Opinion
Editorials represent the opinions of the authors and JAMA and not those of the American Medical Association.
EDITORIAL
The Cardiovascular Disease Researcher J. Michael Gaziano, MD; Eric Peterson, MD
Each year at the time of the American Heart Association (AHA) Scientific Sessions, we devote an issue of JAMA to cardiovascular disease (CVD). The issue provides an opportunity to focus on some of the latest findings and to provide viewpoints on important challenges ahead. This year, as tens of thousands gather at the AHA meeting in Dallas, Texas, to share their work and learn from others, we acknowledge and celebrate the dedication of the researchers responsible for this important work. Combined, the CVD research community has had an amazing influence on the health of nations. As an example, deaths from CVD in the United States have declined 60% from the peak in the mid-1960s. These improvements in part reflect the continuous refinement in the understanding of the underlying pathophysiology of CVD and through the development of new ways to improve detection, prognosis, and treatment. Researchers of CVD represent numerous disciplines and include biochemists and other basic scientists, epidemiologists and ethicists, computational biologists and bioengineers, statisticians and trialists, health informaticists and health service researchers, and health policy and economics experts. Some work only as investigators, while others have hybrid careers as physicians, nurses, psychologists, and physician assistants who conduct important research. The researchers are also supported by scores of laboratory technicians, database programmers and analysts, project managers, patient recruiters, and budget and contracting personnel who perform countless often hidden and thankless tasks that are vital to the success of the research endeavor. What allowed for the development of this important scientific workforce that is such an essential part of the health industry? In the post–World War II era, government funding transformed academic medical centers by permitting faculty to dedicate an increasing portion of their effort to research. This support was followed by substantial investment by expanding drug and device industries that developed extensive research and development activities and also supported research at academic medical centers. This academic-industry-government collaboration has permitted a robust research community to be established and flourish. Although the nature of the science and its setting may vary, there are a number of essential characteristics of the health care researcher regardless of the discipline. One unifying feature is dedication. Years of personal sacrifice are often necessary to develop the skill sets needed to pursue a research career. Research is often conducted outside the hours of busy clinical training or practice. There needs to be an understanding that the daily schedule may not be regular. Experiments or grant writing sessions may extend late into the night. The fami2048
lies and friends of most researchers have learned that they need to share their loved ones with the researchers’ other demanding priority, science. This theme issue of JAMA is a shining testament to CVD researchers and their dedication to research. This year we had an overwhelming response to our solicitation for papers for the CVD theme issue, with more than 400 manuscripts submitted for consideration. Among these submitted manuscripts, 5 major articles and 4 Viewpoints are published in this issue of JAMA. In addition, 7 late-breaking clinical trials are being published online to coincide with their AHA presentation, other reports will be published in upcoming issues of JAMA, and still other studies are being published in JAMA Internal Medicine. The articles in this issue of JAMA address several important topics in CVD, including atrial fibrillation, aortic valve disease, cholesterol measurement, and coronary artery disease. In a randomized trial by Abed and colleagues,1 a weight loss intervention among obese patients with atrial fibrillation reduced the burden of atrial fibrillation events and improved symptoms. Barreto-Filho and colleagues 2 documented national trends in surgical aortic valve replacement (AVR) among Medicare beneficiaries from 1999 to 2011, and they report an increase in use of AVR procedures and reduced 30-day postoperative mortality. Based on data from the national Transcatheter Valve Registry, Mack and colleagues3 report exciting initial findings from a novel intervention— transcatheter AVR— and document that in-hospital mortality rates were similar to those in clinical trials of this device. The article by Martin and colleagues4 identifies new means of more accurately estimating low-density lipoprotein cholesterol levels, thereby supporting better risk stratification and treatment. In a thoughtful clinical review article, Deb and colleagues5 summarize the state of the art evidence on coronary artery bypass graft surgery compared with percutaneous coronary interventions for patients with advanced coronary artery disease. This issue of JAMA also includes 4 scholarly Viewpoints on timely topics in cardiovascular medicine. McLean and Jessup6 discuss the challenge of treating heart failure in an increasingly diverse population and suggest that no group of patients, as defined by sex, race, and ethnicity, should be left behind. Butler and colleagues,7 also discussing heart failure, suggest that the high disease burden and lack of significant progress in heart failure is based, in part, in medical and societal underappreciation of the disease burden associated with failure, and they recommend increased attention, advocacy, and investment in addressing this disease. Califf and Platt8 highlight key limitations of the current research system and
JAMA November 20, 2013 Volume 310, Number 19
Copyright 2013 American Medical Association. All rights reserved.
