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Cardiovascular Sciences

Description:

The NHLBI Division of Cardiovascular Sciences (DCVS) plans and directs research grant, contract, and training programs to support basic, clinical, population, and health services research on the causes, prevention, and treatment of cardiovascular diseases. These programs encompass institute and investigator-initiated basic research, targeted research, specialized centers and clinical trials. The DCVS maintains surveillance over developments in its program areas and assesses the national need for research on the causes, prevention, diagnosis, and treatment of cardiovascular disease. The DCVS ensures that effective new techniques, treatments and strategies resulting from medical research are transferred to the community through professional, patient, and public education programs in a timely manner. DCVS-supported research also includes a broad array of epidemiological studies to describe disease and risk factor patterns in populations and to identify risk factors for disease; clinical trials of interventions to prevent and treat disease; studies of genetic, behavioral, sociocultural, and environmental influences on disease risk and outcomes; and studies of the application of prevention and treatment strategies to determine how to improve clinical care and public health.

The Division is comprised of three programs, in which reside eight branches, and the Office of Research Training and Career Development, and the Office of Biostatistics Research. These are described below.

Adult and Pediatric Cardiac Research Program

Atherothrombosis and Coronary Artery Disease Branch. Supports basic, translational, and clinical research on the etiology, pathogenesis, prevention, diagnosis, and treatment of coronary artery disease and atherothrombosis.

Heart Development and Structural Diseases Branch. Supports basic, applied, and clinical research in normal and abnormal cardiovascular development as well as the etiology, pathogenesis, prevention, diagnosis, treatment of pediatric and adult structural heart disease, and heart transplantation.

Heart Failure and Arrhythmias Branch. Supports basic, translational, and clinical research on normal cardiac function and pathogenesis to improve the diagnosis, treatment, and prevention of heart failure and arrhythmias.

Basic and Early Translational Research Program

Advanced Technologies and Surgery Branch. Supports basic, translational, and clinical research on innovative and developing technologies for the diagnosis, prevention, and treatment of cardiovascular diseases.

Vascular Biology & Hypertension Branch. Supports basic, translational, and clinical research on vascular biology and the etiology, pathogenesis, prevention, diagnosis, and treatment of hypertension and vascular diseases.

Population Sciences Program

Clinical Applications and Prevention Branch. Supports, designs, and conducts research on behavioral, environmental, clinical, and healthcare approaches to reduce occurrence and consequences of cardiovascular diseases.

Epidemiology Branch. Supports, designs, and conducts research in the epidemiology of cardiovascular, lung, blood and sleep diseases and disorders.

Women?s Health Initiative Branch. Supports clinical trials and observational studies to improve understanding the causes and prevention of major diseases affecting the health of women. Current studies focus on cardiovascular disease, cancer, and fractures, in collaboration with NCI, NIAMS, NIA, NINDS, and ORWH.

Office of Research Training and Career Development. This office supports research training and career development programs for individuals at many educational levels, from high school to faculty, as well as training programs for individuals from under-represented groups. Many of these programs are designed to take emerging and promising scientific and technological advances from discovery through pre-clinical and clinical studies. A K12 institutional training program, Research Career Development in Vascular Medicine, was established in 2007 to provide comprehensive clinical research training for physicians wanting to specialize in vascular medicine. The office also collaborates with the scientific community and professional organizations to ensure that training programs meet both the current and future needs of the cardiovascular research workforce.

Office of Biostatistics Research (OBR). Provides statistical expertise to members of all Divisions of the NHLBI and performs diverse functions in planning, designing, implementing and analyzing NHLBI-sponsored studies. The OBR is concerned with designing efficient studies and monitoring data while studies are ongoing. The OBR?s methodological interest concern survival analysis, longitudinal data analysis, and efficient study designs, including the monitoring of ongoing clinical studies for efficacy and safety. Recently the OBR has made contributions to statistical genetics and has extended its expertise to bioinformatics.

Research topics of interest to the Division of Cardiovascular Sciences include but are not limited to the following:

A. Clinical research/intervention studies designed to improve cardiovascular disease outcomes

1. Approaches to facilitating adoption of evidence-based guidelines

2. Approaches to improving care of cardiovascular patients transitioning from hospital to ambulatory or home care

3. Approaches to improving prevention and treatment of ischemic heart disease (IHD), including prevention of recurring events and optimization of functional capacity in patients with IHD

B. New or improved clinical trial methodologies, including modeling and simulations and ?value-of-information? research

C. Novel and improved lifestyle interventions, including matching patients to lifestyle, intervention, or treatment

D. Health-care systems and outcomes research, including development of new quality measures for evidence-based cardiovascular health care

