Building on NHLBI's Research Legacy & Capacities to Advance a Healthier America

The mission of the NHLBI has historically and consistently focused on promoting the prevention and treatment of heart, lung, blood, and sleep diseases and conditions. In fact, the four goals of our Strategic Vision anchor the mission and seek to understand and promote health and resilience, stimulate discoveries about the causes of disease, accelerate the translation of basic research discoveries into clinical practice, and foster training and mentoring of emerging scientists and physicians – all such that individuals, families, and communities can live longer and more fulfilling lives. Notable for NHLBI is our legacy of research, which includes a broad array of epidemiological studies that have improved public health by identifying risk factors for disease; describing diseases and risk factor patterns across communities; conducting clinical trials of interventions to prevent and treat disease; and studying approaches to improving clinical care and public health. Thanks in part to pioneering cohort studies, landmark clinical trials, and groundbreaking discovery science supported by the NHLBI, the life expectancy of Americans has significantly increased over the last half century. Indeed, over the last 75 years, NHLBI-supported research has helped drive many major advances in heart, lung, blood, and sleep health. Some notable examples include: Advances in understanding and treating heart disease Research helped shape how we prevent and treat high blood pressure, high cholesterol, and coronary heart disease, contributing to the evidence behind widely used medicines and lifestyle approaches that lower heart attack and stroke risk. A leading study showed that tighter blood pressure control (targeting less than 120mm HG, down from the previous 140mm HG target) saves lives and prevents heart problems in some adults, if done carefully. Large NHLBI clinical trials helped show that lowering LDL ('bad') cholesterol reduces the risk of heart disease, thus influencing today's prevention guidelines and treatments, including statins. Asthma and lung disease Studies supported by NHLBI helped improve the diagnosis and long-term management of asthma. Research also contributed to better care for COPD and other chronic lung conditions. Sleep medicine NHLBI-supported research helped establish sleep apnea as an important medical condition linked to heart disease, stroke, and daytime sleepiness. This research contributed to better diagnosis and treatment, including CPAP therapy. Blood diseases A trial conducted in 1998 and funded by NHLBI examined the impact of hydroxyurea therapy for infants and toddlers with sickle cell disease on prevention of end organ damage to major organs. The secondary endpoints of the trial examined the impact of hydroxyurea on acute complications of SCD. The trial demonstrated significant decrease in initial and recurrent vaso-occlusive crises and reduced hospitalizations and medical costs – demonstrating the efficacy of that treatment. Subsequent research 20-years later confirmed that hydroxyurea, in some circumstances, could be used safely in place of long-term blood transfusions for secondary stroke prevention (SWiTCH trial). The STOP trial conducted by the NHLBI ended early in 1997 due to finding efficacy in use of long-term blood transfusion to prevent the occurrence of overt stroke in children who were at higher risk of stroke. Despite this rich research legacy, there is far more work to be done. More than half of Americans live with multiple chronic conditions or comorbidities, and this increases greatly with age, affecting almost three quarters of older adults. Tackling chronic diseases and conditions remains at the 'heart' of NHLBI's mission. Thus, with enthusiasm, the Institute is leveraging our robust chronic disease research portfolio to support NIH in advancing the administration's priorities aligned with HHS's Make America Healthy Again (MAHA) initiative – as making America healthier is deeply anchored within our mission and Strategic Vision. NHLBI stands ready to support NIH MAHA efforts to further understand the contributions of biology, lifestyle, social context and environmental exposures to health outcomes through the lifespan, and what is required to promote, maintain, and restore health for many living with chronic conditions. In addition, we are readying NHLBI available research infrastructure and resources to deploy for the MAHA opportunities, which include: harnessing data from longitudinal cohort studies towards a multi-level approach to understanding chronic disease , l everaging population-based cohort studies to comprehensively understand health through the life cycle and inform intervention strategies , advancing clinical science to improve health and health outcomes through prevention and early intervention, integrating evidence-based interventions into communities with high disease burden to improve maternal health before, during, and after pregnancy, and supporting rigorous community-engaged research and implementation science to promote thriving communities. Importantly, NHLBI's expertise and commitment to community-engaged research serves to ensure that we leverage the power resting within every community to co-design evidence-based health interventions to promote healthy living in communities across the country – especially those with the highest prevalence of chronic diseases.