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Editorial Opinion
describe an evolving national infrastructure with the potential to increase cardiovascular health research substantially. Mordwinkin and colleagues9 discuss advances that have occurred since the discovery of human-induced pluripotent stem cells and suggest that by providing a more powerful platform for the identification of novel cardiovascular therapeutic targets and compounds, approaches using this dynamic technology may help foster efficient productivity in the pharmaceutical research and development process. The articles in this CVD theme issue focus on just a few diseases for which important gains have been made through substantial investment in cardiovascular research by dedicated investigators, but many challenges remain. The world population ARTICLE INFORMATION Author Affiliations: VA Boston Healthcare System and Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts (Gaziano); Associate Editor, JAMA (Gaziano, Peterson); Duke University Medical Center, Durham, North Carolina (Peterson). Corresponding Author: J. Michael Gaziano, MD, Division of Aging, Brigham and Women's Hospital, 1620 Tremont St, Boston, MA 02120-1613 ( [email protected]). Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
is aging. Cardiovascular disease has become the major cause of morbidity and mortality globally. While age-adjusted CVD mortality rates are declining in some parts of the world, these rates are increasing rapidly in other areas. Moreover, where CVD deaths rates are decreasing, more people are living longer with CVD. To meet the evolving challenges associated with the burden of CVD, there will need to be continued support for the community of CVD researchers and their dedication will clearly be needed to address these challenges. As many CVD researchers come together this year in Dallas, it is fitting and proper to say thanks for the dedication and contributions that the research community has made and continues to make to improve the lives of many around the world.
2. Barreto-Filho JA, Wang Y, Dodson JA, et al. Trends in aortic valve replacement for elderly patients in the United States, 1999-2011. JAMA. 2013;310(19):2078-2085. 3. Mack MJ, Brennan JM, Brindis R, et al; for the STS/ACC TVT Registry. Outcomes following transcatheter aortic valve replacement in the United States. JAMA. 2013;310(19):2069-2077. 4. Martin SS, Blaha MJ, Elshazly MB, et al. Comparison of a novel method vs the Friedewald equation for estimating low-density lipoprotein cholesterol levels from the standard lipid profile. JAMA. 2013;310(19):2061-2068. 5. Deb S, Wijeysundera HC, Ko DT, Tsubota J, Hill S, Fremes SE. Coronary artery bypass graft surgery vs percutaneous interventions in coronary
revascularization: a systematic review. JAMA. 2013;310(19):2086-2095. 6. McLean RC, Jessup M. The challenge of treating heart failure: a diverse disease affecting diverse populations. JAMA. 2013;310(19):2033-2034. 7. Butler J, Fonarow GC, Gheorghiade M. Need for increased awareness and evidence-based therapies for patients hospitalized for heart failure. JAMA. 2013;310(19):2035-2036. 8. Califf RM, Platt R. Embedding cardiovascular research into practice. JAMA. 2013;310(19):20372038. 9. Mordwinkin NM, Lee AS, Wu JC. Patient-specific stem cells and cardiovascular drug discovery. JAMA. 2013;310(19):2039-2040.
REFERENCES 1. Abed HS, Wittert GA, Leong DP, et al. Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial. JAMA. 2013;310(19):2050-2060.
jama.com
JAMA November 20, 2013 Volume 310, Number 19
Copyright 2013 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a UB-Universitaets Landesbibliothek Dusseldorf User on 12/03/2013
2049
Editorials represent the opinions of the authors and JAMA and not those of the American Medical Association.
