|
|
|
|
|
A
Public Health Action Plan to Prevent Heart Disease and Stroke
Return to Table of
Contents
Appendix C: Profiles of the Co–Lead Agencies for the Healthy People
2010 Heart Disease and Stroke Focus Area
The Centers for Disease
Control and Prevention and the National Institutes of Health are co–lead
federal agencies responsible for undertaking activities to move the nation
toward achieving the Healthy People 2010 goal for preventing heart
disease and stroke and for reporting progress on the objectives for this
focus area over the next decade. The following profiles highlight the work
of these agencies in heart disease and stroke prevention. An exhaustive
account of these and related activities is beyond the scope of this
document, but further details and updates can be obtained from each agency's
Web site.
Centers for Disease Control and Prevention (CDC) www.cdc.gov
CDC is recognized as the
lead federal agency for protecting the health and safety of people at home
and abroad, providing credible information to enhance health decisions, and
promoting health through strong partnerships. CDC serves as the national
focus for developing and applying disease prevention and control,
environmental health, and health promotion and education activities designed
to improve the health of the people of the United States.
National Center for Chronic Disease Prevention and Health Promotion
CDC's National Center for
Chronic Disease Prevention and Health Promotion (NCCDPHP) is at the
forefront of the nation's efforts to prevent and control chronic diseases.
The center conducts studies to better understand the causes of chronic
diseases, supports programs to promote healthy behaviors, and monitors the
health of the nation through surveys. Critical to the success of these
efforts are partnerships with state health and education agencies, voluntary
associations, private organizations, and other federal agencies. Together,
the center and its partners are working to create a healthier nation.
Chronic diseases—such as
heart disease, cancer, and diabetes—are the leading causes of death and
disability in the United States. These diseases account for 7 of every 10
deaths and affect the quality of life of 90 million Americans. Although
chronic diseases are among the most common and costly health problems, they
are also among the most preventable. Adopting healthy behaviors such as
eating nutritious foods, being physically active, and avoiding tobacco use
can prevent or control the devastating effects of these diseases.
In the area of
cardiovascular health (CVH), the center established in October 2000 the
Cardiovascular Health Coordinating Committee, whose primary responsibility
is communication and coordination among the several NCCDPHP divisions most
actively engaged in CVH: the Divisions of Adult and Community Health,
Adolescent and School Health, Diabetes Translation, and Nutrition and
Physical Activity and the Office on Smoking and Health. Highlights of
relevant programs in these divisions are outlined in the following
sections.
State Heart Disease and Stroke Prevention Program
In 1998, Congress funded CDC to launch a nationwide effort to help states
develop the capacity, commitment, and resources necessary for a
comprehensive program to prevent death and disability from heart disease and
stroke and to improve the cardiovascular health of all Americans. CDC funds
states for basic implementation or at a lower capacity–building level.
Program priorities include the following:
- Prevent and control
high blood pressure and high blood cholesterol levels.
- Improve quality of
care to prevent and manage high blood pressure, stroke, and heart
disease.
- Get people to
appropriate emergency care quickly.
- Eliminate health
disparities (e.g., based on geography, gender, race or ethnicity, or
income).
- Promote heart health
in a variety of settings (health care facilities, work sites, schools, and
communities) through education and policy and environmental changes.
CDC works with partners
both inside and beyond the health sector to address the Healthy People
2010 objectives for preventing heart disease and stroke. Partners
include other federal agencies (e.g., Centers for Medicare & Medicaid
Services, National Institutes of Health), national health organizations
(e.g., American Heart Association/American Stroke Association, National
Stroke Association), and professional groups (e.g., American College of
Cardiology).
Surveillance of Heart Disease and Stroke
As part of its national leadership, CDC supports and conducts the
surveillance necessary to build a strong foundation of science for
preventing heart disease and stroke. The resulting data can be used to guide
state and local public health programs. For example, the recently released
Atlas of Stroke Mortality: Racial, Ethnic and Geographic Disparities in
the United States presents detailed national and state maps with
county–level data of local disparities in heart disease and stroke death
rates for the nation's five largest racial and ethnic groups. This
publication is the third in a series on cardiovascular health, following
Women and Heart Disease: An Atlas of Racial and Ethnic Disparities in
Mortality and Men and Heart Disease: An Atlas of Racial and Ethnic
Disparities in Mortality.
In 2001, CDC established
the Paul Coverdell National Acute Stroke Registry to design and test
prototypes to measure the delivery of acute care for stroke. Eight sites are
developing prototypes for statewide, hospital–based registries that are
expected to improve hospitals' delivery of the critical emergency care that
can prevent permanent disabilities from stroke.
Prevention Research Centers (PRCs) Program
In 1984, Congress authorized the secretary of the U.S.
Department of Health and Human Services (HHS) to create a network of
academic health centers to conduct applied public health research. The first
three centers were funded two years later. CDC was selected to administer
the PRC network and to provide leadership, technical assistance, and
oversight.
Individual behaviors and
environmental factors cause many chronic diseases as well as injuries and
some infections. Prevention researchers develop strategies to help people
reduce risk factors in their lives and their communities. By involving
community members, academic researchers, and public health agencies, the
PRCs find innovative ways to promote health and prevent disease. Together,
these partners design, test, and disseminate strategies—often as new
policies or recommended public health practices.
PRCs are associated with
schools of public health, medicine, or osteopathy and are located throughout
the country. Each center conducts at least one core research project with an
underserved population that has a disproportionately large burden of disease
and disability. The centers also work with partners on special interest
projects defined by CDC and other HHS agencies. Expertise gained from this
work makes the centers competitive for research funding from other sources.
PRCs are a national
resource for developing effective prevention strategies and applying those
strategies at the community level. Each center encourages interaction among
faculty from different disciplines (e.g., education, social work,
psychology, nursing), whose expertise is essential to solving complex health
and psychosocial problems.
Behavioral Risk Factor Surveillance System
(BRFSS) The BRFSS is a state–based system of health surveys
established in 1984 by CDC. Information on health risk behaviors, clinical
preventive health practices, and health care access, primarily related to
chronic disease and injury, is obtained from a representative sample of
adults in each state. For most states, the BRFSS is the only source for this
type of information. Currently, data are collected monthly in all 50 states,
the District of Columbia, and Puerto Rico; annual point–in–time surveys are
conducted in the Virgin Islands and Guam. Interviews are completed each year
with more than 200,000 adults, making the BRFSS the largest telephone health
survey in the world. In addition to being a unique source of risk behavior
data for states, the BRFSS is also useful for measuring progress toward
Healthy People 2010 national objectives. Seven of the 10 leading health
indicators for 2010 can be assessed through the BRFSS.
As the demand for data
has increased, so has the number of requests to add questions to the survey.
Currently, almost every division in NCCDPHP and other CDC Centers,
Institutes, and Offices has questions on the BRFSS. Interest in the BRFSS
has also grown outside CDC. Other federal agencies, such as the Health
Resources and Services Administration (HRSA), the Administration on Aging (AoA),
and the Department of Veterans Affairs (VA), have added questions. Requests
for technical assistance also have come from other countries that are eager
to develop similar surveillance systems, notably China, Australia, Canada,
and Russia. The World Health Organization (WHO) is developing a model
surveillance system based on the BRFSS for export to any country.
