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DALLAS, February 12, 2024 — In the 100 years since the American Heart Association, the world’s leading volunteer organization focused on heart and brain health, was founded in 1924, dramatic advances in the understanding and treatment of cardiovascular disease have saved millions of lives. Heart disease and stroke remain the leading causes of death worldwide, and solutions to the challenges of the next century will need to combine the lessons of the past with the innovations of the future, says the American Heart Association. American Heart Association Centennial: A Century of Scientific Advances and the Future of Cardiovascular Sciences – Presidential Advisory, Published today Circulation, The Society’s flagship peer-reviewed journal.
The recommendations are the first of their kind to be written solely by volunteer current and past presidents of the American Heart Association. The recommendations’ authors present the Association’s historic journey over the past century and outline potential challenges and opportunities for the coming years. Additionally, the recommendations call for the medical and scientific communities to collaborate with public and private stakeholders to accelerate research, clinical care, and public health efforts. These steps are necessary to achieve optimal patient care, integrity and advancement of science and research, health equity for all, and ultimately a world free of cardiovascular disease and stroke.
“Scientific research to identify the causes, prevention, diagnosis and treatment of cardiovascular disease is the foundational pillar on which the American Heart Association was founded in 1924. This scientific advancement since 1924 has led to remarkable achievements in preventing and treating heart disease and stroke, with heart disease deaths falling by more than half (70%) between 1950 and 2021 and stroke deaths falling by nearly one-third since 1998,” said Advisory Writing Committee Chair Mitchell S. V. Elkind, MD, MS, FAHA, who served as the American Heart Association’s Volunteer President for 2020-21. “As our understanding of cardiovascular disease has evolved, so has the way we pursue our mission, which now includes not only disease prevention but also the active promotion of ideal cardiovascular health.”
Elkind, who currently serves as the association’s chief clinical and scientific officer, noted that the American Heart Association is a global 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 member networking and mentoring opportunities, the Society provides immeasurable support to the scientific community around the world,” he said. “Armed with a century of research, the Society has made significant efforts in state and federal advocacy, professional and consumer education, global coalitions and collaborations, and ongoing investments in health equity, all of which have a direct impact on patients and the public.”
The recommendations highlight many of the important advances that have changed the trajectory of successful prevention, diagnosis, and treatment of heart disease over the past 100 years, many of which have been made possible by the expansion of the field of cardiovascular science to include multidisciplinary teams of scientists from basic, translational, clinical, and population sciences around the world.
“Advances over the past century are far beyond what the American Heart Association’s founders could have imagined. We know so much more about the molecular and cellular mechanisms of cardiovascular disease and how to treat it. We’ve learned how genetics influence disease development. Advances in imaging allow us to see inside the body and see where blood clots form or where there are structural problems. We can now perform open-heart and closed-heart surgeries, revive hearts through resuscitation and defibrillation, and even give people a second chance at life with heart transplants,” said Mariell Jessup, MD, FAHA, vice chair of the advisory committee and chief scientific and medical officer at the American Heart Association. “Medical technology is literally within our reach through our smartphones and watches. Yet despite these incredible achievements, even with today’s knowledge, gaps remain in access to health care and ensuring quality care, especially for people from diverse and underrepresented populations.”
The establishment of population science is perhaps best exemplified by the insights provided by the Framingham Heart Study, which led to the discovery that heart disease and stroke are often caused by modifiable risk factors such as high blood pressure, cholesterol, diabetes, and obesity, many of which can be mitigated by healthy lifestyle behaviors or treated with medication. But population science has also revealed consistent disparities among certain populations, including women, and among different racial and ethnic groups.
“We’ve made great advances in medicine and the benefits of living a healthy lifestyle are many, but these tools remain unavailable to many people. One of the greatest challenges going forward will be reducing socioeconomic barriers to health and increasing access to care when people get sick,” said Jessup, who also served as volunteer president of the American Heart Association from 2013 to 2014. “Understanding the biological mechanisms of cardiovascular disease is no longer enough. Future scientific approaches must also look at epigenetic mechanisms and behavioral and environmental interactions that may lead to the development of cardiovascular disease. This includes underlying social and structural factors such as education, housing, transportation, quality of neighborhood resources, air and water quality, access to health care, and chronic mental stress.”
The writing committee noted that the American Heart Association is already at the forefront of the next explosion of scientific discovery.
