A century of advances sets the stage for future scientific advances in cardiovascular health

Dramatic advances in the understanding and treatment of cardiovascular disease have saved millions of lives in the 100 years since the founding of the American Heart Association (AHA) in 1924.As heart disease and stroke remain the leading causes of death worldwide, solutions to the challenges of the next century will need to combine the lessons of the past with the innovations of the future, says American Heart Association Centennial: Scientific Advances. 100 Years of the Future of Cardiovascular Science—Presidential Recommendations, published in Circulation.

This recommendation is the first written solely by current and former AHA volunteer presidents. The advisory authors present the association’s historical journey over the past century and outline potential challenges and opportunities for the coming years. Additionally, the recommendations are a call to action for the medical and scientific communities to work with public and private stakeholders to accelerate efforts in research, clinical care, and public health.

These steps are necessary to ensure optimal patient care, the integrity and progress of science and research, health equity for all people, and ultimately a future of a world free of cardiovascular disease and stroke.

“Scientific research to identify the causes, prevention, diagnosis, and treatment of cardiovascular disease is a fundamental pillar on which the American Heart Association was founded in 1924. “Essentially, from 1950 to 2021, death rates from heart disease have been reduced by more than half (70%), and since 1998, death rates from stroke have decreased by almost 30%.” 1 decrease,” said Mitchell SV Elkind, MD, MS, FAHA, volunteer advisory writing committee chair. He will serve as AHA President from 2020 to 2021.

“As our understanding of cardiovascular disease has evolved, the way we carry out our mission has evolved and now includes not only disease prevention but also actively promoting ideal cardiovascular health. .”

Elkind, who currently serves as the association’s chief clinical and scientific officer, said the AHA is a world leader in the advancement of cardiovascular science and medicine.

“Through funding research grants, publishing in scientific journals, hosting educational conferences, developing clinical practice guidelines, and providing networking and mentoring opportunities for our members, the Society provides valuable support to the scientific community around the world,” he said. We are providing it.”

“Armed with a century of research, the Society has made significant efforts in state and federal advocacy, professional and consumer education, global collaboration and collaboration, and continued investment in health equity. However, all of these have a direct impact on patients and the general public.”

This recommendation highlights many important advances that have changed the course of successful prevention, diagnosis, and treatment of heart disease over the past 100 years. Many of these have been made possible by expanding the field of cardiovascular science to include interdisciplinary teams of scientists from around the world from basic, translational, clinical, and population sciences. .

“Progress over the past century has far exceeded anything the American Heart Association’s founders could have imagined,” said FAHA Vice Chair of the Advisory Writing Committee and the association’s Chief Scientific and Medical Officer. said Mariel Jessup, MD, PhD.

“We know a lot more about the molecular and cellular mechanisms of cardiovascular disease and how to treat it. We learned what role genetics can play in the development of the disease. Image processing Advances in technology now allow us to look inside the body and see where it is.”If a blood clot is forming or there is a structural problem, we can perform open or closed-chest surgery or , we can bring hearts back to life through resuscitation and defibrillation, and we can also give people a second chance at life through heart transplants. ”

“Medical technology is literally at our doorstep, through our smartphones and watches. But despite these impressive achievements, even with today’s knowledge, access to health care, especially for diverse and underrepresented populations, remains at our fingertips. Gaps remain in ensuring quality care.”

The establishment of population science is perhaps best represented by the insight provided by the Framingham Heart Study, the discovery that heart disease and stroke are often caused by modifiable risk factors such as high blood pressure and cholesterol, diabetes and obesity. It led to It can be alleviated by healthy lifestyle behaviors or treated with medications. But population science also reveals consistent disparities not only among specific populations, including women, but also among different racial and ethnic groups.

“Medical care has come a long way and we have a lot to say about maintaining a healthy lifestyle. But there are many people who don’t have access to those tools. One of the biggest challenges of the future “One is to reduce the socioeconomic burden by removing barriers to health and ensuring people have access to health care when they get sick,” said AHA Volunteer President in 2013-2014. said Mr. Jessup.