As the BRFSS data have
become more useful, the demand for more local data (i.e., district–,
county–, or city–level data) has increased. This demand led to the Selected
Cities Project, in which data from the 1997–2000 BRFSS were used to
calculate estimates for selected urban areas in the United States with at
least 300 respondents. This project has yielded estimates for nearly 200
metropolitan areas for the 1997–1999 combined data. The 2000 data provided
estimates for 100 metropolitan areas. Preliminary results showed that the
prevalence of certain behaviors varied across cities, not unlike the
differences found across states. Variation in prevalence was also observed
when cities were compared with their surrounding metropolitan areas and with
the rest of the state. Plans are to add the new weights soon to the BRFSS
public–use data file, allowing researchers outside CDC to analyze data for
metropolitan areas. This new use of BRFSS data fills a critical public
health need for local surveillance data to support targeted program
implementation and evaluation, and these data should help cities to better
plan and direct their prevention efforts.
Racial and Ethnic Approaches to Community Health (REACH) 2010
REACH 2010 is the cornerstone of CDC's efforts to eliminate
racial and ethnic disparities in health, one of the two overarching goals of
Healthy People 2010. Launched in 1999, REACH 2010 is designed to
eliminate disparities in the following six priority areas: cardiovascular
disease, immunizations, breast and cervical cancer screening and management,
diabetes, HIV infections/AIDS, and infant mortality. The racial and ethnic
groups targeted are African Americans, American Indians, Alaska Natives,
Asian Americans, Hispanic Americans, and Pacific Islanders.
REACH 2010 is a
two–phase, 5–year demonstration project that supports community coalitions
in designing, implementing, and evaluating community–driven strategies to
eliminate health disparities. Each coalition comprises a community–based
organization and three other organizations, of which at least one is either
a local or state health department or a university or research group.
During a 12–month
planning phase, REACH 2010 grantees use local data to develop a community
action plan that addresses one or more of the six priority areas and targets
one or more racial and ethnic minority groups. During the 4–year
implementation phase, community coalitions carry out activities outlined in
their community action plans and evaluate program activities.
Evaluating REACH 2010
programs is critically important in determining their effectiveness in
reducing health disparities. Working with its grantees and partners, CDC has
developed an evaluation model to guide the collection of national data. This
model evaluates programs on their effectiveness in the following areas:
building community capacity, developing targeted actions, improving health
systems and agents of change, decreasing risk behaviors and increasing
protective behaviors, and reducing disparity–related illness and death.
REACH 2010 projects are
empowering community members to transform their neighborhoods into places
that encourage people to adopt and sustain healthy behaviors and to avoid
risk behaviors. Through close collaboration with community members and
creative partnerships with public and private organizations, CDC will
continue to spearhead the country's efforts to eliminate health disparities
by carrying out the lessons learned from the REACH 2010 projects in
communities across the country.
School Health
Every school day, 53 million young people attend nearly
117,000 schools across our nation. Because of the size and accessibility of
this population, school health programs are one of the most efficient means
to reach young people and prevent/address behaviors that lead to serious
health problems. CDC began an initiative in 1992 to support coordinated
school health programs in the states that promote healthy behavior, such as
eating nutritious foods, being physically active, and avoiding tobacco use.
These programs aim to reduce young people's risk for developing chronic
diseases later in life.
CDC funding and
assistance enable state departments of education and health to work together
efficiently, respond to changing health priorities, and use limited
resources effectively to meet a wide range of health needs among the state's
school–aged population.
CDC has also established
a national framework to support these programs. More than 40 national,
nongovernmental education and health organizations work with CDC to develop
model policies, guidelines, and training to help states establish
high–quality school health programs. Through this national framework and in
collaboration with health and education partners, CDC helps funded states
provide young people with information and skills needed to choose healthy
behaviors. The eight components of a coordinated school health program
include health education, nutrition services, physical education, health
services, health promotion for staff, counseling and psychological services,
a healthy school environment, and parent and community involvement.
Since 1991, the Youth
Risk Behavior Surveillance System (YRBSS) has provided data on
health–related behaviors, such as tobacco use, physical activity levels, and
fruit and vegetable intake, among young people. Developed by CDC with
federal, state, and private–sector partners, this voluntary system includes
a national survey of high school students plus surveys conducted by state
and local education and health agencies. The YRBSS provides vital
information to improve health programs.
Because national efforts
for coordinated school health programs have been hampered by a lack of
information on school health policies and programs, CDC has conducted the
School Health Policies and Programs Study (SHPPS). SHPPS provides valuable
answers to questions about programs in areas such as health education,
physical education, and school food service at state, district, school, and
classroom levels.
To help schools plan and
implement effective health policies and programs, CDC has published
guidelines for school health programs. These guidelines are based on a
synthesis of theory, research, and best practices and were developed jointly
by scientific experts, school practitioners, and appropriate national
organizations. To help schools implement these guidelines, CDC has developed
several tools, including The School Health Index: A Self–Assessment and
Planning Guide, and supported development of other tools, such as
Fit, Healthy, and Ready to Learn: A School Health Policy Guide, which
was produced by the National Association of State Boards of Education.
Diabetes Prevention and Control
CDC provides leadership and funding to diabetes prevention and control
programs nationwide. CDC also works with many partners to provide data for
sound public health decisions, inform the public about diabetes, and ensure
good care and education for Americans with diabetes. CDC provides support to
states, territories, and the District of Columbia for core diabetes control
programs and more substantial support to some states for comprehensive
programs.
Timely data and public
health research are essential for understanding how diabetes affects
different populations and for improving quality of care. CDC analyzes
information from several national data sources, including the BRFSS, and
explores ways to collect better diabetes data on groups most at risk. To
translate scientific data into higher–quality care, CDC works with many
research partners, including the National Diabetes Laboratory. CDC also
works with managed care organizations and community health centers to
- Assess how accepted
standards of diabetes care are applied by health care providers and in
clinical care settings.
- Explore variations in
the quality of diabetes care provided.
- Develop and test
strategies to move existing care practices closer to optimal standards.
Educating others about
diabetes is a priority at CDC. The National Diabetes Education Program (NDEP)
has a network of more than 200 public and private partners that provide
education to improve treatment, promote early detection, and prevent the
onset of diabetes. The NDEP is sponsored by CDC and the National Institutes
of Health, and many NDEP products are available on the Internet (www.ndep.nih.gov).
CDC also develops new
resources for health professionals, people with diabetes, and communities,
including Diabetes Today, a train–the–trainer program that allows health
professionals and community leaders to develop a community plan for
preventing the complications of diabetes.
Nutrition and Physical Activity
Beginning in fiscal year 2001, Congress appropriated funds
that allow CDC to help states plan and initiate nutrition and physical
activity programs to help prevent and control obesity and other chronic
diseases. With further funding, CDC will help to expand these programs and
will support research to increase physical activity and improve nutrition in
states and communities.
In 1995, CDC's landmark
publication, Physical Activity and Health: A Report of the Surgeon
General, brought together the results of decades of research on physical
activity and health. Among its findings were that physical activity need not
be strenuous to produce benefits and that inactive people can improve their
health by becoming moderately active on a regular basis. The implications of
these findings compel CDC to ensure that physical activity receives the
attention and commitment given to other important public health issues. CDC
research is strengthening knowledge of the role of physical activity and
nutrition in health.
To further address these
issues, CDC has established a nationwide framework for coordinated health
education programs in schools. Inactivity and unhealthy diets are among the
risk behaviors that these programs address. CDC has also collaborated with
national health and education organizations to develop guidelines and
materials to help schools promote healthy eating and physical activity.
Since the 1950s, the
infrastructure to support walking and bicycling in the United States has
been neglected. Trips made by walking or cycling have declined by more than
40% since 1977. CDC's Active Community Environments Initiative (ACES) works
with partners to promote the development of accessible recreation
facilities, including more opportunities for walking and cycling.
