(Circulation. 1996;94:3016-3022.)
© 1996 American Heart Association, Inc.
Articles |
Why You Should Support the American Heart Association!
Presented at the 69th Scientific Sessionsof the American Heart AssociationNovember 10, 1996New Orleans, Louisiana
Key Words: AHA Medical/Scientific Statements • cardiovascular diseases • stroke
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Introduction |
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Today it is my pleasure to address you as president of the American Heart Association. The main topic I have chosen to speak about is the organization itself. I have been associated with the AHA since 1973. During the first half of this long and happy association, my involvement was typical of many medical scientists. I belonged to a scientific council, the Council on Arteriosclerosis, attended the annual Scientific Sessions, and applied for research grant support. I viewed the Arteriosclerosis Council as my intellectual home and the AHA as a source of research funds. However, in the last decade my experiences at the New York City Affiliate and the National Center have shown me that the organization is much broader than I originally thought. My purpose today is to share this new perspective with you. The AHA scientific councils have been and continue to be of great importance to the AHA. However, I believe that few scientific council members truly understand the nature of the organization. It is my hope that with better understanding, scientific council members can play an even greater role in helping the AHA fulfill its goals.
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What Is the American Heart Association? |
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My initial impression that the AHA was principally a provider of research grants and a professional home for medical scientists and healthcare professionals interested in cardiovascular disease was in error. These things do come under the umbrella of the AHA. However, I now realize that this is a narrow view, which misses the main thrust of the organization. To be understood, the AHA must be thought of as a not-for-profit voluntary health organization whose mission is to reduce disability and death from heart disease and stroke. To accomplish this mission, the organization has a strategic driving force: the delivery of reliable information about heart disease and stroke to the public. The breakthrough in my own thinking about the AHA came when I realized that the AHA exists primarily to serve the public, not medical scientists and healthcare professionals. Don't get me wrong! Medical scientists and healthcare professionals are very important to the AHA. Their work creates new knowledge about cardiovascular disease and provides the authoritative information base on which the AHA makes its recommendations to the public. Nevertheless, the strength and effectiveness of the AHA is derived from its mission to serve the public, and this concern must be uppermost in any actions it takes.
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Who Is the American Heart Association? |
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The AHA consists of the National Center and 51 separately incorporated affiliates with 2200 divisions. The activities of the AHA are carried out by 2500 full-time staff nationwide and 4.5 million volunteers. In addition, the AHA is the home for 14 scientific councils with 30 000 members. The AHA also coordinates the efforts of patient groups, such as 800 Mended Hearts Clubs and 1000 Stroke Clubs. Think about these figures and what they imply. The AHA is a partnership of many people, most of whom are lay volunteers. For every scientific council member, there are 150 lay volunteers. Why do these people devote their time and energy to the AHA? None of these people benefit professionally from their association with the AHA, as virtually all of the people in this room have. They are volunteers for the AHA for two reasons: they want to make a difference in the fight against heart disease and stroke, and through their efforts they seek personal growth.
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How Does the American Heart Association Do It? |
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The AHA began in 1924 as a professional society with a strong commitment to public health and the clinical aspects of cardiovascular disease and a strong belief that more research was needed. During its first 25 years the AHA's annual budget, derived largely from professional dues, was never more than $50 000. AHA leaders realized that these funds were inadequate to support the goals of the organization. In 1948 the AHA changed from a professional society to a not-for-profit voluntary health organization. This decision created a partnership between healthcare professionals and lay volunteers, bankers, lawyers, teachers, accountants—indeed, people from all walks of life, united in the fight against cardiovascular disease. This partnership allowed the AHA for the first time to effectively raise money from the general public and greatly expand its public health and clinical efforts as well as start a research program. Today the AHA is the second largest not-for-profit voluntary health organization in the world. In FY 1996 the AHA raised $347.5 million. This money did not come from a few wealthy individuals or the federal government. In fact, it came from over 10 million donors. The median donation was only $18.50.
