The people's agenda
How public-private partnerships can advance cardiovascular research
In separate interviews with Lens editor Bill Snyder in 2007, Elizabeth G. Nabel, M.D., director of the National Heart, Lung, and Blood Institute (NHLBI), and Rose Marie Robertson, M.D., chief science officer of the American Heart Association (AHA), discussed the challenges in the fight against heart disease and stroke, and the value of collaboration.
Nabel is a well-known cardiovascular researcher who was chief of Cardiology at the University of Michigan before joining the NHLBI in 1999 as scientific director of clinical research. She was named institute director in 2005. Robertson is a professor of Medicine at Vanderbilt University School of Medicine. A long-time researcher and AHA volunteer, she served as the association’s president in 2000-2001, and has been its chief science officer since 2003.
Death rates from heart disease and stroke have dropped by about two thirds in the past 30 years. What can we expect in the next 30?
Nabel: The dramatic drop in coronary heart disease… is largely due to identification of risk factors for heart disease and implementation of primary and secondary prevention programs. But… we have not been fully successful in implementing (them) ... We need more research to understanding the social and behavioral reasons why we haven’t.
If everyone in the United States fully knew their risk factors for heart disease and fully implemented risk factor modification or reduction, could we eliminate heart disease in this country? I would predict that we probably could, except perhaps for those cases where there’s a clear genetic cause of heart disease.
Robertson: Surely we will be able to better direct our interventions, of whatever sort they are—lifestyle improvements, drugs, devices, other new therapies—because we’ll better understand the people to whom we’re delivering them. We’ll understand the genetic makeup of individuals and which interventions will most benefit them.
However, there are a number of aspects of heart disease that continue to be related to lifestyle, and so individuals can outdo our best efforts with drugs and devices if they don’t eat well, exercise and avoid smoking.
And of course we have so many people who have no access to health insurance. If that isn’t improved, there will be millions of people who may not benefit at all from whatever benefits we derive from biomedical research.
We need to fix that; people need to have access to the benefits that we can provide. I actually am encouraged that there seems to be more public will to address that issue than there has been before.
Which areas of research do you think will be most fruitful, and why?
Nabel: We’ve just initiated a clinical cardiovascular stem cell network to conduct in a collaborative way clinical trials in stem cell therapies for cardiovascular diseases ... Vanderbilt is one of those centers…