The National 5–A–Day
program, which is a comprehensive, coordinated national nutrition program
designed to increase consumption of fruits and vegetables to five or more
servings each day by the year 2010, is implementing recommendations from a
recent comprehensive review. The most significant recommendations were to
strengthen and expand the program's organizational structure to include new
partners and to support research, surveillance, and applied public health
programs to increase vegetable and fruit consumption. The National Cancer
Institute, the U.S. Department of Agriculture, and CDC are currently
defining the roles and responsibilities of each partner in the new model.
Well–Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN)
WISEWOMAN is a CDC–funded program that helps women in need gain access to
screening and lifestyle interventions that can reduce their risk for heart
disease and other chronic diseases. Eligible women are 40–64 years old and
have little or no health insurance. Many are from racial and ethnic minority
populations. WISEWOMAN is the result of 1993 legislation that expanded the
services offered within the National Breast and Cervical Cancer Early
Detection Program (NBCCEDP). Through the NBCCEDP, CDC helps states,
territories, and tribal organizations provide potentially life–saving
screening for breast and cervical cancers to low–income and uninsured women.
Through WISEWOMAN projects and community partnerships, women participating
in the NBCCEDP are offered screenings and interventions for obesity,
sedentary behavior, poor dietary habits, high blood pressure, high
cholesterol, and smoking. Some projects also screen women for diabetes or
osteoporosis, because these conditions also are affected by nutrition and
physical activity. WISEWOMAN staff also provide referrals when treatment is
needed.
Smoking and Health
CDC provides national leadership for a comprehensive,
broad–based approach to reducing tobacco use. A variety of federal, state,
and local government agencies; professional and voluntary organizations; and
academic institutions have joined together to advance this comprehensive
approach, which involves
- Preventing young
people from starting to smoke.
- Eliminating exposure
to secondhand smoke.
- Promoting quitting.
- Identifying and
eliminating disparities in tobacco use among different population groups.
Essential elements of
this approach include state– and community–based interventions, countermarketing, policy development, surveillance, and evaluation. These
activities target groups (e.g., young people, racial and ethnic minority
groups, people with low incomes or low levels of education, and women) at
highest risk for tobacco–related health problems.
CDC supports programs to
prevent and control tobacco use in all 50 states, 7 territories, 7 tribal
organizations, and the District of Columbia. Supplemental funding is
provided to some programs to identify tobacco–related disparities and
develop strategic plans for reducing them. CDC also funds national networks
to promote prevention and control efforts among organizations that serve
priority populations; provides grants to states for coordinated school
health programs that include components for preventing tobacco use; and
provides technical assistance to help states plan, establish, and evaluate
tobacco control programs.
CDC recently released
several publications to help states manage their tobacco control programs,
including Best Practices for Comprehensive Tobacco Control Programs,
Reducing Tobacco Use: A Report of the Surgeon General, and
Investment in Tobacco Control: State Highlights 2002. Guidance is also
offered through CDC's Guidelines for School Health Programs to Prevent
Tobacco Use and Addiction and the Guide to Community Preventive
Services: Tobacco Use Prevention and Control.
To strengthen the
scientific foundation for preventing and controlling tobacco use, CDC
examines trends, health effects, and economic costs. Examples include the
U.S. Surgeon General's reports on the health consequences of tobacco use,
published since 1964; CDC's air toxicants laboratory, which is developing
and applying laboratory technology to prevent death and disease from tobacco
use and exposure to secondhand smoke; and the school–based Global Youth
Tobacco Survey (GYTS), developed by WHO and CDC to track tobacco use among
young people in over 140 countries using a common methodology and a core
questionnaire. In addition, CDC's National Tobacco Information Online System
(NATIONS) provides country–level data on tobacco use and its health effects,
laws and regulations, and economics, and CDC's State Tobacco Activities
Tracking and Evaluation (STATE) System provides similar state–level data.
CDC researches, develops,
and distributes tobacco and health information nationwide. It also
distributes hundreds of thousands of publications and video products each
year and provides information and databases through its Web site. Through
its Media Campaign Resource Center and its interactive database, CDC
provides high–quality counteradvertising materials and technical assistance
to help state and local programs conduct media campaigns to prevent tobacco
use.
CDC's health
communication messages continue to focus on reducing smoking among young
people while increasing the emphasis on helping people to quit, reducing
exposure to secondhand smoke, and reducing disparities. In partnership with
other federal, state, and local agencies, CDC communicates key tobacco
messages through the media, schools, and communities.
As the only WHO
Collaborating Center on Global Tobacco Prevention and Control in North
America, CDC implements international studies, conducts epidemiologic
research, and provides international assistance on reducing tobacco use..
Back to
top
National Center for Environmental Health (NCEH)
The National Center for
Environmental Health (NCEH) is dedicated to serving the global community by
providing leadership, through science and service, to promote health and
quality of life by preventing and controlling disease, disability, and death
resulting from interactions between people and their environment. NCEH
activities most directly related to CVH include laboratory programs, such as
the Lipid Standardization Program, and the Public Health Genomics Program.
Lipid Standardization Program (LSP)
CDC developed and maintains reference methods and serum–based
reference materials for total cholesterol (TC), high–density lipoprotein
cholesterol (HDLC), low–density lipoprotein cholesterol (LDLC), and
triglycerides (TG). In 1957, CDC began efforts to standardize cholesterol
measurement and became the first to develop a standardization program
designed to improve and normalize clinical test results. In 1961, CDC, in
collaboration with the National Heart, Lung, and Blood Institute (NHLBI),
National Institutes of Health, developed and continues to maintain a
three–phase LSP to provide an accuracy–based standard for measuring TC, HDLC,
LDLC, and TG in national and international lipid laboratories.
The LSP's standardization
efforts extend to a variety of clinical trials and population studies,
including the
- Multiple Risk Factor
Intervention Trial (MRFIT).
- Framingham Heart
Study.
- Lipid Research
Clinics–Coronary Primary Prevention Trial (LRC–CPPT).
- Women's Health
Initiative.
- West of Scotland
Coronary Prevention Study (WOSCOPS).
- Air Force/Texas
Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS).
- National Health and
Nutrition Examination Surveys (NHANES).
Each year, about 100
domestic and international laboratories participate in the LSP and receive
about 16,000 individual vials of fresh–frozen serum reference samples to
assess laboratory performance.
As a result of frequent
and responsive assessments of laboratory performance, CDC ensures the
accuracy and uniformity of population–study and clinical–trial data,
regardless of the testing method or the analytical system used. These
clinical investigations provide cardiovascular medicine with a reliable
scientific database for evaluating risk factors associated with CVD. This
database provides the basis for the National Cholesterol Education Program's
(NCEP's) intervention strategy to reduce morbidity and mortality from CVD.
CDC's Lipid Reference Laboratory is the cornerstone of the National
Reference System for Cholesterol to which all cholesterol measurements are
traceable, thus ensuring reliable testing results in the nation's clinical
laboratories.
Cholesterol Reference Method Laboratory Network (CRMLN)
CDC established the CRMLN to help manufacturers calibrate diagnostic
products used for lipid and lipoprotein testing. CDC researchers believe
that working with manufacturers is the most effective way to improve and
standardize these measurements within clinical laboratories and to achieve
the NCEP's goals. CRMLN laboratories use CDC reference methods or designated
comparison methods (DCMs) that are closely linked to CDC reference methods.
Manufacturer certification is based on the analysis of fresh samples from
patients by both the diagnostic test method and the CRMLN laboratory.