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How Does the American Heart Association Raise Funds? |
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The income of the AHA is the result of the hard work of 4.5 million volunteers who plan and conduct thousands of events like Jump Rope for Heart, Hoops for Heart, Heart Walk, and Heart Balls. Each of these events involves hundreds of hours of effort by volunteers and staff. An example is Jump Rope for Heart. In this event elementary and junior high school students learn about physical fitness and other heart-healthy behaviors. Each Jump Rope for Heart participant has sponsors who support the jumper's efforts with donations. Prizes go to the students who raise the most money. In 1996 Jump Rope for Heart events conducted in 18 804 schools raised a total of $26.5 million. Other events require similar efforts. How many scientific council members know how the AHA raises money? How many scientific council members donate their time and money to this effort? The vast majority of the money that the AHA raises is through its affiliates and divisions. I urge you as a scientific council member to get involved in your affiliate and division—your help is needed! Without effective fund-raising, the good works of the AHA, from which we have all benefited, could not be carried out.
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How Does the American Heart Association Spend Its Money? |
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The AHA performs four fundamental activities:
1. It discovers, processes, and interprets science.
2. It communicates cardiovascular science, medical, and consumer health information.
3. It is an advocate at federal, state, and community levels.
4. It generates resources.
Science Discovery
In the area of science discovery the AHA spends approximately $100 million each year to support investigator-initiated research. These funds are divided between the National Center research program and affiliate research programs. The national research program has recently undergone changes to increase its impact in the fight against heart disease and stroke. With limited funds, the focus has been placed on career development of young investigators and support of new, cutting-edge basic and clinical science.
The National Center now offers a Scientist Development Grant, which provides an opportunity for a cadre of excellent young people to enter cardiovascular research each year. Individuals may apply in the last year of their fellowship and the first few years of their initial faculty appointment. The 4-year grant provides $65 000 per year for salary and project support and will serve as a bridge from fellowship to successful competition for National Institutes of Health (NIH) support.
The National Center also offers an Established Investigator Grant, which can begin after completion of the Scientist Development Grant. This 4-year grant provides $75 000 per year for salary and project support. (Previous Established Investigator Awards mainly provided salary support.) The new Established Investigator Grant supports specific goals and cannot overlap with existing support from other agencies such as the NIH.
The third program offered by the National Center is an enhanced Grant-in-Aid. This 3-year grant provides $55 000 per year to support new and innovative research projects and allows investigators to gather the necessary preliminary data to apply for more extensive funding from the NIH or other agencies.
The first applications for this new National Center program were accepted in June with funding to start January 1, 1997. This cuts in half the previous time from grant submission to start date. The applications are peer reviewed by subject-based committees involving 20 study sections in subject areas as diverse as molecular signaling, cardiovascular physiology, and behavioral science epidemiology and prevention.
In contrast to other US not-for-profit organizations that support research, the AHA runs a decentralized program, with affiliate-based programs accounting for half of its research funding. Over the last few years the AHA has made a concerted effort to standardize the programs across the affiliates to ensure uniform funding of highly meritorious research. Standardization has three aspects. The first is focus. Dollars should be spent in areas that count the most. In the current climate the focus should be career development, to ensure that there is a next generation of heart-disease researchers, and grants-in aid, to support new ideas and allow their development to the point that they can attract NIH funds.
The second aspect of standardization is quality. AHA program offerings must provide enough dollars and be of sufficient duration to attract the best applications and allow significant discovery to be accomplished should a grant be awarded. AHA funds should also support only grants of high scientific enthusiasm. The final aspect of standardization is peer review. All grants should undergo subject-based peer review to ensure the best match between grant content and reviewer competence and that the best research in each area relevant to the AHA mission is funded.
There is a great disparity between affiliates in their commitment to research, with spending ranging from 15% to 51% of gross divisible income. Each affiliate is being encouraged to spend more income on research. In repeated surveys donors say they give to the AHA to support research so that they, their families, and their friends will not suffer from heart disease or stroke. I am asking you today to get involved in your affiliate: Make sure that its research program is of the highest quality and that the maximum is being spent on research.
Science Processing
It is not enough for the AHA to simply support research, but to accomplish its mission the AHA must also process and interpret science. Science processing involves sponsoring meetings such as these Scientific Sessions, preparing scientific statements, and publishing the five AHA scientific journals: Circulation, Circulation Research, Hypertension, Stroke, and Arteriosclerosis, Thrombosis, and Vascular Biology.