E. Models of behavior modification and other approaches to behavior change

F. Preventative Approaches

1. Nutrition and dietary interventions and products

2. Technologies to control weight

3. Stress reduction interventions

4. Smoking cessation interventions

5. Physical activity interventions

6. Interventions to promote healthy lifestyles, adherence to medications, and cardiac rehabilitation, including stress and exercise

G. New or improved treatment agents or strategies, including medications and devices

H. New or improved methods, tools, and techniques for:

1. Screening, assessment, and tracking of hypertension, coronary heart disease, heart failure and other cardiovascular risk factors and diseases

2. Communication of research results

3. Collection, transmission, management and analysis of clinical data

4. Population tracking

5. Communication with minority and low-income populations

6. Disease self-management, including telemetric monitoring

7. Assessing polypharmacy, particularly for the elderly

I. New or improved measures, analytical methods, and instruments for:

1. Gene expression in individuals

2. Heart failure, including diastolic heart failure

3. Small vessel disease

4. Behavioral and lifestyle variables, e.g., diet and physical activity (Note: Measures include survey questionnaires.)

5. Psychosocial assessment, especially in minority populations, including chronic social stress, depression, and discrimination

6. Sleep useful for population based studies

7. Impaired glucose tolerance

8. Nutrition and physical activity

9. Patient responses to behavioral or medical interventions

10. Quality of life and other components of health status

11. Patient adherence/compliance

12. Cell immortalization, storage and distribution service

J. Materials and Devices

1. Angioscopes with increased flexibility and enhanced resolution

2. Medical implants (heart valves, vascular grafts, stents, pacemakers, defibrillators, intracardiac hemodynamic monitors, etc.):

a. Novel technologies (e.g., nanofabrication), designs and materials

b. Failure prediction/analysis

c. Manufacturing

d. Monitoring

e. Preservation methods

f. Quality assurance and quality control

g. Reference biomaterials for evaluation of biocompatibility

h. Reliability

i. Biological response

j. Devices designed specifically for pediatric patients and/or patients with congenital heart disease

3. Circulatory support systems:

a. Artificial heart

b. Ventricular assistance

c. Automatic control

d. New animal models for in vivo testing

e. Percutaneous and transcutaneous transmission of electrical energy

f. Implantable rechargeable batteries and alternate power sources

4. Percutaneous valve technology

5. Molecular probes

6. Biological, chemical, and mechanical sensors

7. Diagnostic instrumentation for the mouse and rat

8. Devices to improve resuscitation outcomes

9. Point-of-care (POC) devices for monitoring, diagnostics, and personalized medicine

a. Biosensors for detection of early ischemia in the absence of necrosis

b. Minimally-invasive monitoring of heart rhythm, cardiac hemodynamics and/or blood pressure

K. Computing and Informatics

1. New or Improved Software for:

a. Clinical trials

b. Epidemiology studies

c. Literature abstracting

d. Meta-analysis

e. Statistical analysis

f. Shared clinical decision-making

g. Monitoring and providing feedback to patients and providers in clinical care settings

h. Analysis of context-dependent genetic effects

i. Longitudinal data analysis

j. Microarray data analysis

k. Automated systems for genotyping quality control and error checking

l. Sequencing data analysis

2. Computerized systems to support evidence-based clinical practice in prevention and treatment of hypercholesterolemia, coronary heart disease, heart failure, hypertension, and other cardiovascular risk factors and diseases

3. Interactive databases

4. Computational Modeling:

a. Systems biology approaches to study complex disease

b. Mathematical and computer modeling of the cardiovascular system in health and disease. Examples include: vessel wall biology; hemodynamics in complex congenital heart disease; structure, function, and electrical activity of the normal and diseased heart; blood pressure regulation

c. Optimization of implantable defibrillator algorithms for arrhythmia prediction, efficient intervention, device fault detection or early failure detection

5. Informatics:

a. Novel use of information technology to enhance adherence to medical regimens or promote translational research. Examples include: use of the Electronic Health Record (EHR) to improve clinical care; research to interface clinical trial and registry data bases with common source data found in the EHR.

b. Approaches to integrating diverse types of data from cardiovascular research, including genomic data

L. Animal Models

1. Development of phenotypic screening methods in the mouse for cardiovascular diseases

2. Animal models for assessing genetic determinants of disease

3. Animal models of cardiovascular diseases. Examples include: complications of diabetes mellitus, cerebrovascular disease, arrhythmias, aortic aneurysms, and lower extremity arterial disease

M. OMICS Methods and Analytical Approaches

1. Genetics and epigenetics:

a. Relationship, structure, and function of genes and their products

b. Technologies for gene discovery, assessment, and diagnostics

c. Genetics of complex diseases ?gene/gene and gene/environment interactions, epigenetics (heritable, non-sequence variations in DNA and its associated proteins)

d. Pharmacogenetics/Pharmacogenomics and personalized medicine

2. Genomics

3. Metabolomics

4. Proteomics

5. RNA - Development of new and improved antisense agents and RNA interference (RNAi) technologies for cardiovascular disease therapies