Manufacturers who successfully complete the comparison are issued a
Certificate of Traceability, which is valid for two years. Manufacturers are
encouraged to repeat the certification on a regular basis. This approach
ensures that diagnostic products are properly calibrated and traceable to
the accuracy base maintained by CDC.
C–Reactive Protein Standardization Program
CDC convened a forum for manufacturers of high sensitive
C–reactive protein (hs–CRP) assays to identify measurement problems, discuss
the need for developing a reference method and materials, and plan
approaches for methodology improvement and standardization. CDC conducted a
major study to evaluate various materials for their applicability and
commutability as potential reference materials for calibration and
standardization of hs–CRP. CDC co–sponsored with NHLBI, the American College
of Cardiology, the American Heart Association, and the American Association
for Clinical Chemistry a special focus workshop to address issues concerning
the appropriate clinical use of hs–CRP in predicting risk for CVD. This led
to publication in 2003 of the American Heart Association/CDC Scientific
Statement, Markers of Inflammation and Cardiovascular Diseases:
Application to Clinical and Public Health Practice. CDC is helping the
College of American Pathologists (CAP) implement proficiency testing surveys
for hs–CRP and Lp(a) as part of its efforts to establish a cardiac risk
survey program.
Homocysteine Standardization Program
CDC is addressing the need for accurate and precise
laboratory measurements of plasma homocysteine on many fronts. Using a CDC
reference method, the laboratory measures plasma homocysteine levels in
samples obtained from participants in the NHANES. In 1998, CDC conducted an
international laboratory comparison study for plasma homocysteine with 14
laboratories to evaluate method differences. In 2000, CDC helped the CAP
develop its first homocysteine survey. CDC continues to provide confirmation
values for each CAP homocysteine survey on the basis of results obtained
using the CDC reference method. CDC is collaborating with the Mayo Clinic to
evaluate a mass spectrometry method that the Mayo Clinic developed as a
potential high–order reference method. CDC is also collaborating with the
National Institute of Standards and Technologies to support reference
materials development. CDC participates in the International Federation of
Clinical Chemistry Working Group for Homocysteine Standardization. CDC
continuously evaluates new assays for measuring homocysteine and publishes
evaluation results in professional journals.
Genomics and Disease Prevention
To move beyond gene discovery to public health action
requires additional research and planning. Clinical and epidemiologic
studies are needed to assess the interaction between genetics and
environment in causing disease and to evaluate the clinical validity and
utility of genetic tests. Public health policies are needed to address
related social, ethical, and legal issues and to guarantee access to genetic
services. Training the public health workforce and keeping the public
informed are also important components of a plan to integrate genetics into
public health. CDC's activities in genomics and disease prevention reflect
the enormity of the challenge facing public health today. They are based on
a commitment to meet the challenge to use genetic information to improve
health and prevent disease in the 21st century.
In October 2001, CDC
established Centers for Genomics and Public Health in schools of public
health at the Universities of Michigan, North Carolina, and Washington. The
centers will help build the knowledge base on genomics and public health,
focusing on chronic diseases with modifiable environmental risk factors such
as diet, exercise, or exposure to chemicals. They will also provide training
and technical assistance to local, state, and regional public health
organizations. The Center at the University of Michigan is focused on
cardiovascular diseases.
In collaboration with
CDC, the Chronic Disease Directors convened a Genomics and Chronic Disease
Summit in Atlanta in early 2002 to focus on emerging human genetic
information relevant to prevention of cardiovascular disease, as well as
asthma, cancer, diabetes, and obesity.
CDC is evaluating family
history as a tool for assessing risk and influencing early detection and
prevention of common diseases, including coronary heart disease, stroke, and
hypertension. Coordinated by CDC's Office of Genomics and Disease Prevention
(OGDP), this collaborative effort includes several CDC programs and NIH
institutes, including CDC's Cardiovascular Health Branch and NHLBI,
respectively.
A CDC–wide working group
has developed a proposal for analyzing DNA samples collected in the NHANES
III to determine the prevalence of genotypes of potential public health
importance in a nationally representative, population–based sample and
demographic subgroups. The proposal encompasses genes in pathways considered
important in the pathogenesis and progression of cardiovascular diseases,
including folate and homocysteine metabolism, lipid metabolism, blood
pressure regulation, and hemostasis.
Epidemiological research
is needed to understand how modifiable risk factors (e.g., diet, chemical
exposures, infections, lifestyle) interact with genetic factors in the
causation and progression of cardiovascular disease and to suggest ways that
this information can help target disease prevention efforts. Through the
1999 Prevention Research Initiative, CDC funded the University of Texas
Houston Health Science Center to study gene–environment interactions related
to cardiovascular disease in over 15,000 African American and white men and
women aged 45–64 years who participated in the multicenter Arteriosclerosis
Risk in Communities (ARIC) Study conducted by NHLBI.
CDC supports the Stroke
Prevention in Young Women Study, a population–based casecontrol study in
Maryland and the District of Columbia that seeks to identify behavioral and
genetic factors that may help explain the increased risk for stroke among
African American women. CDC funds the Oregon Sudden Unexplained Death Study,
which tracks all cardiac arrests that occur in Multnomah County, Oregon, and
assesses the determinants of sudden death.
Back to
top
National Center for Health Statistics (NCHS)
As the nation's principal
health statistics agency, NCHS compiles statistical information to guide
actions and policies to improve the health of our people. NCHS is a unique
public resource for health information—a critical element of public health
and health policy. NCHS health statistics are used to
- Document the health
status of the population and of important subgroups.
- Identify disparities
in health status and use of health care by race, ethnicity, socioeconomic
status, region, and other population gradients.
- Describe people's
experiences with the health care system.
- Monitor trends in
health status and health care delivery.
- Identify health
problems.
- Support biomedical and
health services research.
- Provide information
for making changes in public policies and programs.
- Evaluate the impact of
health policies and programs.
Working with partners
throughout the health community, NCHS uses a variety of approaches to
efficiently obtain information from the sources most able to provide
information. The center collects data from birth and death records, medical
records, interview surveys, and through direct physical exams and laboratory
testing. NCHS is a key element of our national public health infrastructure,
providing important surveillance information that helps identify and address
critical health problems.
NCHS employs a variety of
data collection mechanisms to obtain accurate information from multiple
sources. This process provides multiple perspectives to help understand the
population's health, influences on health, and health outcomes.
National Vital Statistics System (NVSS)
The NVSS provides the nation's official vital statistics data
on the basis of the collection and registration of birth and death events at
the state and local level. The NVSS provides the most complete and
continuous data available to public health officials at the national, state,
and local levels and in the private sector. Vital statistics are a critical
component of our national health information system, allowing us to monitor
progress toward achieving health and welfare reform goals.
Examples of NVSS data
include
- Number of teen
births.
- Prenatal care and birthweight.
- Risk factors for
adverse pregnancy outcomes.
- Firearm–related
mortality in teens.
- Infant mortality
rates.
- Leading causes of
death.
- Life expectancy.
- Firearm–related
mortality.
National Health Care Survey (NHCS)
National Health Care Survey (NHCS) The NHCS is a family of surveys that
collects data from health care establishments about the use of services
across the major sectors of the U.S. health care system. These data may be
used to profile changes in the use of health care resources, patterns of
disease, and the impact of new medications and technologies. Information on
the characteristics of providers, facilities, and patients allows
researchers to study shifts in the delivery of care across the health care
system, variations in treatment patterns, and patient outcomes.
Provider sites surveyed
include
- Hospitals.
- Nursing homes.
- Emergency departments.
- Hospital outpatient
departments.
- Office–based
physicians.
- Ambulatory surgery
centers.
- Home health agencies.