Science Interpretation
Equally important is interpretation of science for the public. The AHA is regarded as the most trusted source of information on cardiovascular disease and stroke in the world. The public is barraged by health claims it hears every day and relies on the AHA to interpret the information fairly and honestly.
An example of how the AHA can interpret science follows. In February 1995, under the leadership of former AHA president Dr. Sidney C. Smith and the Risk Reduction Task Force, chaired by Dr. Scott M. Grundy, the AHA put together a comprehensive secondary prevention program aimed at stopping reinfarction in persons with coronary heart disease (CHD). The program was endorsed by the American College of Cardiology (ACC), and a joint statement was issued by the AHA and the ACC and published in July 1995 in Circulation and the Journal of the American College of Cardiology. The nine-point prevention program includes smoking cessation; cholesterol and blood pressure management; use of ß blockers, angiotensin converting enzyme inhibitors, and aspirin; weight control; physical exercise; and postmenopausal estrogen replacement therapy. Currently, few heart attack victims follow a comprehensive secondary prevention program. Successful implementation of this program would halve the reinfarction rate among heart attack survivors, with a similar decrease in related episodes such as coronary artery bypass surgery and angioplasty. The program is now being marketed to cardiologists, primary care physicians, and other healthcare providers, as well as patients with heart disease and their families. There are indications that much of the program will become part of the testing set for HEDIS 3.0, which sets the standards for managed care and other segments of the healthcare industry.
The AHA is looking at ways to expand the role of the scientific councils in interpreting cardiovascular science information for the public. At the suggestion of the Council on Epidemiology and Prevention, the AHA recently established a prevention coordinating committee to deal with issues related to population behaviors that influence heart disease and stroke susceptibility, such as diet, smoking, physical activity, weight control, stress, and other issues. A Science and Medicine Information Committee is also being established to address consumer health topics, prioritize needs, recommend expert panels, and monitor the content of the association's messages. This group will work with AHA lay experts in communication and marketing of cardiovascular information. This effort represents a new challenge to scientific council members, requiring not only relevance and expertise but also timeliness. Otherwise, in this age of instant communications the public will go elsewhere for information about heart disease and stroke.
Communications
In addition to discovering, processing, and interpreting science, the AHA conducts extensive programs to communicate cardiovascular science and medical and consumer health information to the public. The association has many channels of distribution, including community, school- and worksite-based programs, efforts based on mass media, and a very successful Web site, which has been in existence for over a year.
Advocacy
The AHA engages in advocacy at the federal level through a 12-person office in Washington that deals with issues related to research funding, disease prevention and health promotion, and government regulations related to healthcare policies. Through its affiliates the AHA also serves as an advocate at the state level, an example being the recent battles on cigarette smoking in many state legislatures. The association is also expanding its grass-roots advocacy to encourage citizens to work for cardiovascular health in their communities by fighting for school physical activity programs and healthy school lunches, among others.
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Chronic Underfunding of Cardiovascular Disease Research |
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In the course of its Washington-based advocacy, the AHA has encountered a serious problem with alarming implications for the fight against heart disease and stroke: namely, a pattern of chronic underfunding of cardiovascular disease research at the NIH over the last 10 to 15 years.
Background
After World War II two things dramatically changed cardiovascular research in the United States. The first was the AHA's decision to become a not-for-profit voluntary health organization, which enabled it to raise sufficient money from the public to support a research program. Since 1949 the AHA research program has provided more than $1.4 billion in research funds. The second was the AHA-spearheaded "Heart Lobby" in Washington, which led to the creation of the National Heart Institute, the major federal agency for funding heart disease research. The continued partnership between the AHA and the NIH has encouraged and supported much of the cardiovascular research in the United States and has led to world leadership in this area.
Unfortunately, the vision of curing heart disease through the AHA-NIH partnership has grown very dim over the last decade and a half. Heart disease has lost the attention of the American public, and politicians and scientists in policy-making positions have chosen to underfund heart disease research. Heart disease has come to be regarded as an old person's disease and a good way to die. People do not fear heart disease, and as a result, NIH funding for heart disease research has slowed dramatically.