EDITORIAL
The Cardiovascular Disease Researcher J. Michael Gaziano, MD; Eric Peterson, MD
Each year at the time of the American Heart Association (AHA) Scientific Sessions, we devote an issue of JAMA to cardiovascular disease (CVD). The issue provides an opportunity to focus on some of the latest findings and to provide viewpoints on important challenges ahead. This year, as tens of thousands gather at the AHA meeting in Dallas, Texas, to share their work and learn from others, we acknowledge and celebrate the dedication of the researchers responsible for this important work. Combined, the CVD research community has had an amazing influence on the health of nations. As an example, deaths from CVD in the United States have declined 60% from the peak in the mid-1960s. These improvements in part reflect the continuous refinement in the understanding of the underlying pathophysiology of CVD and through the development of new ways to improve detection, prognosis, and treatment. Researchers of CVD represent numerous disciplines and include biochemists and other basic scientists, epidemiologists and ethicists, computational biologists and bioengineers, statisticians and trialists, health informaticists and health service researchers, and health policy and economics experts. Some work only as investigators, while others have hybrid careers as physicians, nurses, psychologists, and physician assistants who conduct important research. The researchers are also supported by scores of laboratory technicians, database programmers and analysts, project managers, patient recruiters, and budget and contracting personnel who perform countless often hidden and thankless tasks that are vital to the success of the research endeavor. What allowed for the development of this important scientific workforce that is such an essential part of the health industry? In the post–World War II era, government funding transformed academic medical centers by permitting faculty to dedicate an increasing portion of their effort to research. This support was followed by substantial investment by expanding drug and device industries that developed extensive research and development activities and also supported research at academic medical centers. This academic-industry-government collaboration has permitted a robust research community to be established and flourish. Although the nature of the science and its setting may vary, there are a number of essential characteristics of the health care researcher regardless of the discipline. One unifying feature is dedication. Years of personal sacrifice are often necessary to develop the skill sets needed to pursue a research career. Research is often conducted outside the hours of busy clinical training or practice. There needs to be an understanding that the daily schedule may not be regular. Experiments or grant writing sessions may extend late into the night. The fami2048
lies and friends of most researchers have learned that they need to share their loved ones with the researchers’ other demanding priority, science. This theme issue of JAMA is a shining testament to CVD researchers and their dedication to research. This year we had an overwhelming response to our solicitation for papers for the CVD theme issue, with more than 400 manuscripts submitted for consideration. Among these submitted manuscripts, 5 major articles and 4 Viewpoints are published in this issue of JAMA. In addition, 7 late-breaking clinical trials are being published online to coincide with their AHA presentation, other reports will be published in upcoming issues of JAMA, and still other studies are being published in JAMA Internal Medicine. The articles in this issue of JAMA address several important topics in CVD, including atrial fibrillation, aortic valve disease, cholesterol measurement, and coronary artery disease. In a randomized trial by Abed and colleagues,1 a weight loss intervention among obese patients with atrial fibrillation reduced the burden of atrial fibrillation events and improved symptoms. Barreto-Filho and colleagues 2 documented national trends in surgical aortic valve replacement (AVR) among Medicare beneficiaries from 1999 to 2011, and they report an increase in use of AVR procedures and reduced 30-day postoperative mortality. Based on data from the national Transcatheter Valve Registry, Mack and colleagues3 report exciting initial findings from a novel intervention— transcatheter AVR— and document that in-hospital mortality rates were similar to those in clinical trials of this device. The article by Martin and colleagues4 identifies new means of more accurately estimating low-density lipoprotein cholesterol levels, thereby supporting better risk stratification and treatment. In a thoughtful clinical review article, Deb and colleagues5 