“These advances — the increasing capacity of large computers and cloud-based platforms for storing and sharing data, the simultaneous analysis of millions of complex data sets using artificial intelligence (AI), gene editing with technologies like CPISPR, and the ability to take a person’s own blood cells and regenerate them into replicas of their heart cells at birth — are no longer a futuristic dream but a reality,” said Joseph C. Wu, MD, FAHA, current volunteer president of the American Heart Association, director of the Stanford Heart and Vascular Institute, and the Simon H. Sturtzer Professor of Medical Radiology at the Stanford University School of Medicine. “These advances help us expand our ability to learn more, faster, beyond traditional research. We can conduct what I call ‘clinical trials in petri dishes,’ with possibilities far beyond what’s possible with individual studies of hundreds or thousands of subjects that would have to be conducted over several years.”
Wu noted that these new technologies could help discover new ways to treat heart disease, such as new medicines, new medical procedures, or even actually repairing heart tissue damaged by a heart attack.
“These advances will continue to uncover the specific mutations and combinations of genetic alterations that lead to individual cardiovascular disease, and chip-based diagnostics will become increasingly available in hospitals and clinics in the not-too-distant future,” he said. “These and related technologies, and future discoveries, will perhaps bring us closer to the realization of precision medicine – personalized treatment.”
The Advisory Writing Committee concluded that for the American Heart Association’s next 100 years of life-saving work to be as impactful as its first 100, several issues must be addressed.
- Scientific literacy It must be strengthened to increase public knowledge and understanding of methods and interpretation of scientific data, including the inherently evolving, incomplete and uncertain nature of science.
- Non-traditional approaches to healthcare We need to address the social and structural determinants of health by rapidly deploying evidence-based approaches in communities and meeting people where they are to address food insecurity, transportation issues, education, housing, access to health care, chronic mental stress, and other social needs.
- Interrelationships between organ systems, disease mechanisms, and life stages These are important for understanding how cardiovascular health relates to overall health: There is growing evidence that diseases that manifest later in life, such as coronary artery disease and dementia, often begin in early childhood, raising the need for enhanced prevention and treatment throughout the lifespan.
- Assessment of systems of care In the future, relying on individual physicians will become increasingly important to achieve significant clinical benefit, which may not be practical when managing diseases that involve multiple organ systems, such as cardiovascular, renal and metabolic diseases, or disorders that simultaneously affect the heart, brain and mind.
- More funding for research This is a critical need because funding is growing at a faster rate than scientific advances. Progress in the next century will likely require even greater technology investments. Laboratory experiments will require more sophisticated equipment. Translational science will incorporate expensive new technologies such as AI. And population health will require more computing power and larger sample sizes to realize the promise of precision medicine.
Additional challenges include the need for a stronger and more diverse workforce across the scientific community, addressing changes in how scientific information is disseminated and published, preserving scientific integrity through innovative collaborations between academic, nonprofit, and industry stakeholders, and establishing more global collaborations that connect scientists around the world. For more information and specific calls to action, please see the Recommendations.
In a commentary accompanying the presidential recommendation, American Heart Association CEO Nancy Brown said that 100 years after it was founded by scientists seeking new insights into the mysteries of heart disease, the organization remains steadfastly focused on the power of science and research to improve and extend lives.
“The scientific know-how of this century means we have a lot of proven solutions to offer,” Brown said. “The next century offers an incredible opportunity to advance our knowledge and hopefully conquer heart disease and stroke.”
Brown declared that the American Heart Association, working with more than 32 million volunteers, supporters, donors and countless other partners around the world, will ensure that the progress of the last century will continue into the next.
“Our future is about improving your future – everyone can be a champion for their own heart and brain health and support healthy living in their community,” said Brown. “We’re fearless in our mission to work tirelessly for a world where everyone can live longer, healthier lives. Join us! Learn more at www.heart.org/centennial.”
Additional author names and author disclosures can be found in the manuscript.
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About the American Heart Association
The American Heart Association works tirelessly for a world where people live longer, healthier lives. We are committed to ensuring equitable health in all communities. Working with countless organizations and harnessing the power of millions of volunteers, we fund innovative research, advocate for public health and share resources that save lives. The Dallas-based organization has been the leading source of health information for a century. As 2024 marks our 100th anniversary, we celebrate a century of rich history and accomplishments. As we move into our second century of bold discovery and impact, our vision is to advance health and hope for all people, everywhere. Connect with us at heart.org, Facebook, and LinkedIn. X Or call 1-800-AHA-USA1.
For media inquiries and AHA/ASA expert opinion pieces, please contact: 214-706-1173
Cathy Lewis: cathy.lewis@heart.org
Public Inquiries: 1-800-AHA-USA1 (242-8721)
heart.org and stroke.org
