoring and identification, so that patients could then be treated before progression. It will also be critical to accelerate risk-scoring systems that are beginning to incorporate biomarker candidates into the algorithm for use in clinical trials. Studies that will focus on correlating risk-assessment scores and biomarker research findings will provide a more accurate risk prediction and diagnostic value.

Name of idea submitter and other team members who worked on this idea : Alice Kuaban on behalf of the American Society of Hematology (ASH)

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30 net votes
41 up votes
11 down votes
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Goal 2: Reduce Human Disease

Balancing Risks and Benefits: How Do Clinical Guidelines in Cardiovascular Medicine Promote the Health of an Individual?

Much of the hopes for precision medicine (as outlined Dr. Dr. Collins) are based on deriving large amounts of genomic, proteomic, epigenomic and metabolomic data on large cohorts of patients. It will take decades to build these cohorts and even more time to analyze them and derive specific conclusions on how these will help individualize treatments. However, there is a pressing need for how to individualize contemporary ...more »

Submitted by (@jalees)

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

Details on the impact of addressing this CQ or CC :

Decisions on whether or not to place a patient with atrial fibrillation on chronic anticoagulation or on statin therapy are often based on guidelines and cardiovascular risk calculators.

 

Patients with a higher risk of stroke are more likely to receive anticoagulation and patients with a higher risk of a myocardial infarction are more likely to receive statin therapy.

 

However, these cardiovascular risk calculators do not really take into account the potential side effects and impact on the lifestyle of the patients.

 

Physicians will stop anticoagulation in a patient with atrial fibrillation if the patient has suffered a life-threatening bleed but there are no specific evidence-based guidelines as to how one should proceed if the bleeding is minor.

 

it is easy to compute the cardiovascular risk and overall mortality benefit of placing a patient on statins but how does one factor in the impact that statins have on the quality of life of an individual?

 

Developing novel evidence-based approaches to individualize therapies that factor in cardiovascular benefits as well as potential side effects and diminished quality of life could have a major impact on appropriately using treatments and reduce the arbitrariness of some medical decisions.

Name of idea submitter and other team members who worked on this idea : Jalees Rehman

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1 net vote
1 up votes
0 down votes
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Goal 2: Reduce Human Disease

Adult cardiovascular risk in patients with congenital heart disease

Do patients with congenital heart disease have the same, higher, or lower risk for coronary artery disease as they age into adulthood?

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 :

By improving our understanding of cardiovascular risk in patients with congenital heart disease we may be able to improve our surveillance for disease and intervene earlier to address this risk factors. The adult population with congenital heart disease is undergoing rapid growth.

Feasibility and challenges of addressing this CQ or CC :

The adult population with congenital heart disease is undergoing rapid growth. Novel uses of electronic health records (EHRs) and registries may enable us to answer these questions in a cost-efficient manner.

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

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3 net votes
15 up votes
12 down votes
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Goal 4: Develop Workforce and Resources

Funding high risk/high reward ideas

There is a need to develop funding mechanisms for high risk/high reward ideas which have a high potential to open new paths for investigation in important fields which would lead to new discoveries.

Submitted by (@vfenik)

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 new funding mechanisms would attract more ideas to the field.

Feasibility and challenges of addressing this CQ or CC :

A special expert teams would need to be created to review such applications.

Name of idea submitter and other team members who worked on this idea : Victor Fenik

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74 net votes
95 up votes
21 down votes
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Goal 2: Reduce Human Disease

Identifying the High Venous Thromboembolism-Risk Individual

Over 500,000 incident or recurrent venous thromboembolism (VTE) events occur annually in the US. Almost one-quarter of acute pulmonary embolism patients suffer sudden death. To improve survival, the occurrence of VTE must be reduced. However, the incidence of VTE has increased over the last 30 years. Moreover, near universal prophylaxis of patients hospitalized for surgery or for medical illness has not reduced hospitalization-associated ...more »

Submitted by (@heit.john)

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

Details on the impact of addressing this CQ or CC :

Effective and safe VTE prophylaxis regimens are widely available but near universal prophylaxis of hospitalized patients has failed to reduce the occurrence of VTE. Moreover, about half of all VTE events in the community are unrelated to hospitalization. Known major VTE risk factors account for about 85% of all VTE disease in the community but have a poor predictive value for the individual. Identifying the high VTE-risk individual by incorporating genetic variation and biomarkers into clinical risk prediction scores will reduce VTE occurrence by allowing providers to stratify VTE risk and target risk factor modification and/or intensive VTE prophylaxis to the high VTE-risk individual.

Feasibility and challenges of addressing this CQ or CC :

Genetic variation and plasma biomarkers associated with VTE have been identified among individuals of European ancestry and are readily available for incorporation into clinical VTE risk prediction tools. Limited work has identified genetic variation associated with VTE among individuals of African ancestry but more work is needed in this area. Active cancer accounts for about 20% of all incident VTE and genetic variation associated with VTE compounds VTE risk in cancer patients. More work is needed to identify plasma biomarkers and cancer tissue expression characteristics that are associated with VTE in cancer patients. Acute trauma/fracture accounts for about 12% of all VTE in the community and these patients are at high risk for both VTE and anticoagulant-associated bleeding. More work is needed to incorporate genetic variation and plasma biomarkers into risk prediction scores for the individual acute trauma/fracture patient. Finally, large candidate gene and GWA studies have identified relatively common, low VTE-risk genetic variation that together account for about 5% of VTE. Clearly, additional as yet, unidentified high VTE-risk genes exist. Additional studies are needed to identify these high VTE-risk genes, both in populations of European and African origin.

Name of idea submitter and other team members who worked on this idea : John A. Heit, MD

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2 net votes
18 up votes
16 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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Goal 2: Reduce Human Disease

Young Adult Research

How to manage CVD risk factors in young adults

Submitted by (@hm2000)

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

Details on the impact of addressing this CQ or CC :

Management of hypertension and other cardiovascular risk factors among young adults (18 to <40 years old) in the U.S.

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6 net votes
11 up votes
5 down votes
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