- Hospices.
National Health and Nutrition Examination Survey (NHANES)
The NHANES is NCHS's most in–depth and logistically complex
survey, designed to assess the health and nutritional status of Americans.
This comprehensive survey combines personal interviews with standardized
physical and dental examinations, diagnostic procedures, and lab tests for
approximately 5,000 persons each year.
The survey provides
information related to
- Diseases.
- Health risk factors.
- Genetics and health.
- Diet and nutritional
health status.
- Oral health.
- Environmental
exposures.
- Obesity and physical
fitness.
National Health Interview Survey (NHIS)
The NHIS provides information annually on the health status
of the U.S. civilian noninstitutionalized population through confidential
interviews conducted in households. The NHIS is the nation's largest
household health survey, providing data for analysis of broad health trends,
as well as the ability to characterize persons with various health problems,
determine barriers to care, and compare racial and ethnic populations'
health status, health–related behaviors, and risk factors.
Health topics addressed
annually include
- Health status and
disability.
- Insurance coverage.
- Access to care.
- Use of health
services.
- Immunizations
(child).
- Health behaviors.
- Injury.
- Ability to perform
daily activities.
Additional topics
addressed in 2002 include
- Alternative medicine.
- Arthritis.
- Disability and
secondary conditions.
- Environmental health.
- Vision and hearing.
Back to
top
National Institutes of Health www.nih.gov
National Heart, Lung, and Blood Institute
Cardiovascular Disease Research and Outreach Efforts
The National Heart, Lung, and Blood Institute (NHLBI) provides leadership
for a national program in diseases of the heart, blood vessels, lung, and
blood; blood resources; and sleep disorders. Since October 1997, the NHLBI
has also had administrative responsibility for the NIH Woman's Health
Initiative.
The Institute plans,
conducts, fosters, and supports an integrated and coordinated program of
basic research, clinical investigations and trials, observational studies,
and demonstration and education projects. Research is related to the causes,
prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood
diseases and of sleep disorders. The NHLBI plans and directs research in
development and evaluation of interventions and devices related to
prevention, treatment, and rehabilitation of patients suffering from such
diseases and disorders. It also supports research on clinical use of blood
and all aspects of the management of blood resources. Research is conducted
in the Institute's own laboratories and by scientific institutions and
individuals supported by research grants and contracts.
For health professionals
and the public, the NHLBI conducts educational activities, including
development and dissemination of materials in the aforementioned areas, with
an emphasis on prevention.
The NHLBI supports
research training and career development of new and established researchers
in fundamental sciences and clinical disciplines to enable them to conduct
basic and clinical research related to heart, blood vessel, lung, and blood
diseases; sleep disorders; and blood resources through individual and
institutional research training awards and career development awards. The
Institute coordinates relevant activities in these areas, including the
related causes of stroke, with other research institutes and federal health
programs. Relationships are maintained with appropriate institutions and
professional associations; international, national, state, and local
officials; and voluntary agencies and organizations.
Each year, the NHLBI
assesses progress in the scientific areas for which it is responsible and
updates its goals and objectives. As new opportunities are identified, the
Institute expands and revises its areas of interest. Throughout the process,
the approach used by the Institute is an orderly sequence of research
activities that includes
- Acquisition of
knowledge.
- Evaluation of
knowledge.
- Application of
knowledge.
- Dissemination of
knowledge.
Several components of the
Institute are engaged in research and education activities aimed at the
prevention and control of cardiovascular disease (CVD). Highlights of
activities are summarized in the following sections.
Division of Heart and Vascular Diseases
The Division
of Heart and Vascular Diseases (DHVD) plans and directs a coordinated
research program on the causes of heart and vascular diseases and on their
prevention, diagnosis, and treatment. Fundamental biomedical research is
emphasized. Multidisciplinary programs are supported to advance basic
knowledge of disease and to generate the most effective methods of clinical
management and prevention. Clinical trials are an important part of the
research program; they provide an opportunity to test and apply promising
preventive or therapeutic measures.
Research in
atherosclerosis encompasses the etiology, pathogenesis, diagnosis,
prevention, and treatment of the disorder. Programs include pathobiology and
genetics of the vasculature; vascular growth and angiogenesis; interactions
of the vascular wall with systemic and humoral factors promoting
atherogenesis; and lesion progression, complication, and regression.
Targeted areas involve characterization of atherosclerotic plaque prone to
rupture, pathogenesis of abdominal aortic aneurysms, the role of
homocysteinemia in atherosclerosis, mechanisms of atherosclerosis in various
vascular beds, and research on atherosclerotic lesions using human autopsy
tissue. Additional studies focus on pathobiological determinants of
atherosclerosis, cardiovascular complications of diabetes mellitus,
vessel–wall calcification, the role of infectious agents in atherosclerosis, immunobiology of the vessel wall, hormone replacement therapy on
atherosclerosis, and effect of protease inhibitors on atherosclerosis
development in human immunodeficiency virus (HIV) infection. Of special
interest is understanding atherosclerosis risk among minorities.
Studies related to
hypertension focus on identifying and characterizing genes involved with
hypertension; elucidating regulation mechanisms associated with blood
pressure control; identifying causative factors of essential hypertension as
well as rare forms of high blood pressure; examining mechanisms by which
high blood pressure increases the risk of, or occurs concomitantly with
other diseases, such as kidney failure, stroke, diabetes, atherosclerosis,
preeclampsia, and left ventricular hypertrophy; and developing preventive
strategies as well as novel interventions for hypertension. Additional areas
of interest include understanding the biological underpinnings of salt
sensitivity; identifying neurological mechanisms responsible for long–term
control of blood pressure and functional neurological changes that result in
essential hypertension; and understanding the basis of target–organ damage inhypertension. Of special interest is eliminating health disparities among
minorities and between men and women.
Basic and clinical
studies on arteriogenesis (formation of new arteries), angiogenesis
(formation of new blood vessels), and the biology and pathophysiology of
blood vessel structure and function in the cerebral, coronary, and
peripheral vascular beds are designed to increase understanding of how
oxygen, nutrient, and fluid exchange occurs within vessels; how vascular
inflammatory response originates and contributes to CVD; how blood flow
within the tissues is autoregulated; how vascular smooth muscle contraction
is altered; how new vessels are formed; and how vascular remodeling is
orchestrated. Scientists are investigating ways to control the inflammatory
response in blood vessels, manipulate mechanisms that regulate blood flow,
and stimulate the formation of new blood vessels (especially after an
ischemic event in the brain, heart, or a limb).
Gene transfer is being
used to deliver growth factors to the myocardium to promote development of
new blood vessels. Clinical trials are under way to test the safety and
efficacy of this approach in humans. Ultimately, these studies should offer
insight into developing new therapeutic agents for ischemic disease.
Research in
cardiovascular medicine is focused on new strategies to ameliorate disease
through improving risk stratification and management and developing novel
drugs and therapies. In addition to risk factor reduction, healthy
lifestyles and behaviors are emphasized. The preventive and therapeutic
potential of nutrition and exercise are currently being evaluated. To date,
hormone replacement trials consistently demonstrate lack of benefit with
regard to cardiovascular outcomes despite benefits suggested by fundamental
and observational data. Devices are used to prevent fatal consequences of
ventricular fibrillation in patients at high risk of sudden death, improve
ventricular function in heart failure patients with intraventricular
conduction delays, and improve survival in selected end–stage heart failure
patients who are ineligible for heart transplantation. The development of
drug–eluting stents holds promise of significant reduction of restenosis
even in patients with a tendency for a hypercellular response to coronary
interventions. Current projects encompass developing new strategies for
acute and chronic heart disease, cardiomyopathies of different etiologies
(i.e., ischemic, valvular, genetic, metabolic, and HIV–related), peripheral
vascular disease, aortic aneurysms, and restenosis after percutaneous
coronary interventions. Examples of therapies and approaches include diet,
exercise, and pharmacologic management of dyslipidemias, genetic
susceptibility and directed treatment, diagnosis and management of
arrhythmias; surgical and medical management of heart failure; and novel
imaging of atherosclerosis. Studies also seek to understand and reduce
disparities associated with minority and women's cardiovascular health.
