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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 urgent new questions. In addition, the iQOS product, recently approved for sale by the FDA, and advertised to “heat-not-burn” tobacco has been reported by the tobacco industry to reduce health risk relative to combustible tobacco products, although these studies have not been corroborated by independent research teams.  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 report 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) identifying mechanisms by which e-cigarettes, iQOS, and other new and emerging tobacco products may harm the cells and tissues of the heart and vasculature; (2) human and animal studies of the effects of new and emerging tobacco products on the cardiovascular and cerebrovascular system (3) new interventions to decrease CVD and CVA health disparities among priority groups (see a list of priority groups under Research Award).

Sub-focus areas and examples of relevant research topics

Sub-focus areas and examples of relevant research topics

Effects of new and emerging tobacco products on the development of or complications of CVD or CVA

  • How new and emerging tobacco products affect oxidative stress, mitophagy, and endothelial cell function.
  • Effect of nicotine, and or e-liquid flavorings on cardiovascular diseases such as:
    • Cardiomyopathy
    • Vascular function/vasoconstriction
    • Inflammatory responses leading to atherosclerosis and thrombosis

Determining the causal link (if any) between atrial fibrillation (AF) and combustible and/or new and emerging tobacco products.

  • Epidemiological studies of combustible tobacco product users to identify causal links to atrial fibrillation.
  • Human studies of new and emerging tobacco users to explore the effects of nicotine and flavorings on arrhythmogenic phenotypes.

Population-level studies to assess the cardiovascular and cerebrovascular risk posed by new and emerging tobacco products

  • Studies of biological samples from new and emerging tobacco product users to determine whether subclinical markers of CVD and CVA are altered.
  • Genomic studies of new and emerging tobacco users to assess epigenetic changes across the genome.
  • Epidemiological studies of new and emerging tobacco product users to identify emerging health issues.

New, culturally appropriate interventions to decrease CVD and CVA health disparities among priority groups

  • Community-based participatory research partnerships that address commercial tobacco-related CVD and CVA health disparities. (see CPPRA pilot grant mechanism guidance on page 39)
  • Evaluation of interventions to decrease commercial tobacco-related health disparities in priority populations.