“It is no longer enough to understand the biological mechanisms of cardiovascular disease. Future scientific approaches will also look at epigenetic mechanisms, behavioral and environmental interactions that can lead to the development of cardiovascular disease. These include fundamental social and structural factors such as education, housing, transportation, quality of neighborhood resources, air and water quality, access to care, chronic psychosocial stress. ”

The writing committee noted that the AHA is already at the forefront of the next explosive growth in scientific discovery.

“The increasing power of giant computers and cloud-based platforms to store and share data, the use of artificial intelligence (AI) to analyze millions of complex pieces of data at once, and gene editing through techniques such as CISPR. , taking your own blood cells and regenerating them into replicas of the heart cells you had at birth—this type of advancement is no longer a futuristic vision, but a reality,” said Joseph C. Wu, MD, FAHA. said. He is currently the volunteer president of the AHA, director of the Stanford Heart and Vascular Institute, and the Simon H. Stelzer Professor of Medicine and Radiology at the Stanford School of Medicine.

“These extend our capabilities beyond traditional research and help us learn more and learn faster. We are developing what I like to call ‘clinical trials in a dish.’ Things can be conducted, and there are subjects that have to be conducted over many years, which can go far beyond what could be done in hundreds or thousands of individual studies. ”

Wu noted that these new technologies will help discover new ways to treat heart disease, including new drugs, new medical procedures, and even by actually repairing heart tissue damaged by a heart attack. .

“These advances will continue to uncover the specific mutations and combinations of genetic variations that cause individual cardiovascular diseases, and will lead to the increasing use of chip-based diagnostics in hospitals and clinics in the not-too-distant future,” he said. “It will become more commonplace,” he said. “By leveraging these and related technologies, as well as those yet to be discovered, we will move closer to precision medicine, or personalized treatments specific to the individual.”

The Advisory Writing Committee concluded that several issues must be addressed if the next 100 years of AHA’s lifesaving work are to be as impactful as the first 100 years.

• Scientific literacy must be strengthened to increase the public’s knowledge and understanding of the methods and interpretation of scientific data, including its evolving, unfinished nature and the inherent uncertainties of science.
• Nontraditional approaches to health care use evidence-based approaches to address food insecurity, transportation issues, education, housing, access to care, chronic psychosocial stress, and other social needs. Rapid implementation into communities is needed to address social and structural determinants of health. People where they are.
• The interconnectedness of organ systems, disease mechanisms, and life stages is critical to understanding the complete relationship that cardiovascular health plays in overall health. Increasing evidence shows that conditions that appear later in life, such as coronary artery disease and dementia, often begin in childhood, raising the need for enhanced prevention and treatment across the lifespan.
• Evaluation of treatment systems will become increasingly important in order to achieve significant clinical benefits. Reliance on individual physicians may be impractical when managing diseases that involve multiple organ systems, such as cardiovascular, renal, and metabolic diseases, and diseases that simultaneously affect the heart, brain, and heart. there is.
• Securing further funding for research is critical as the pace of funding growth has not kept pace with the pace of scientific progress. The next century of progress will require even larger technological investments. Laboratory experiments may require more sophisticated equipment. Translational science will incorporate expensive new technologies like AI. And achieving population health will require greater computing power and larger sample sizes to realize the potential of precision medicine.

Additional challenges include the need for a stronger and more diverse workforce across the scientific community. Address changes in the way scientific information is disseminated and published. Ensure innovative collaboration between academic, non-profit, and industry stakeholders and maintain scientific integrity. and establish more global collaborations to connect scientists around the world. Please see the advisory for more information and specific calls to action.

In comments accompanying the presidential advisory, AHA CEO Nancy Brown said that 100 years after it was founded by scientists seeking new insights into the mysteries of heart disease, the association continues to He said the focus is squarely on the power of science and research to improve and extend lifespans. .

“This century of scientific know-how means we have a number of proven solutions that we can offer,” Brown said. “Our next century is a thrilling opportunity to advance our knowledge and, hopefully, defeat heart disease and stroke.”

Mr. Brown declared that the progress of the last century will continue into the next as the AHA works with more than 32 million volunteers, supporters, donors, and countless other collaborators around the world.

“Our future is about improving your health. Everyone can be an advocate for their own heart and brain health and support healthy living in their communities,” Brown said. he said. “Join us as we boldly pursue our mission to be a relentless force for a world where everyone lives longer, healthier lives. Find out how at www.heart.org/ Please see centennial.”