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Cardiovascular and cerebrovascular diseases

Support innovative, timely and high impact research to better understand basic, translational or clinical sciences of disorders of the heart, blood vessels, and cardiac and brain vasculature, collectively called cardiovascular disease (CVD) and cerebrovascular accident (CVA) or stroke.

CVD is a leading cause of global deaths contributing to as much as one third of deaths, according to the World Health Organization’s Global Status Report on Noncommunicable Diseases, 2014. In California, the Department of Public Health recently reported that CVD remains the leading cause of death in the state, and over eight million Californians live with CVD or CVA-related conditions or diagnoses. The national economic burden of CVD and related diseases will increase by year 2030 to an estimated $918 billion, according to a 2016 report from the American Heart Association. Scientific evidence shows clearly that tobacco use is the leading preventable cause of death globally, and it increases risks of multiple diseases, including cancer, pulmonary and cardiovascular disease.

Health disparities exist among Californians diagnosed with CVD and CVA.  According to the 2012 California Health Interview Survey, Native Americans and African Americans reported substantially higher rates of CVD than other ethnic groups. In addition, Californians with less education and those living in poverty also reported higher rates of cardiovascular disease.  As reported in the 2016 “Burden of Cardiovascular Disease in California,” between 2000 and 2014 death from CVD was substantially higher among African Americans and Pacific Islanders as compared to other racial/ethnic groups.  Among Californians, strokes occur most frequently among African American and multiracial adults over 65.  Between 2000 and 2014, death resulting from stroke was higher among African Americans and Pacific Islanders than other racial/ethnic groups.  Research into interventions to reduce CVD and CVA among these and other priority groups is urgently needed.

The emergence of electronic cigarettes and other tobacco products that deliver nicotine aerosolized in various solvents raises new critical questions. In addition, a new category of tobacco products, called “heat-not-burn” has been touted to reduce health risk relative to combustible tobacco products in global markets. Use of these new and emerging tobacco products has soared in the last few years, particularly among adolescents, and is expected to overtake the conventional cigarette market within the next decade. Due to the rapid uptake of these products among young people and the lack of existing regulation of these products, research is vital to understand more about the toxicity profile of these products and their potential for harm.  The National Academies of Sciences, Engineering and Medicine recently published a consensus study report reviewing the available evidence of the health effects related to the use of e-cigarettes and identifying gaps and opportunities for future research.  The report states that “There is no available evidence whether or not e-cigarette use is associated with clinical cardiovascular outcomes (coronary heart disease, stroke, and peripheral artery disease) and subclinical atherosclerosis (carotid intima-media thickness and coronary artery calcification).”

TRDRP support for this priority focuses on (1) understanding and identifying functional pathways of normal and diseased cells of the heart and vasculature; (2) identifying mechanisms by which e-cigarettes and other new and emerging tobacco products may disrupt these pathways; (3) innovative treatments to improve health outcomes of those who suffer from CVD and CVA; (4) new interventions to decrease CVD and CVA health disparities among priority groups (see a list of priority groups under “High Impact Research Project Award”).

Sub-focus areas

  • Molecular and cellular pathways of initiation and progression of cardiovascular diseases, such as atherosclerosis, hypertension, and coronary heart disease.
  • Factors associated with increased risk of heart failure.
  • Molecular and cellular pathways of initiation and progression of cerebrovascular diseases (e.g. receptor biology of transient ischemia).
  • Mechanisms by which tobacco use promotes development or complications of CVD or CVA, especially by pathologic effects on vascular function, inflammation, oxidation, thrombosis or cell metabolism.
  • Determining the causal link (if any) between atrial fibrillation (AF) and tobacco or new and emerging tobacco related products.
  • Innovative and novel approaches to risk evaluation, prevention, diagnosis and treatment using:
    • New diagnostic tools, assays, devices, technologies or treatments
    • Genetics, epidemiology, big data-based population science approaches or other assays
    • New interventions to prevent cardiovascular disease, especially in priority groups.
  • Correlative studies to better understand the shared and causative parameters of heart disease and periodontitis; related oral vasculature, especially in the context of tobacco use.
  • Research to determine whether e-cigarette and new and emerging tobacco product use is associated with
    • Clinical cardiovascular outcomes such as coronary heart disease, stroke, and peripheral artery disease and atherosclerosis (including subclinical atherosclerosis pathologies such as carotid intima media-thickness and coronary artery calcification).
    • Long-term changes in heart rate, blood pressure, and cardiac function.

Examples of relevant research topics

  • Mechanisms of atherosclerosis and coronary heart disease.
  • Innovative treatments to prevent and reduce the harm caused by cardiovascular and cerebrovascular events.
  • Cerebrovascular studies focused on vasculature, thrombotic or embolic stroke, ischemia, blood brain barrier and targeted therapies.
  • Effects and mechanisms of tobacco toxicants and oxidative stress on endothelial function.
  • Effect of nicotine, sub-micro particles and other constituents of tobacco products and aerosols on:
    • Endothelial function
    • Vascular function/vasoconstriction
    • Inflammatory responses
  • Studies on and solutions for vulnerable populations that are disproportionately affected by cardiovascular disease due to exposure to tobacco smoke.