Biomedical Research in CVD: More Investment Today Will Yield Long-term Rewards

Biomedical research, though costly and time consuming, will ultimately repay society by lowering healthcare costs and staving off lost productivity, according to a new scientific statement from the American Heart Association (AHA). Its authors say the document should serve as a reminder that despite the gains made in cardiovascular disease treatments and prevention, scientists cannot “rest on [their] laurels” but need to engage in the fight against cardiovascular disease from the ground up.

“For the last decade, biological research has been under siege owing to tightening budgets at the taxpayer-funded National Institutes and Health (NIH) and private funders,” writing committee chair Joseph A. Hill, MD, PhD (University of Texas Southwestern Medical Center, Dallas), said in a press release. The AHA document, which was published online Monday in Circulation Research, notes that current NIH funding levels are approximately 25% lower than they were 13 years ago when considering inflation.

Hill, who serves as editor-in-chief of the journal Circulation, told TCTMD that these concerns bridge across political divisions. “If you talk to lawmakers across the political spectrum, from Bernie Sanders on one end to Ted Cruz on the other, across that spectrum everybody wants to cure heart disease [and] everybody wants to cure cancer,” he said, suggesting that the stronger argument, then, isn’t about curing disease but about the societal consequences over a longer horizon.

Eventually “we will bankrupt our society with people who have heart failure and Alzheimer’s disease and are institutionalized in nursing homes,” Hill stressed. The best way to “bend the cost curve of ever-spiraling-upward expenditures in healthcare,” he said, “is by tackling it at the front end” via biomedical research.

The Trump administration has called for decreases in research funding across many agencies, and the situation is evolving, Hill noted. “Draconian, catastrophic cuts have been proposed, but it’s my understanding that they’re unlikely to move forward.”

Douglas Mann, MD (Washington University School of Medicine in St. Louis, MO), editor-in-chief of JACC: Basic to Translational Science, pointed out to TCTMD that regardless of which agency or medical specialty they affect, “all cuts to basic science or translational science or clinical science will eventually negatively impact healthcare for Americans.”

Moreover, “lapses in funding have a dramatic chilling effect on training the next generation [of researchers],” he said. “When young trainees are trying to decide whether they want to dedicate their career to basic investigative research and then they see that the funding lines are low and their mentors can’t get funded, they’re not going to go into that. They’ll choose something else.”

This “collateral damage” will dampen the ability to develop new therapies 15 years from now, Mann predicted.

It All Starts With Basic Research

Giving an outside perspective, Mann said he strongly agreed with the AHA statement’s assertions.

“All of the major advances in cardiology have come from the basic science origin, and cardiovascular disease remains the number one killer, so . . . continued funding for basic research will be the future of cardiology now and for the foreseeable future,” Mann commented. Several clinical trials recently in the news, including CANTOS and FOURIER, he said, stemmed from basic science.

When it comes to funding, “all of these investments are in the best interests of the health of the American people,” Mann stressed. “What portion of society’s taxes should go to that versus all the other worthy causes? I can’t comment. But I do feel that we [in the] cardiovascular community have been very good about being good stewards of the resources, using the knowledge to develop new therapies that improve the lives of Americans.”

According to the AHA statement, there are numerous factors that together are making the problem of cardiovascular disease more acute at a societal level even though age-adjusted mortality from heart disease “has declined an astonishing 75% over the past 50 years.”

Now, patients who would have died from their disease are surviving longer with injured hearts, the document points out. This combined with the overall aging of the population, ever more unhealthy lifestyles, and an uptick in obesity “have culminated in robust increases in the prevalence of heart failure, a chronic condition that can persist for years, causing untold suffering and entailing considerable expense,” Hill and colleagues write. They report that by 2030, it’s estimated that more than 40% of the US population will have heart failure or another type of CV disease, with costs exceeding $1 trillion.

Return on Investment

To further studies that will meet these needs, the statement co-authors say, the “biomedical research community must do a better job of defining, quantifying, and articulating” what sort of return on investment (ROI) society can expect to gain.

“Critically, we do not recommend that funding by NIH or the American Heart Association target primarily short-term gain to society. Reaping the ROI in basic research requires a longer perspective,” they advise. Rather than taking on the “mentality of venture capital investing,” which seeks immediate gains, “fundamental research must occur in the context in which clinical or commercial benefit may not provide immediate tangible return,” Hill and colleagues note. “Watson and Crick did not solve the double-helix structure of DNA seeking short-term, economic benefit. However, no one would question the enormous gain to society that has accrued from their work.”

As Hill put it to TCTMD, “we have an obligation to explain to society why what we do is important. It’s just not manifestly apparent at the surface. People who aren’t facile with these concepts don’t understand why you do experiments in mice, or why you study cells in culture, or zebrafish, or Drosophila. . . . There’s no reason why they’d be born understanding why that’s important, and yet we ask society to invest in this.”

Mann recently wrote an editorial on the 2017 March for Science that calls on researchers to raise awareness. “We as scientists don’t necessarily communicate effectively, and some of the burden is on us to more effectively communicate why what we do is important for everyone,” he stressed.