6. Sequencing

7. Integration and combined analysis of OMICS data

N. Preventive Approaches

1. Nutrition and dietary interventions and products

2. Technologies to assess energy balance and control weight

O. Transplantation

1. Methods to induce tolerance to cardiac allografts

2. Non-invasive methods to diagnose cardiac allograft vasculopathy and cellular and antibody mediated rejection

3. Strategies to enhance donor utilization such as better preservation methods for cardiovascular tissues or organs

4. Immunosuppression-including renal sparing strategies

5. Pediatric heart transplantation

P. Training and Education

1. Community education and demonstration research studies

2. Studies of cardiovascular disease information, education, prevention, and treatment systems for use in primary medical care and home care, including care by family caregivers

3. Training techniques and modules

4. Interactive web-based programs for health promotion

5. Instructional, research, and clinical computer programs for the normal and abnormal cardiovascular system

6. Educational materials and approaches targeting self-directed or supervised exercise therapy for (1) treatment and management of peripheral arterial disease, coronary heart disease, or heart failure and (2) for children and adults with congenital heart disease to improve exercise capacity and to prevent or treat obesity in this population.

Q. Diagnostic and Therapeutic Approaches

1. Device-Related:

a. Interventions to improve resuscitation outcomes

b. Device-based approaches aimed at preventing cardiac ischemia/reperfusion injury

c. Improved devices and technologies to detect and treat arrhythmias

d. Robotics in treatment of cardiovascular disease. For example: treatment of congenital heart disease

e. Computer-assisted surgery for treating cardiovascular diseases

f. Point-of-care (POC) approaches and techniques

g. Technologies targeting self-directed or supervised exercise therapy for treatment and management of peripheral arterial disease

h. Non-invasive device strategy to monitor ambulatory heart rhythm over extended period

2. Cell or Gene-Based:

a. Development of gene-based or cell-based therapies for cardiovascular diseases

b. Tissue engineering and cell or gene-based approaches for repair or replacement of damaged or diseased tissue

c. Genetic testing or screening for inherited cardiovascular diseases and defects

d. Biomarkers and surrogate markers for risk assessment, detection, and monitoring of cardiovascular diseases

e. Biomarkers for long term exposure to environmental factors including diet, physical activity, smoking, alcohol, and contaminants

f. Development of viral and non-viral vectors for gene therapy for cardiovascular diseases

g. Pro- and anti-angiogenic and vasculogenic genes, proteins and drugs

3. Other:

a. Prognostic assays

b. Approaches and technologies to measure lipid content in the blood

c. Standardized assays of glycosolated hemoglobin

d. Non-invasive methods of detecting cardiac rejection, particularly in infants and young children

e. Non-toxic and selective molecular cages for delivering short-lived vasoactive agents to the vasculature

f. High-throughput assays or screening for cardiovascular research and disease detection

g. Non-invasive diagnostic tests. For example: salt sensitivity; vascular and renal tubular fluid dynamics

h. Heart failure, early detection and treatment strategies

i. Novel approaches to reduce cardiac ischemia/reperfusion injury following myocardial infarction

j. Anti-hypertensive drugs from natural and synthetic sources

k. Vaccines for the prevention or treatment of atherosclerosis or other cardiovascular diseases

l. Technologies, tools, and/or processes to better study transient molecular complexes that are an integral part of normal cell physiology or that play a role in cardiovascular disease processes

m. Tools to investigate mitochondrial functions and interactions with cell components in vivo or in intact single cells

n. Atrial fibrillation, tools for non-invasive strategy for early detection and management

R. Imaging

1. Molecular and cellular imaging, including imaging to detect gene expression and to track viable implanted stem cells

2. Imaging methods to measure molecular events in living cells in real time. For example: luminescent dyes to measure toxic metabolic intermediates; optical imaging methods for dynamic tracking of reactive species within organelles; echogenic molecular imaging agents that signal early events in calcific aortic valve disease

3. New medical imaging systems, enhancements, equipment, materials, software, and applications

4. Imaging characterizing vessel walls and lesions

5. Clinical imaging in congenital heart disease

6. Neuro-imaging in hypertension

7. Radiologic phantoms mimicking the human cardiovascular system

8. High resolution functional and molecular imaging of the human lymphatic system

9. 3-D fetal echocardiography or magnetocardiography

10. Image-guided therapy: Catheter and imaging guidance system for mapping and ablation to treat cardiac arrhythmias

11. MRI-compatible diagnostic electrophysiology catheters and MRI-compatible ablation catheters

12. New ambulatory imaging of cardiac rhythm to detect irregular or aberrant atrial or ventricular impulses over long (week(s)) period of observation.

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