Division of Epidemiology and Clinical Applications
The Division
of Epidemiology and Clinical Applications (DECA) plans, directs, and
evaluates research on the causes, prevention, diagnosis, and treatment of
CVD, as well as on the need for technological development in the acquisition
and application of research findings. It supports epidemiologic studies,
clinical trials, demonstration and education research, disease prevention
and health promotion research, and basic and applied research in behavioral
medicine.
Research in the
prevention of CVD encompasses clinical trials, community intervention
studies, prevention trials, nutrition studies, health education research,
and behavioral medicine studies. DECA supports a number of multicenter
prevention and education trials to test the efficacy and effectiveness of,
and demonstrate the capability of, prevention strategies designed to reduce
cardiovascular risk factors. Major studies include determining the
effectiveness of school– and home–based interventions to reduce development
of CVD risk factors in children, especially those from minority populations;
examining the effects of dietary patterns, sodium intake, and other
lifestyle factors on blood pressure; and comparing the efficacy of various
treatments to prevent major cardiovascular events in adults with diabetes.
Studies on increasing the implementation of interventions known to be
effective are of particular interest.
Clinical trials are used
to evaluate the effectiveness of various medical procedures and therapeutic
agents in patients with coronary heart disease, hypertension, and heart
failure. Examples include assessing the long–term safety and efficacy of an angiotensin converting enzyme inhibitor to prevent major CVD events in
patients with documented normal ventricular function, testing the ability of
selected antihypertensive and lipid–lowering drugs to prevent heart attack
among individuals at high risk for hypertension and coronary heart disease (CHD),
and comparing the use of an implantable cardiac defibrillator to
conventional pharmacologic therapy to improve survival among heart failure
patients.
Research in behavioral
medicine focuses on biopsychologic and sociocultural factors involved in
heart, lung, and blood diseases. Areas of interest include central nervous
system regulation of the cardiovascular system; identification of
psychosocial factors (social support, depression, and hostility) affecting
disease etiology, treatment, and rehabilitation; and effects of psychosocial
and behavioral interventions on risk factors (smoking, adverse diet,
physical inactivity), disease outcomes, and quality of life. Study
participants are from all levels of health and from all ages and racial
groups.
Investigators are
conducting long–term epidemiological studies of heart and vascular, lung,
and blood diseases in defined populations in the United States and other
countries. These studies focus on the development and progression of CVD
risk factors in children and young adults, the development and progression
of atherosclerosis measured noninvasively or at autopsy in middle–aged or
older adults, and the development and progression of overt cardiovascular
and pulmonary disease in older adults. Areas of emphasis include genetic and
environmental influences on CVD and its risk factors; trends in incidence,
prevalence, and mortality from CVD, stroke, peripheral vascular disease,
congestive heart failure, and cardiomyopathy; and relationships between
insulin, insulin resistance, and overt diabetes and CVD and its risk
factors. Another area of interest is the incidence of and mortality from
cardiovascular, lung, and blood diseases. Research strategies apply family,
longitudinal, demographic, and vital statistics to study their natural
history, etiology, and epidemiology.
Genetic epidemiology has
become an increasingly important component of the DECA Research Program.
Several long–term studies of twins, multiple generations, Native Americans,
and blacks focus on related individuals to estimate heritability and
identify genes that contribute to the development of CVD risk factors and
CVD. Other long–term studies are storing DNA and testing candidate genes
from unrelated individuals. In addition to examining associations between CHD risk factors and development of atherosclerosis, heart failure,
cardiomyopathy, and stroke in adults and the elderly, investigators will
seek to identify and characterize genes related to CHD and atherosclerosis
and to determine how they interact with environmental factors in the
development of disease. Additional studies are underway to identify genetic
factors influencing coronary and aortic calcification and individual
variability in the inflammatory response and to investigate gene–environment
interaction, collaborative approaches to linkage analysis, and population
screening for genetic diseases.
Office of Prevention, Education, and Control
The NHLBI
Office of Prevention, Education, and Control (OPEC) coordinates the
translation and dissemination of research findings and scientific consensus
to health professionals, patients, and the public, so that information can
be adapted for and integrated into health care practice and individual
health behavior. To accomplish its mission, OPEC established health
education programs and initiatives that address high blood pressure, high
blood cholesterol, asthma, early warning signs of heart attack, obesity, and
sleep disorders. The programs use two strategies: one focuses on individuals
at high risk; the other focuses on the general public. The four largest
programs have coordinating committees consisting of national medical, public
health, and voluntary organizations and of other federal agencies. These
committees help to plan, implement, and evaluate program efforts in
professional, patient, and public education.
The National High Blood
Pressure Education Program (NHBPEP) was initiated in 1972 to reduce death
and disability related to high blood pressure through professional, patient,
and public education programs. It is a cooperative effort among the NHLBI,
professional and voluntary health agencies, and state health departments
that has served as a model for national health education programs and
continues to be adopted by other national and international groups. Special
attention is directed to reducing health disparities among people with
hypertension.
Since the program's
inception, the number of people with hypertension who are aware of their
condition has increased fourfold, and four times as many people are
receiving treatment and controlling their disease. Data from the National
Health and Nutrition Examination Surveys (NHANES) indicate that over the
past four decades, mean systolic blood pressure has declined by 10 mmHg and
age–adjusted mortality rates from heart disease and stroke have decreased by
50% and 60%, respectively.
The NHBPEP is focused on
translating research results to improve medical care outcomes and the
public's health. It is committed to raising public awareness of the
importance of adopting a heart–healthy lifestyle. Research has identified
steps that individuals can take to control their blood pressure and to lower
their risk for heart disease. For example, certain dietary habits can
decrease blood pressure and can prevent it from rising. The DASH (Dietary
Approaches to Stop Hypertension) diet—rich in fruits and vegetables, low in
saturated and total fat and cholesterol, and containing low–fat dairy
products—has been shown to be beneficial for individuals who have high blood
pressure and for those who wish to prevent high blood pressure. Combined
with a reduced salt intake, the diet can further lower blood pressure.
In 2002, community and
professional activities focused on updating the Primary Prevention Report,
encouraging communities to hold local events to mark May as National High
Blood Pressure Education Month, and redesigning and expanding the Your
Guide to Lowering High Blood Pressure Web page. The NHLBI initiated the
development of a major repositioning strategy, which will include new
partners, to enhance its position as the U.S. leader in high blood pressure
prevention and control, raise the importance of high blood pressure on the
national public agenda, and reach individual audiences by designing
activities directed specifically to them.
The National Cholesterol
Education Program (NCEP) was initiated in 1985 to educate health
professionals and the public about high blood cholesterol as a risk factor
for CHD and about the benefits of lowering cholesterol levels to reduce
illness and deaths from CHD. From 1983 through 1995, the percentage of the
public who had their cholesterol checked rose from 35% to 75%, showing that
70 to 80 million more Americans were aware of their cholesterol levels in
1995 than in 1983. Moreover, in 1995, physicians reported initiating diet
and drug treatment at much lower cholesterol levels than in 1983. Major
elements of the NCEP guidelines for detection and treatment have become
established practice.
