DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health

Statement of the Director
National Heart, Lung, and Blood Institute
FY 2002 Hearing on Chronic Diseases

March 28, 2001

Mr. Chairman and Members of the Committee: The National Heart, Lung, and Blood Institute (NHLBI) has responsibility for a wide range of diseases — nearly all of them chronic — that affect millions of America ns. Indeed, when one considers that our mandate includes such highly prevalent ailments as coronary heart disease, hypertension, congestive heart failure, emphysema, asthma, thrombosis, and sleep disorders, it seems certain that there is no one in this room whose life has not been touched by one or more of our concerns.

Chronic diseases are a modern epidemic; their cost to society is enormous. And paradoxically, this situation is very much a consequence of the success of medical research. Data from U.S. Vital Statistics indicate that coronary heart disease mortality is half of what it was several decades ago, and death rates for stroke have declined 60 percent. Life expectancy for people with inherited diseases, such as cystic fibrosis and sickle cell anemia, has soared as research has armed us with skills to combat their complications. Congenital heart disease is no longer a death sentence. However, having had so much success in averting deaths, we are now confronted with an imposing array of new public health challenges. Many of the patients saved by modern medicine face years of living with a chronic disease — years that involve not only suffering, but also major expenditures for hospitalizations, physician visits, drugs, and other forms of health care. Consider coronary heart disease, which in the past was often more of an "event" than a chronic disease, since a heart attack generally signaled the end of active, productive life — if not of life itself. Today, thanks to advances in medical and surgical treatments, there are many among us, such as the Vice President, who live for decades with this chronic disease and its attendant complications. Congestive heart failure is another example. It has become alarmingly prevalent as growing numbers of people survive heart attacks or other cardiovascular problems, yet live on with damage to the heart muscle. It is an unpleasant way to live, and a miserable way to die.

Although the challenges appear daunting, the opportunities presented by research are vast and promising. Let me provide some examples of the directions we are pursuing to address these public health problems.

CARDIOVASCULAR DISEASES

In the area of cardiovascular diseases, we are focusing particular attention on subgroups of the population who are at high risk. The landmark Jackson Heart Study, now well under way, was established to investigate the causes of the disproportionate burden of cardiovascular disease borne by blacks in the United States and to uncover better preventive approaches. This long-term study of 6,500 men and women in Mississippi will also address barriers to dissemination and utilization of health information in this population; a community health education component will provide members of the community with practical, up-to-date information on reducing risk factors, practicing healthy lifestyles, and improving health and quality of life.

As you will hear today from my colleague in the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), scientists are very optimistic that a cure for diabetes will ultimately be achieved. However, in the meantime the reality is that most diabetic patients are dying of cardiovascular diseases. In collaboration with the NIDDK, the NHLBI has launched pilot phases of two large clinical trials designed to identify ways to reduce cardiovascular complications of type 2 diabetes. One will study the benefits of intensified control of high blood sugar, cholesterol, and hypertension; the other will focus on the benefits of weight loss in obese individuals with diabetes. Together, they will provide important information about the effectiveness of several new medications and treatment regimens to reduce the complications of diabetes.

National data indicate favorable trends in blood pressure and cholesterol levels among all segments of the population, but levels of obesity have skyrocketed. Because obesity predisposes its victims to develop a host of cardiovascular problems — coronary heart disease, hypertension, high blood cholesterol – as well as diabetes, it is a major concern of the Institute. A recent report from the Centers for Disease Control and Prevention, which noted a 10 percent increase in sudden cardiac deaths among people aged 15-34 during the past decade — and a 30 percent increase among young women — underscores the need to address preventable risk factors such as obesity at an early age. The NHLBI is focusing particular attention on two groups who are especially at risk of becoming overweight adults, elementary-school-aged American Indians and black pre-adolescent women, to develop strategies to prevent excessive weight gain.