summarize the state of the art evidence on coronary artery bypass graft surgery compared with percutaneous coronary interventions for patients with advanced coronary artery disease. This issue of JAMA also includes 4 scholarly Viewpoints on timely topics in cardiovascular medicine. McLean and Jessup6 discuss the challenge of treating heart failure in an increasingly diverse population and suggest that no group of patients, as defined by sex, race, and ethnicity, should be left behind. Butler and colleagues,7 also discussing heart failure, suggest that the high disease burden and lack of significant progress in heart failure is based, in part, in medical and societal underappreciation of the disease burden associated with failure, and they recommend increased attention, advocacy, and investment in addressing this disease. Califf and Platt8 highlight key limitations of the current research system and
JAMA November 20, 2013 Volume 310, Number 19
Copyright 2013 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a UB-Universitaets Landesbibliothek Dusseldorf User on 12/03/2013
jama.com
Editorial Opinion
describe an evolving national infrastructure with the potential to increase cardiovascular health research substantially. Mordwinkin and colleagues9 discuss advances that have occurred since the discovery of human-induced pluripotent stem cells and suggest that by providing a more powerful platform for the identification of novel cardiovascular therapeutic targets and compounds, approaches using this dynamic technology may help foster efficient productivity in the pharmaceutical research and development process. The articles in this CVD theme issue focus on just a few diseases for which important gains have been made through substantial investment in cardiovascular research by dedicated investigators, but many challenges remain. The world population ARTICLE INFORMATION Author Affiliations: VA Boston Healthcare System and Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts (Gaziano); Associate Editor, JAMA (Gaziano, Peterson); Duke University Medical Center, Durham, North Carolina (Peterson). Corresponding Author: J. Michael Gaziano, MD, Division of Aging, Brigham and Women's Hospital, 1620 Tremont St, Boston, MA 02120-1613 ( [email protected]). Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
is aging. Cardiovascular disease has become the major cause of morbidity and mortality globally. While age-adjusted CVD mortality rates are declining in some parts of the world, these rates are increasing rapidly in other areas. Moreover, where CVD deaths rates are decreasing, more people are living longer with CVD. To meet the evolving challenges associated with the burden of CVD, there will need to be continued support for the community of CVD researchers and their dedication will clearly be needed to address these challenges. As many CVD researchers come together this year in Dallas, it is fitting and proper to say thanks for the dedication and contributions that the research community has made and continues to make to improve the lives of many around the world.
2. Barreto-Filho JA, Wang Y, Dodson JA, et al. Trends in aortic valve replacement for elderly patients in the United States, 1999-2011. JAMA. 2013;310(19):2078-2085. 3. Mack MJ, Brennan JM, Brindis R, et al; for the STS/ACC TVT Registry. Outcomes following transcatheter aortic valve replacement in the United States. JAMA. 2013;310(19):2069-2077. 4. Martin SS, Blaha MJ, Elshazly MB, et al. Comparison of a novel method vs the Friedewald equation for estimating low-density lipoprotein cholesterol levels from the standard lipid profile. JAMA. 2013;310(19):2061-2068. 5. Deb S, Wijeysundera HC, Ko DT, Tsubota J, Hill S, Fremes SE. Coronary artery bypass graft surgery vs percutaneous interventions in coronary
revascularization: a systematic review. JAMA. 2013;310(19):2086-2095. 6. McLean RC, Jessup M. The challenge of treating heart failure: a diverse disease affecting diverse populations. JAMA. 2013;310(19):2033-2034. 7. Butler J, Fonarow GC, Gheorghiade M. Need for increased awareness and evidence-based therapies for patients hospitalized for heart failure. JAMA. 2013;310(19):2035-2036. 8. Califf RM, Platt R. Embedding cardiovascular research into practice. JAMA. 2013;310(19):20372038. 9. Mordwinkin NM, Lee AS, Wu JC. Patient-specific stem cells and cardiovascular drug discovery. JAMA. 2013;310(19):2039-2040.
REFERENCES 1. Abed HS, Wittert GA, Leong DP, et al. Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial. JAMA. 2013;310(19):2050-2060.
jama.com
JAMA November 20, 2013 Volume 310, Number 19
Copyright 2013 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a UB-Universitaets Landesbibliothek Dusseldorf User on 12/03/2013
2049
![[Researcher of the month].](/assets/img/hold.png)