NHANES III (1988–1994)
data demonstrate that the NCEP's dual strategy—one emphasizing the need for
detection and treatment for individuals whose high blood cholesterol places
them at increased risk for CHD and the other encouraging heart–healthy
eating patterns to lower average cholesterol levels for the general
public—has had a substantial effect on measured blood cholesterol levels of
U.S. adults. Since 1978, the intake of saturated fat, total fat, and
cholesterol among the general public decreased significantly, resulting in
an impressive decline in average blood cholesterol levels. The prevalence of
high blood cholesterol in the U.S. population has also fallen significantly.
Cholesterol levels in adolescents likewise have declined.
In 2002, the NCEP focused
its attention on disseminating the new Adult Treatment Panel III (ATP
III) Guidelines on managing high cholesterol in adults. It developed a
Web–based kit of materials derived from the guidelines to support
cholesterol education for Cholesterol Month 2002 and throughout the year. An
ATP III Opinion Leader Dissemination kit was distributed to influential
members of the medical community to encourage them to use the guidelines and
communicate their importance to professional colleagues. The NCEP is
producing a new patient booklet on therapeutic lifestyle changes based on
the ATP III recommendations. Additional activities include developing an
action plan for reducing lifetime risk for CHD and convening an
international conference on scientific issues that should be addressed in
developing cardiovascular guidelines. The NHLBI, the American College of
Cardiology, and the American Heart Association issued a clinical advisory on
the use and safety of statins—specifically focusing on myopathy—in response
to concerns that arose after cerivastatin was voluntarily withdrawn from the
market by its manufacturer. The advisory provides reassurance that the
benefits of statins far outweigh the risks if patients are properly selected
and attention is paid to possible side effects.
The National Heart Attack
Alert Program (NHAAP) was initiated in June 1991 to reduce morbidity and
mortality from acute myocardial infarction (AMI), including out–of–hospital
cardiac arrest, through education of health professionals (e.g., physicians,
nurses, and emergency medical services personnel), patients, and the public
about the importance of rapid identification and treatment of individuals
with heart attack symptoms. In 1997, the program's scope was broadened to
include early identification and treatment of individuals with acute
coronary syndromes such as unstable angina. Since its inception, the program
has taught health care providers in emergency departments and emergency
medical services systems about the importance of reducing the interval
between a heart attack and treatment. Available treatments, if administered
soon after heart attack symptoms start, can save lives and minimize heart
muscle damage in heart attack survivors.
In 2001, the NHAAP, in
partnership with the American Heart Association, the American Red Cross, and
the National Council on Aging, launched a major campaign to urge physicians
and health care providers to educate their patients about heart attack risk,
warning signs, and steps to survival. As part of the campaign to increase
awareness of the need to act fast when someone may be having a heart attack,
the NHLBI established its Act in Time to Heart Attack Signs Web page
with educational materials for health professionals, patients, and the
public.
The NHLBI Obesity
Education Initiative (OEI) began in January 1991 to inform the public and
health professionals about the health risks associated with overweight and
obesity. Obesity is not only an independent risk factor for CVD, but also a
contributor to high blood pressure and high blood cholesterol and is related
to sleep apnea.
In 2002, 50 at–risk
communities belonging to the NHLBI Hearts N' Parks project, made a 3–year
commitment to create model community–based programs to increase the number
of children, adults, and seniors practicing heart–healthy behaviors. The
project's goal is to reduce obesity, improve nutritional status, and
increase physical activity. The American Dietetic Association, in
partnership with the project, is providing nutrition consultation. A
Hearts N' Parks Web page has been established with information on the
program.
The NHLBI Women's Heart
Health Education Initiative was launched in 2001 in response to the Women's
Health Research and Prevention Amendments, Public Law 105–304, which
requires the Institute director “to expand, intensify, and coordinate
research and related activities, including information and educational
programs, with respect to heart attack, stroke, and other cardiovascular
diseases in women.” The Heart Truth—a campaign directed at women 40–60 years
old and health professionals—was launched in 2002 to increase awareness
about heart disease, improve detection and treatment of risk factors by
health professionals, and motivate national and community organizations to
become involved in heart health education. Special attention is given to
minority women who are at increased risk for developing CVD.
As a key part of its
response to the Healthy People 2010 national health objectives, the
NHLBI initiated a new funding mechanism to establish CVD educational
outreach programs in high–risk communities. The program—Enhanced
Dissemination and Utilization Centers (EDUCs)—is a partnership between the
NHLBI and local communities to eliminate cardiovascular health disparities
and increase quality and years of health in underserved populations. In
2001, the Institute awarded EDUCs to high–risk health service areas in
Arkansas, North Carolina, Texas, Virginia, and West Virginia to conduct
educational projects targeting populations at greatest risk for heart
disease and stroke. Multiple strategies to prevent and control CVD risk
factors and to promote heart–healthy behavior have been designed
specifically for different age groups, ranging from childhood to adulthood.
Six additional EDUCs were awarded to areas in Maryland, Ohio (2), Colorado,
Nebraska, and North Carolina in 2002.
A major goal of the
Institute is to eliminate health disparities and to increase the quality and
years of healthy life of all Americans. Through partnerships with groups
that have special ties and access to targeted populations, the NHLBI is
extending its outreach and educational activities to underserved
communities. The Institute is collaborating with the Baltimore City
Cardiovascular Health Partnership on a project that has a two–pronged
strategy consisting of a population–wide public education campaign and a
targeted subgroup outreach and educational approach to build and reinforce
positive cardiovascular health lifestyle skills and behaviors. The targeted
population consists of blacks who reside in Baltimore City public housing
developments.
The Institute's Salud
para su Corazón (Health for Your Heart) Initiative, a community–based heart
health program for Latinos, is expanding across the United States. Trained
local lay health workers (promotores), applying values and culture of the
communities and mobilizing partners, teach people how to reduce their risk
of developing CVD. As advocates for change, they have increased the number
of Latinos in their communities who are engaging in heart–healthy behaviors.
In 2002, the NHLBI and the Health Resources and Services Administration
signed an interagency agreement to expand the program to communities along
the Texas–Mexico border and along the southern border areas of California
and New Mexico.
The NHLBI–Indian Health
Service Partnership to Strengthen the Heartbeat of American Indian and
Alaskan Native Communities is a collaborative effort to educate three tribal
communities —the Ponca Tribe of Oklahoma, the Bristol Bay Area in Western
Alaska, and the Laguna Pueblo in New Mexico—about cardiovascular health and
to reduce their risk for CVD. In 2002, tribal heart health teams received
training on topics related to cardiovascular health, including physical
activity, obesity, smoking prevention, nutrition, high blood cholesterol,
and high blood pressure, as well as on theories of team building,
evaluation, and community interaction and intervention. Since then, they
have initiated community outreach education activities on cardiovascular
health and disease. In addition, they have developed connections with local
organizations to aid them with their missions.
Asian Americans and
Pacific Islanders are a diverse and heterogeneous group with varying levels
of CVD risk factors, acculturation, and socioeconomic status and with
different cultures, languages, immigration histories, and community norms
related to health and well–being. In 2002, the NHLBI, along with the Asian
and Pacific Islander American Health Forum, conducted health assessments
among Americans of Philippine, Vietnamese, and Cambodian heritage to obtain
information on their knowledge of and attitudes toward CVD and its risk
factors, disease prevention, and health behaviors. The assessments will
guide the Institute in its development of culturally and
language–appropriate materials and activities for these groups.
