NHLBI Work Spans Heart, Kidney Care

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Gary H. Gibbons, MD, is director of the National Heart, Lung, and Blood Institute (NHLBI), the third largest institute at the NIH, with an annual budget of more than $3 billion. Before joining the NHLBI, Gibbons served as founding director of the Cardiovascular Research Institute, chairperson of the Department of Physiology, and professor of physiology and medicine at the Morehouse School of Medicine in Atlanta.

KN:

You have led NHLBI for a year. Tell us about the institute and your vision for the future direction of NHLBI.

Gibbons:

The National Heart, Lung, and Blood Institute (NHLBI) provides global leadership for a research, training, and education program to promote the prevention and treatment of heart, lung, blood, and sleep diseases and disorders and enhance the health of all individuals so that they can live longer and more fulfilling lives.

My vision for the NHLBI is guided by several key enduring principles:

  • Value and support investigator-initiated fundamental discovery science.
  • Maintain a balanced, cross-disciplinary portfolio (basic, translational, clinical, population science).
  • Support implementation science that empowers patients and enables partners to improve the health of the nation.
  • Train and nurture a diverse biomedical workforce.
  • Value the health of all communities; elucidate and eliminate health inequities in the U.S. and around the globe.

KN:

How do you balance basic, clinical, and translational research opportunities? Do you see the mission of NHLBI changing with the expanded focus by NIH recently on translational research?

Gibbons:

The NHLBI has a proud legacy of funding a balanced portfolio that includes the full spectrum of basic, clinical, translational, and population science. We are pursuing a leadership agenda that rethinks prior approaches and incorporates the lessons from a “holistic,” systems approach in order to address the complexities of diseases such as sickle cell disease, hypertension, heart failure, and asthma.

Science is an iterative, interactive process. In my Director’s Corner “Behind the Bench” conversations with NHLBI grantees, these renowned experts offer provocative viewpoints on how these four arenas are increasingly seen as interdependent parts of their research. Many of them talk about the benefits of being a clinician-scientist and how the patients, i.e., clinical science, often guide the research questions that they ask and seek to answer. These conversations are instructive and reinforce our “balanced portfolio” philosophy here at NHLBI.

We are always seeking new opportunities to innovate and have an even greater impact on human health, which often means further engagement in the translational research space. One recent example is the launch of the NIH Centers for Accelerated Innovations (NCAIs). The NHLBI currently is the only NIH IC (institute or center) funding these centers, which are a great example of the intersection between basic and translational science. Our hope is that through the NCAIs, we can better leverage our existing R&D investments and ensure that the basic research we’re supporting through Small Business grants results in breakthroughs that can become commercially viable products to improve patient care and advance public health.

KN:

High blood pressure and cardiovascular disease place patients at increased risk for conditions such as kidney disease. The reverse is also true. What is NHLBI doing to address this issue?

Gibbons:

Research into causes of hypertension and ways to control blood pressure are top priority areas for the NHLBI.

We fund a number of clinical trials related to the link between high blood pressure and cardiovascular disease and kidney disease. One example of a trial we’re currently funding along with NIDDK is the Systolic Blood Pressure Intervention Trial (SPRINT), a randomized controlled trial that is testing whether a systolic blood pressure (SBP) level of less than 120 mm Hg (intensive arm) is better than a SBP level of less than 140 mm Hg (standard arm). The trial is looking at whether the lower SBP will further reduce the risk of cardiovascular disease (CVD), kidney disease, stroke, or dementia.

Another great example is the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), which was the largest antihypertensive treatment trial ever conducted. The main study and subsequent studies using ALLHAT data have looked at a number of issues including blood pressure, diabetes, heart failure, chronic kidney disease, atrial fibrillation, and metabolic syndrome. The NHLBI is supporting the continuing analysis of the ALLHAT data by the scientific community. There are also highly productive Renal Working Groups within a number of our studies—including ALLHAT, the Cardiovascular Health Study (CHS), Multi-Ethnic Study of Atherosclerosis (MESA), Atherosclerosis Risk in Communities Study (ARIC), and the Jackson Heart Study—that are looking at the relationships among cardiovascular disease, hypertension, and chronic kidney disease.

Our work to address issues related to CVD and high blood pressure reaches beyond research and into health education campaigns that seek to help individuals live healthier lifestyles. Examples include We Can! (Ways to Enhance Children’s Activity & Nutrition), The Heart Truth (focused on raising awareness of heart disease in women), and the DASH eating plan (Dietary Approaches to Stop Hypertension).

KN:

How does NHLBI collaborate with other NIH institutes and federal agencies on kidney-related studies?