In part, I believe this happened because we were too focused on our early triumphs and oversold our successes. Our philosophy was that to get more money from Congress, we had to show that good things were happening. Although plausible as a strategy, this approach has backfired. Dr. Sid Smith, past AHA president, and I recently met with the director of the NIH and with pride presented him with the AHA publication Heart and Stroke Facts Statistical Supplement. For 2 years the cover of Heart and Stroke Facts has had a graph showing the declining age-specific death rate from heart disease in the United States. The NIH director looked at the booklet and said, "Problem solved. Next problem!" This was a double disappointment. First, that such an influential person regarded heart disease as a problem that had been solved and second that our own literature had done us in. It is urgent that we stop broadcasting our successes and get the message out that heart disease, and more broadly cardiovascular disease, remains the most important health problem in the United States. In fact, the prevalence of heart disease and stroke is increasing. Far from being a problem solved, the situation is actually growing worse.
Decreased Federal Funding
The misperception that heart disease is a problem solved has resulted in chronic underfunding of research on heart disease at the NIH. Over the years the AHA has lobbied for more money for the NIH as a whole in the belief that this would result in enhanced funding for cardiovascular research. Unfortunately, this has not happened. Although the total NIH budget increased 31.3% in constant dollars from 1985 to 1995, over the same time period funding for the National Heart, Lung, and Blood Institute (NHLBI) Heart and Vascular Disease Program actually decreased 5%. In FY 1995 the budget for the Heart and Vascular Disease Program was only $669 million; had the program gotten its fair share of the overall NIH increase since 1985, it should have been $936 million. In 1 year alone this is a shortfall of $267 million, which has resulted in many missed research opportunities. Even more seriously, the chronic underfunding of heart disease research has discouraged young people from entering the field. This is dramatically reflected in the following statistics: In 1994 the total number of both competing and noncompeting RO1s in the Heart and Vascular Disease Program held by investigators under the age of 40 was 123, or roughly one per medical school. This is down 63% from 336 RO1s 10 years earlier. These incredible numbers tell us the sad fact that we have lost or are losing a whole generation of heart disease researchers.
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Strategies to Increase Federal Funding |
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The AHA is now mounting a two-pronged attack to correct this deplorable situation. First, we must tell the dramatic story of cardiovascular disease, basing our arguments on the prevalence of the disease and its impact on the healthcare system. However, this is not enough. We must also clearly make the intellectual arguments for scientific opportunities in the field to justify enhanced research funding.
Prevalence of Cardiovascular Disease
With regard to the burden of cardiovascular disease, we must destroy the myth that heart disease is a good disease—we must tell the real story. Heart disease is still the number one killer of Americans, and stroke is number three. Moreover, most people do not have a heart attack or a stroke in old age and promptly die. In fact, only as many as 30% of people die of their first heart attack. This is certainly tragic, as many of these people are in the prime of their lives, with family and job responsibilities. However, an even more dramatic story is the people who survive their first heart attack and live with heart disease. The number of these Americans is staggering, eclipsing those with any other disease. Currently 13.5 million Americans have survived heart attack or have symptoms of CHD. In 1 year more than 300 000 patients undergo coronary bypass operations in the United States, and approximately 400 000 undergo PTCA. Of the 13.5 million Americans with clinical CHD, 6.6 million are under the age of 60, belying the myth that heart disease affects only the elderly, and nearly 5 million have been diagnosed with congestive heart failure, a condition marked by personal suffering and tremendous medical expense. In addition, there are 3.8 million stroke survivors and untold numbers of elderly with multi-infarct dementia. Stroke is in fact the number one cause of permanent disability in the United States. Cardiovascular disease is an equal opportunity disease, affecting both sexes. Remarkably, while approximately one of 25 women will die of breast cancer, nearly one of every two will die of heart disease and/or stroke. Finally, under Medicare, atherosclerotic cardiovascular diseases, namely ischemic heart disease, cerebrovascular disease, congestive heart failure, and acute myocardial infarction account for four of the five most frequent hospital discharge diagnoses and expense of billed charges, and for all payers account for four of the top seven most expensive billed charges.
