Seventh Annual Public Interest Organization Meeting

Dr. Carl A. Roth, Director of the NHLBI Office of Science and Technology, presented data on the NHLBI's most outstanding successes in reducing deaths from heart, lung, and blood diseases—a topic requested by the PIO planning committee for this 7th annual meeting. He summarized the NHLBI mission and mandate, changes that have occurred in mortality from cardiovascular disease, other examples of NHLBI's progress against disease, and prospects for the future.

Mission and Mandate

Dr. Roth noted that the Congress established the National Heart Institute, the NHLBI's predecessor, in 1948 to "improve the health of the people of the United States…relating to…diseases of the heart and circulation…" Over the years, the mandate was expanded to include additional areas of research (lung diseases, blood diseases and resources, and sleep disorders) and other activities (e.g., education, prevention, and control).

Changes in Cardiovascular Mortality

Since 1950, mortality from cardiovascular diseases has declined 63 percent, and mortality from stroke has declined 70 percent. Less than half a million deaths from coronary heart disease occurred in the United States in 2002—a significant decrease from the almost 1.4 million deaths that would have been expected if the peak death rate, reached in the late 1960s, continued to prevail.

Reason for Successes

Dr. Roth highlighted one major reason for the decline in mortality from heart disease and stroke—the identification and modification of risk factors for coronary heart disease. In a paper published in 1961 (Annals of Internal Medicine, volume 55, number 1, November), scientists participating in the NHLBI-supported Framingham Heart Study defined the concept of risk factors and enumerated six main risk factors for coronary heart disease—high blood pressure, elevated serum cholesterol, smoking, diabetes, family history, and male gender.

Thereafter, the NHLBI launched many studies to define the potential effects of contributing risk factors and to evaluate interventions to control or prevent them. The studies yielded valuable information that the NHLBI has disseminated to health professionals and the public.

Other Successes

• A major decline in deaths from neonatal respiratory distress syndrome over the past 30 years—from a rate per 100,000 live births of approximately 275 in 1973 to approximately 25 in 2003. This decline can be attributed, in large part, to development of continuous positive airway pressure (CPAP) ventilation, antenatal treatment with steroids, and surfactant replacement therapy.
• Elimination of the risk of post-transfusion hepatitis. In 1960, hepatitis was transmitted in almost one-fourth of all blood transfusions.
• Longer life for patients with sickle cell disease. For patients with sickle cell anemia, life expectancy increased from the mid-teens in 1970 to the mid-40s in 2000. For patients with sickle cell-hemoglobin disease, life expectancy increased during the same period to the mid-60s.

Prospects for the Future

Dr. Roth noted that NHLBI efforts have resulted in tremendous progress in many areas. Nonetheless, 3 of the 10 leading causes of death in the United States are within the purview of the NHLBI. As in 1950, and despite the impressive gains made during the past half-century, heart disease is still the leading cause of death and cerebrovascular disease is the 3rd most common cause. Unlike the case in 1950, however, COPD is now among the top 10 causes of death, ranking 4th.

Dr. Roth concluded by saying "there is still a long way to go." Coronary heart disease is one example of the ongoing need for research. Despite the dramatic decline in age-adjusted mortality from this disease since 1970, the United States has yet to approach the level seen in modern-day Japan-that is, 50 deaths per 100,000 population. Achieving this low level is one of the many objectives NHLBI has for the future.

Discussion

The PIO representatives noted that enhanced quality of life (e.g., for patients with asthma), which also has resulted from NHBLI-supported research, is another measure of success.

A particular concern was raised about the sharp increase in COPD in recent years. Dr. Roth noted that the NHLBI allocates a significant portion of its budget (approximately 18 percent) to research on lung diseases and that COPD is a major area of research emphasis.