Gibbons:

The NHLBI co-funds a number of studies with other NIH institutes and federal agencies that have kidney disease as a component of the study, such as the SPRINT trial mentioned earlier. We’re always looking for new opportunities to co-fund important studies. Increasingly, investigators are realizing that you can’t isolate biological systems and that medical research requires a true multidisciplinary, systems biology approach. We are increasingly seeing this research cross traditional boundaries.

Another example is a study published in the September New England Journal of Medicine from the Chronic Kidney Disease Prognosis Consortium (CKD-PC). The study looked at cystatin C and its ability to characterize risk related to renal dysfunction, cardiovascular disease, and end stage renal failure. Five NHLBI-supported studies, including REGARDS, ARIC, CHS, the Framingham Heart Study, and MESA, provided patient data for that report.

KN:

Have the 2013 budget cuts affected NHLBI, and what happens if Congress does not stop the additional cuts planned for 2014–2021?

Gibbons:

The sequester is having an impact on investments in biomedical research across all NIH institutes and centers, including the National Heart, Lung, and Blood Institute. The NHLBI is engaging scientific experts to take a strategic look at its portfolio, from basic science to clinical trials to observational epidemiology, as part of its efforts to maximize scientific output within the current budget climate.

That said, the NHLBI prioritizes investments in investigator-initiated R01 awards, new/early stage investigators, and trainees. In May 2012, I was pleased to announce an increase in the R01 awards payline for fiscal year 2013 from the 6th percentile to the 11th percentile. In September, I also announced an increase in the paylines for the pre- and postdoctoral National Research Service Award (NRSA) grants and fellowships (F31, F32, and F33) from the 30th percentile to the 38th percentile and the NHLBI’s decision to participate in NIH’s R56 mechanism, known as the “High-Priority, Short-Term Project Award.”

If additional cuts happen, the NHLBI will continue to prioritize the investments I’ve mentioned above. The fiscal challenges may force us to be more imaginative; however, it doesn’t change the fact that there are unprecedented scientific opportunities out there today thanks to the incredible advances in the tools and technologies available to researchers.

KN:

How does NHLBI balance approaches to retain established researchers with the need to attract new researchers to the field?

Gibbons:

One of the most important investments the NHLBI can make is to support and encourage the next generation. We are committed to ensuring that we help sustain a vibrant, innovative, and diverse biomedical workforce despite the current fiscal challenges. That’s one of the reasons that we’ve prioritized training grants, K-awards, and investigator-initiated grants, despite budget reductions. This is an issue about which I’m extremely passionate. I look forward to ideas coming from the people at the front lines—such as your members—about how we can do an even better job at nurturing career development.

KN:

Studies have shown that, compared to Caucasians, African Americans are at higher risk of developing hypertension, cardiovascular disease, and kidney disease. What is the institute doing to address health disparities?

Gibbons:

The NHLBI is funding hundreds of studies that look at health disparities, including studies such as ARIC, ALLHAT, the Jackson Heart Study, MESA, SPRINT, the Coronary Artery Risk Development in Young Adults (CARDIA) Study, and the Hispanic Community Health Study/Study of Latinos (HCHS-SOL). We also hope to fund several grants that were submitted in response to the “Cardiovascular Risk Reduction in Underserved Rural Communities” RFA.

Beyond the CVD space, we’ve recently funded studies that look at health disparity issues such as genetic variants associated with asthma severity in African Americans, obstructive sleep apnea and co-morbidities in the Hispanic community, and the underdiagnosis of chronic obstructive pulmonary disease in the African American community.

In addition, through the NHLBI’s Excellence in Hemoglobinopathies Research Award program, a study recently began that is looking at why adults with sickle cell disease (which has a higher prevalence in the African American and Latino communities) are at an increased risk for renal disease and more rapid progression to dialysis. In addition to renal disease, as people with sickle cell disease live longer, they are now facing heart disease, lung disease, and stroke.

The institute continues to view sickle cell disease as a high priority and is well poised to match this complex condition with a comprehensive, integrative systems approach that extends beyond the research lab to the primary care and community environments of persons living with the disease.

On a more global level, we co-fund the NIH’s Centers for Population Health and Health Disparities, which promote transdisciplinary research in the area of health inequities to improve health outcomes and quality of life for populations with a disproportionate burden of chronic disease.

KN:

What do you consider the greatest research opportunities for NHLBI over the next decade?

Gibbons:

I mentioned earlier the unprecedented scientific opportunities that currently exist thanks to advances in science that simply were not there just a decade ago. The explosion of –omics and imaging technology and the advances in stem cell technologies, bioinformatics, and big data all present huge opportunities for today’s young investigators who are best poised to leverage these technologies. It is genuinely an exciting time to be in this field, even with the fiscal challenges.