We need you to speak out against the myth that heart disease is a good disease. We must get out the message about the enormity of the heart disease and stroke problem. We must let people know of the increasing prevalence of these diseases and the pain, expense, and suffering they cause. We must do this in individual conversations as well as in our communications with the media and the decision-makers in Washington, DC, beginning with the letter to President Clinton that you received when you arrived. We also need to exert our influence through friends in Congress. To help in this effort, we have set up a Congressional Heart and Stroke Coalition, headed by Bill Frist (R-TN) and Byron Dorgan (D-MD) in the Senate and Tom Coburn (R-OK) and Louis Stokes (D-OH) in the House of Representatives. Finally, it is not enough just for us to speak out. To forcefully get our message across, we need to enlist patients with heart disease and stroke as well as celebrities as spokespeople.
Scientific Opportunities in Cardiovascular Disease Research
In addition to the statistical arguments about disease prevalence and cost to the healthcare system, we must also clearly articulate the scientific opportunities in the field. This approach is especially important now, as some influential policymakers have stated that the prevalence of cardiovascular disease primarily reflects a failure to implement what we already know. They argue that early and effective cholesterol lowering and proper educational and public health policies with regard to lifestyle is sufficient to address the heart disease problem. Therefore, precious research dollars should go to other basic and disease-oriented research, where fundamental problems remain unresolved.
To counter this point of view, we must stress the limitations of known risk factor reduction as the main approach to cardiovascular disease. Known risk factors explain less than 50% of susceptibility to just one form of cardiovascular disease, CHD. Even if this figure is accurate, and if we knew all there is to know about known risk factor reduction, which we don't, millions of Americans would still be suffering from CHD. The facts are that more research must be done before we can effectively implement the necessary educational and public health programs for known CHD risk factor reduction, and new knowledge will lead to even better approaches to prevention and treatment. Many other cardiovascular disease problems afflict large numbers of individuals and have little or nothing to do with known risk factors that require more research. In fact, more research is needed to better understand the basic pathophysiology of all cardiovascular diseases so that improved mechanism-based therapies can be developed to reduce the disease burden in the population. In addition, most cardiovascular research is at a sufficiently fundamental level of basic science or addresses paradigms of general importance that the new knowledge generated will be valuable for understanding other major diseases.
With the help of the scientific councils, the AHA has assembled a document describing some of the promising scientific opportunities in cardiovascular disease research.
Atherogenesis: A Special Case of Chronic Inflammation
CHD is caused by atherosclerotic lesions, which are a response to injury of the blood vessel wall and can be viewed as a special case of chronic inflammation. Lesions begin as foam cells and progress to fibroproliferative lesions and ultimately to complex lesions, which can precipitate heart attacks. We are at the dawn of a new era, in which the tools of vascular biology are sophisticated enough to analyze the molecular events in lesion formation and progression. These insights will lead to new therapies directed to the arterial wall that can block lesion formation and/or progression. The fundamental knowledge gained may also provide insights into understanding other diseases also characterized by chronic inflammation, such as arthritis and autoimmune disorders.
Coronary Heart Disease: A Complex Genetic Disease
CHD is the leading paradigm for the study of complex genetic disease involving the interaction of many genetic loci and environmental factors. Genes controlling lipoprotein levels, blood pressure, energy metabolism, thrombosis, and relevant aspects of vessel wall biology and the immune system are being delineated by classical techniques as well as positional cloning. Defining CHD susceptibility genes in the population will enable identification of populations of presymptomatic individuals for targeted prevention strategies. Classification of symptomatic CHD patients by genotype will subdivide the CHD population and permit more specific and effective therapies. The lessons learned by studying the genetics of CHD will be of value in the study of other common complex genetic diseases, such as cancer, neurodegenerative disorders, behavioral illness, etc.