ASTHMA

This year, our research program in asthma produced some important information about drug treatment in children and some very interesting insights into the etiology of asthma. The Childhood Asthma Management Program reported conclusive evidence that inhaled corticosteroids are safe and effective for long-term treatment of children with mild to moderate asthma. Use of these drugs diminished asthma symptoms and reduced the need for urgent-care visits, hospitalizations, and additional asthma medications, without compromising growth or development. Other research indicated that infants exposed to dust and other allergens may grow up with less risk of suffering allergic asthma than those raised in cleaner homes. This supports the "hygiene hypothesis," which contends that early, normal exposure to infectious organisms or other allergens causes the immune system to develop and respond normally, while minimal exposure causes the immune system to become highly sensitized, leading to an allergic asthma response when exposure occurs later in life. These findings shed additional light on the puzzle of why asthma prevalence is increasing in modern society, and underscore the need for additional basic research in immunology.

BLOOD DISEASES

Over the past several decades, we have made remarkable progress in sickle cell disease. Life expectancy for patients has doubled, and quality of life has improved for many. Nonetheless, it remains a burdensome and expensive chronic disease for its victims. While optimism exists that a cure may ultimately be available through gene therapy or other innovative treatments, the Institute is also pursuing new therapies to relieve symptoms and reduce complications. To this end, we have accelerated our efforts to develop more effective approaches to increase production of normal fetal hemoglobin in sickle cell patients.

Research into the causes, treatment, and cure of hemophilia is a high priority, and the potential for gene therapy is being avidly explored. Last fall, the Institute established a Program of Excellence in Gene Therapy focused on hemophilia; it will provide an environment for rapid translation of findings from basic research into pilot studies in human volunteers, with careful attention to safeguarding patient welfare.

THE PROMISE OF GENOMIC AND GENETIC RESEARCH

With the complete human genome in hand, we have great opportunities to advance our understanding of many chronic diseases, such as hypertension, that are influenced by multiple genes and have protean manifestations. Perhaps the most promising outcome of this research area will be to establish whether and to what extent there may be inherited differences in drug response or sensitivity. The individual and societal benefits of being able to prescribe (only) the right medication(s) to each patient are potentially vast, so we are pursuing this research with great intensity.

GETTING THE MESSAGE OUT

As we capitalize on these research opportunities, we remain cognizant that their impact on public health will be felt only if research results are rapidly translated into action. Thus, we continue to place strong emphasis on education of health care professionals, patients, and the general public.

Although our program on sleep disorders is relatively young, it has already produced a number of findings that can be of immediate benefit to the public. Among them is evidence that getting sufficient sleep is important to overall health and functioning. In an effort to instill good sleep habits in young people, the NHLBI, in partnership with Paws, Inc., has named Garfield, the comic-strip cat, its "Star Sleeper." Garfield will help the NHLBI get the message to elementary school children that "a good night’s sleep is hard to beat," through a variety of contests, games, and activities promoting sleep.

The Institute has also joined forces with the National Recreation and Park Association in an innovative effort to get Americans moving. Hearts N’ Parks aims to reduce the growing trend of obesity and the risk of coronary heart disease by encouraging people of all ages to engage in regular physical activity, follow a heart-healthy eating plan, and achieve and maintain a healthy weight. Information about lifestyle choices that can reduce risk of heart disease and skills for incorporating such behaviors into daily life are being taught as part of regular activities offered by park and recreation departments and other community-based agencies.

Although women’s health issues have long been addressed by NHLBI national education programs, the Institute is developing a new initiative focused specifically on educating the public and health care professionals about women’s heart health. The goal is to reduce death and disability in women by increasing awareness and dispelling misinformation about heart disease risk in women, improving the way health professionals detect and treat cardiovascular disease risk factors in women, reaching minority women who are at increased risk of developing cardiovascular disease, and motivating communities to make greater use of resources already available at the local level.

I would be pleased to respond to any questions the Committee may have about these and other activities of the NHLBI.

CLAUDE LENFANT, M.D.
Director, National Heart, Lung, and Blood Institute, NIH