Developing a Research Agenda for Primary Prevention of Chronic Lung Diseases—An NHLBI Perspective

Abstract

The idea that prevention is better than cure is a long-standing concept recognized by physicians from antiquity. Advances in public health have borne out the validity of this concept, and the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health has been at the forefront of innovative interventions designed to prevent mortality from cardiovascular disease (CVD). The NHLBI research agenda for primary prevention of CVD has involved a balance of basic, translational, clinical, and population science. One important advance occurred when the Framingham Heart Study coined the term CVD “risk factors,” which paved the way for the in-depth characterization of the “preclinical” pathobiology of CVD. The identification of preclinical biomarkers of CVD led to seminal scientific breakthroughs such as the elucidation of low-density lipoprotein metabolism and the identification of key drug targets for CVD preventive interventions. Over the past 25 years, this research agenda has changed the natural history of the disease, decreased coronary heart disease death rates by 60%, and added nearly 25 years to the lifespan of people in the United States since the 1950s. At the same time, recognition of exposure to tobacco smoke as a major risk for both heart and lung disease was critically important in the success of the CVD primary prevention agenda.