Myocardial Insufficiency: The Challenge of Cardiac Myocyte Regeneration
Myocardial insufficiency results from cumulative death of adult cardiac myocytes and the inability of these cells to regenerate. Using fundamental basic science approaches, three strategies aimed at increasing the number of functioning cardiac myocytes are being studied. The first of these attempts to restore the proliferative capacity of adult cardiac myocytes through cell cycle studies designed to reveal the biochemical basis preventing myocardial cell division and develop strategies to defeat the roadblock. The second involves fundamental studies of gene transcription to identify the master genes controlling cardiac myocyte development. This knowledge might lead to methods of transforming fibroblasts in noncontractile myocardium into cardiac myocytes, enabling the resumption of effective contractile function. The third approach involves cell or organ transplantation. Advances in knowledge in any of these areas would benefit other diseases characterized by death of nonregenerating cells, such as neurodegenerative diseases.
Stroke and Dementia: Fundamental Problems in Cerebral Circulation
There are two types of stroke, thrombotic and hemorrhagic. Thrombotic stroke resembles myocardial infarction with some, but not all, of the same risk factors, whereas hemorrhagic stroke appears to be due to developmental abnormalities of the brain blood vessels. Fundamental vascular biology research is needed to understand atherogenesis in brain vessels and how it differs from coronary vessels. We also need to study the developmental biology of brain microvasculature and collateral circulation. To reduce the burden of stroke-related disabilities, we need more research into methods of protecting the brain from ischemic injury. Finally, although most dementia research has focused on Alzheimer's disease, approximately half of all dementia in the elderly is due to multiple small infarcts in the brain. More research is needed to define the risk factors for multi-infarct dementia, its pathophysiology, and effective preventive measures.
Congenital Heart Disease: Developmental Biology of the Heart
Until recently the study of congenital heart disease had been confined to classical pathology and surgical advances. However, the development of animal models in which genetic manipulation can readily be performed, such as zebra fish and mice, shows great promise for rapidly advancing knowledge of heart development. In addition, genetic loci determining several human congenital cardiac defects have been mapped to relatively large chromosomal regions, and attempts are under way to identify the specific genes involved. Together these approaches will allow the identification of genes responsible for congenital heart defects, leading to better prevention and treatment strategies. Heart, and more generally cardiovascular, developmental biology should be of general interest as basic scientists try to extend knowledge of early embryogenesis to the developmental biology of organs.
Arrhythmias: Fundamental Studies of Cardiac Muscle Action Potential
Arrhythmias can be precipitated by atherosclerotic cardiovascular disease, cardiomyopathy, congestive heart failure, and congenital heart disease. It is also now apparent that individuals can have a genetic predisposition to arrhythmias. Family studies have led to the identification of mutant ion channel genes that underlie conditions such as the long QT syndrome. Fundamental studies of cardiac ion channels and their mutations should lead to an understanding of how each channel contributes to cardiac muscle action potential. Such information will be useful in devising new therapies for the more common arrhythmia conditions and perhaps better prophylaxis for presymptomatic genetically affected persons at increased risk for sudden death. Comparisons of cardiac ion channels with ion channels in the nervous system may also shed light on neurological disease.
Congestive Heart Failure: Disordered Myocardial Contractility
Many people with congestive heart failure have suffered a heart attack, and disability is proportional to the amount of heart damage sustained. However, it is increasingly apparent that for a given level of heart damage there is great variability in residual heart function. Presumably, there are differences in individuals in various systems that influence myocardial contractility. Unfortunately, despite its increasing prevalence, almost nothing is known about congestive heart failure at the molecular level. It is clear that more research must be done in animal models and humans to better understand the mechanisms driving the failing heart muscle phenotype, which would allow identification of suitable therapeutic targets.
Cardiomyopathy: Inherited Disorders of Cardiac Muscle
Studies in families have shown that many cases of cardiomyopathy have a genetic basis. The genes for dilated cardiomyopathy have not yet been cloned, but in hypertrophic cardiomyopathy positional cloning has revealed that the causative genes code for contractile proteins, such as cardiac myosin heavy chain. It was not expected that contractile protein abnormalities would result in a hypertrophic phenotype, and induced mutant mouse models are being created to better understand the pathophysiology. Once this is understood, mechanism-based therapies can be contemplated. Research in this field should benefit symptomatic patients but also lead to rationale approaches to even larger numbers of genetically affected asymptomatic young people who have a significantly increased chance of sudden death.