National Institute of Neurological Disorders and Stroke
Stroke Research and Outreach Efforts
The National
Institute of Neurological Disorders and Stroke (NINDS) is the nation's
leading supporter of biomedical research on disorders of the brain and
nervous system. The NINDS also supports basic, clinical, and
population–based research to identify and study the causes, biology,
prevention, early detection, and treatment of stroke. Through years of
dedicated study, researchers supported by the NINDS have amassed a
significant knowledge base about stroke.
-
Landmark Clinical Studies
For the past 25 years, the NINDS has been encouraging and supporting major
multicenter, randomized, controlled clinical trials evaluating medical and
surgical interventions to prevent and treat stroke. More than a score of
trials, involving more than 20,000 participants, have assessed
antiplatelet agents, anticoagulants, thrombolysis, carotid endarterectomy,
hormone replacement, and psychosocial interventions. This large investment
of public research dollars is justified by the huge public health burden
caused by stroke, which costs billions of dollars yearly in the United
States, and the likely savings in health care dollars garnered by the
results of NINDS–sponsored clinical trials.
NINDS–sponsored
clinical trials are flagship studies in many areas of stroke, influencing
treatment decisions daily in clinics throughout the world. The North
American Symptomatic Carotid Endarterectomy Trial (NASCET) and the
Asymptomatic Carotid Atherosclerosis Study (ACAS) provided guidance on
when carotid endarterectomy is indicated for patients with cervical
carotid stenosis. The Stroke Prevention in Atrial Fibrillation (SPAF) I,
II, and III trials showed which antithrombotic therapy should be given to
prevent stroke in patients with atrial fibrillation.
The NINDS t–PA Stroke
Trial resulted in the first FDA–approved acute treatment to reduce
disability from stroke. Until the completion of that trial in 1995,
physicians had nothing to offer their patients that could reduce brain
injury from stroke.
-
Stroke in Minorities
Stroke remains the third leading cause of mortality in the United States
and a leading cause of adult disability; however, the burden of stroke is
even greater among minority racial and ethnic groups because of its higher
incidence and mortality in these populations. Initial evidence suggests
that African Americans may experience more severe strokes and greater
residual physical deficits.
The NINDS 5–Year
Strategic Plan on Minority Health Disparities called for a planning panel
and workshop to generate a set of recommendations to guide NINDS efforts
in research, research capacity building, and outreach to reduce and
eliminate disparities in stroke. A Stroke Disparities Planning Panel was
held in June 2002, and a follow–up workshop was held in November 2002 to
identify specific research needs and areas of opportunity.
The NINDS is proceeding
along several fronts to reduce or eliminate racial disparities in stroke,
including support of a large number of research projects that focus on
minorities. Additionally, as a result of the Stroke Disparities Workshop,
several new prevention and intervention programs are underway or planned.
-
Outreach
The NINDS has been working with investigators, clinicians, and private
groups such as the American Heart Association and the National Stroke
Association to determine the steps that should be taken to educate the
public and the medical community about the need for rapid diagnosis and
treatment of stroke. Especially emphasized are the specific benefits of
the acute stroke treatment, t–PA. The NINDS organized a historic meeting,
a National Symposium on Rapid Identification and Treatment of Acute
Stroke, in December 1996. The symposium drew more than 400 professionals
representing wide areas of the health care system to draft guidelines on
how to treat stroke on an emergency basis. The participants made
recommendations for change in five key areas: prehospital systems,
emergency departments, acute hospital care, hospital systems, and public
education. The proceedings from the meeting were published and distributed
nationally in an effort to increase the number of stroke patients who can
benefit from treatment and the number of hospitals that can offer rapid
treatment to their patients.
Building on the
enthusiasm and spirit of cooperation generated by the symposium, the NINDS
assumed leadership of the Brain Attack Coalition, an umbrella group of
several national organizations that work together to launch major stroke
education campaigns. The latest effort is called Know Stroke. Know the
Signs. Act in Time. The Know Stroke campaign is a multifaceted
public education program designed to raise awareness of the signs and
symptoms of stroke and the need to act quickly to seek medical care. It
includes public service advertising, media outreach, and community
education. Through a variety of voluntary organizations and federal
partners, the NINDS has distributed hundreds of thousands of brochures and
posters and more than 1,000 community education kits. These organizations
are using Know Stroke materials in educational sessions at
hospitals, senior centers, and other places that serve those at the
highest risk for stroke.
As a follow–up to the
1996 symposium, the NINDS hosted a national Stroke Symposium entitled
Improving the Chain of Recovery for Acute Stroke in Your Community in
December 2002. About 400 participants from many organizations attended
this meeting, which was designed to address the problem of the relatively
few number of patients nationwide who are receiving acute treatment for
their strokes. Both the American Stroke Association and the National
Stroke Association were co–sponsors of the meeting. The attendees were to
develop workable plans of action to get more stroke patients treated
rapidly. The NINDS will publish the symposium task force reports and post
them on the Web, in order to provide practical information that can be
used by the medical community for years to come. The result will be
improved treatment for the nation's stroke patients.
New
Programs
-
Specialized Program of Translational Research in
Acute Stroke (SPOTRIAS)
The NINDS has initiated a new concept called Specialized Programs of
Translational Research in Acute Stroke (SPOTRIAS). The objective of this
innovative model is to facilitate translation of basic research findings
into clinical practice. This is done in settings where patients with acute
ischemic and hemorrhagic stroke are evaluated and treated very rapidly
after the onset of their symptoms. The intent of the SPOTRIAS is to
support a collaboration of clinical researchers from different specialties
whose collective efforts will lead to new approaches to early diagnosis
and treatment of acute stroke patients. Training and career development
will be part of the SPOTRIAS program.
-
Human Genetics Resource Center: DNA and Cell Line
Repository
To support its mission of reducing the burden of neurological illnesses
and to support outstanding investigators funded through its research
programs, the NINDS has established a Human Genetics Resource Center: DNA
and Cell Line Repository.
The goal of the
repository will be the elucidation of genetic factors associated with
neurological diseases, including stroke. Genetic studies of neurological
disorders are increasing in number and complexity. Such studies require a
large and diverse sample and accompanying information base. Thus, a
repository of DNA samples, immortalized cell lines (from which DNA can be
extracted continuously), and accompanying clinical and pedigree data is
clearly an invaluable resource for the neuroscience community.
-
Stroke Progress Review Group
The large body of research knowledge acquired over the years, coupled with
new technologies, is providing a wealth of new scientific opportunities.
At the same time, increasing research needs and scientific opportunities
required that the NINDS determine the best uses for its resources. In
order to address these issues and to fulfill a Congressional request, the
NINDS set out to develop a national plan for basic and clinical research
in stroke. In 2001, the Institute formed the Stroke Progress Review Group
(SPRG), consisting of 30 nationally and internationally recognized stroke
experts. The SPRG identified topics to be addressed through a large
Roundtable Meeting, whose participants identified gaps in stroke knowledge
and set research priorities. The SPRG members and other participants of
the meeting issued a report reflecting the energy and enthusiasm of the
clinical, research, industrial, and advocacy communities for identifying
effective prevention strategies and treatments for stroke.
The comprehensive
report from this meeting will serve as a guide for planning research in
stroke prevention, diagnosis, treatment, and rehabilitation for the coming
years.
Back to
top
Next Section: Appendix D: Development of A
Public Health Action Plan to Prevent Heart Disease and Stroke
Return to Table of
Contents
Date last reviewed:
05/12/2006
Content source: Division for Heart Disease and Stroke
Prevention,
National Center for Chronic Disease Prevention and
Health Promotion |
|