Cardiovascular research: a look into tomorrow.

The second half of the last century was a period of tremendous excitement and accomplishment in the fight against cardiovascular diseases. Looking back, one can point to three major events that provided the foundation for this era of great progress in medical as well as surgical approaches to these diseases. One of those events was the introduction of cardiac catheterization into clinical medicine by Andre Cournand and Dickerson Richards in the late 1940s. Its importance was appropriately noted by Liljestrand in his Nobel prize presentation speech in 1956: “Professors Cournand, Forssmann, and Richards: the Karolinska Institute has decided to award this year’s Nobel Prize in Physiology or Medicine to you jointly for your discoveries concerning cardiac catheterization and pathologic changes in the circulatory system. . . . Together, they signify the initiation and development of a new and important approach to our understanding of heart disease.” Indeed, as we reflect on our accumulated knowledge of the pathophysiology of heart disease, we must recognize that much of it is the result of the ever-wider use of cardiac catheterization. The second memorable event of the last century was the introduction of open heart surgery. A myriad of pioneers in many countries contributed to the surgical wonders that we, today, consider ordinary, but the surgeons who took the first steps must be recognized—John Lewis, for the first open heart surgery using hypothermia in 1952, and John Gibben, for the first open heart surgery using a heart-lung machine 1 year later. These two great medical advances would probably not have flourished as quickly, or even possibly as well, if a third truly defining event had not occurred—the creation of the National Heart Institute by the United States Congress in 1948. Supported by the American people and their elected representatives, that organization catalyzed and sponsored most of the advances that have occurred in the last 50 years. This was accomplished by developing a brilliant workforce and supporting its research. Undoubtedly, the Institute has had both direct and indirect impacts on the worldwide cardiovascular disease burden. Today, at the beginning of the 21st century, cardiac catheterization and open heart surgery have become so routine that they are hardly noticed. In fact, both may be soon replaced by more innovative approaches. The support of research has broadened and is shared by countries, voluntary organizations, and relevant industries. Biomedical research, including that on cardiovascular diseases, has itself become an industry stimulated by a greater understanding of those diseases and by the emergence of extraordinary scientific opportunities. These opportunities in the cardiovascular field are derivatives of discoveries and new approaches not only in that field but in other fields as well. A little more than 2 years ago, the successor to the National Heart Institute, that is, the National Heart, Lung, and Blood Institute, convened a group of prominent cardiovascular researchers to chart a blueprint to guide the Institute’s programs. This group, known as SPARK, identified a number of scientific opportunities and enabling approaches on which specific research directions and activities are built.1 The future of cardiovascular research is completely dependent on maximizing the utilization of new approaches and technologies and on building multidisciplinary research teams. But the future is now, and already, multidisciplinary teams are assembled. It is not possible to list all of the research avenues that are currently being pursued and will be pursued in the years to come. The Figure displays some of the most exciting areas of research related to the diagnosis, pathogenesis, and treatment of heart disease. It would be imprudent to attempt to predict which of these directions will bring the greatest benefit to patients with heart disease or to individuals likely to develop this condition. The wisest prognostication is that each and all will contribute to this goal. One area of investigation, however, has received tremendous attention—genomic and genetic research. Leaders in this field have unambiguously stated that the completion of the human genome will lead to “the development of rational strategies for minimizing or preventing disease phenotypes altogether.”2 That this forecast may be correct is in part substantiated by some very interesting studies which have demonstrated that specific polymorphisms may confer a higher risk for disease in the presence of environmental or lifestyle risk factors. Conversely, other polymorphisms have been associated with a protective effect. Likewise, other DNA variations may enable us to predict the course of a condition and, thus, guide therapeutic strategies. The practical value of these observations is very hard to predict, especially The opinions expressed in this editorial are not necessarily those of the editors or of the American Heart Association. From the National Heart, Lung and Blood Institute, Bethesda, Md. Correspondence to Claude Lenfant, MD, Director, National Heart, Lung, and Blood Institute, Bldg 31, Room 5A5231, Center Dr, MSC 2486, Bethesda, MD 20892. E-mail [email protected] (Circ Res. 2001;88:253-255.) © 2001 American Heart Association, Inc.