Hormonal Effects on Cardiovascular Disease
Due to the relative protection against CHD in premenopausal women, postmenopausal estrogen replacement therapy has been recommended. However, more research is needed in several areas. Is it possible to develop a tissue-specific estrogen to achieve beneficial effects on the cardiovascular system yet not stimulate the growth of reproductive tissues with the attendant bleeding problems and cancer risk? What is the mechanism of the estrogen effect on the vasculature and can it be mimicked by a more specific therapy? What is the optimal combination of estrogens and progestins to minimize side effects while achieving maximum benefit? A corollary would be to develop strategies to impart the beneficial effects of estrogens to men without undesirable side effects. This research would help patients with other diseases in which estrogens play a role, such as cancer, osteoporosis, and perhaps Alzheimer's disease.
Nutrition and Coronary Heart Disease
Currently the only dietary recommendations to reduce CHD that we can confidently make are to restrict intake of saturated fat and cholesterol. Many questions remain that require further research, such as do we replace saturated fats with monounsaturated fats or complex carbohydrates? Are fish oils heart-healthy? How bad are trans fatty acids? Is there an optimal amount of polyunsaturated fat in the diet? Is there a role for dietary antioxidants, ie, vitamins E and C and beta carotene? Should alcohol be consumed in moderation to prevent CHD? Is dietary supplementation with vitamins to reduce homocysteine levels advisable? Inevitably, dietary recommendations to decrease CHD will impact other diseases, such as cancer. Beyond providing a rationale for public health recommendations, studies of the mechanisms by which diet alters CHD risk should also increase knowledge of the basic biology of nutrient effects on the body, nutrient-gene interactions, and relevant disease pathophysiology.
Behavior Modification and Coronary Heart Disease
Human behaviors must change to modify CHD risk, but simply pointing this out has not been enough. For example, in the last 5 years smoking among eighth graders is up 30% and smoking among tenth graders is up 20%, over the last 10 years obesity has increased by a third, and less than 25% of the population engages in adequate physical activity. Research is needed in the areas of behavior modification and long-term compliance to determine the most effective educational and public health approaches. In addition, research must be done on the neurophysiological basis of the addictive personality, genetic determinants of behaviors that regulate appetite, and the pathways through which exercise exerts its healthful effects. These efforts will lead to new, more effective mechanism-based therapies for smoking cessation and weight control as well as safe and effective exercise regimes. Controlling these CHD risk factors would also help prevent cancer, diabetes, and many other illnesses.
We must carry our two-pronged message on the prevalence of cardiovascular disease and scientific opportunities in the field to the three levels in Washington where decisions are made that determine the amount of money that ultimately goes into heart disease and stroke research. The first level is the White House and Congress, where the total NIH budget is determined. Grass-roots lobbying and partnerships with other organizations, such as Research America, have the potential to influence total NIH appropriations. The second level at which funding is influenced is in the office of the NIH director, which decides how money allocated to the NIH is distributed to the 14 institutes. We need to make the case that the NHLBI deserves the same—if not greater—increases than other institutes. The third level at which funding is influenced is at the NHLBI, where it is determined how money is divided between heart, lung, and blood programs. The AHA and you as scientific council members must get these messages out to reverse this unjust situation. There is no one else to do it!
The AHA has strengthened its efforts this year to gain a fair share of NIH dollars for research in heart disease and stroke. The road ahead will be difficult and uncertain, but if we stand together as AHA volunteers, we can get the word out, and we can make a difference.
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Conclusion |
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I look forward to serving as AHA president this year. It will be an active year with many matters under consideration. The scientific councils are extremely important to the AHA, and I hope to work closely with many of you to make our organization even better able to achieve its mission as we face the challenges of the twenty-first century.
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Footnotes |
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A single reprint is available by calling 800-242-8721 (US only) or writing the American Heart Association, Public Information, 7272 Greenville Ave, Dallas, TX 75231-4596. Ask for reprint No. 71-0101. To purchase additional reprints: up to 999 copies, call 800-611-6083 (US only) or fax 413-665-2671; 1000 or more copies, call 214-706-1466, fax 214-691-6342, or E-mail pubauth@amhrt.org. To make photocopies for personal or educational use, call the Copyright Clearance Center, 508-750-8400.
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