One Hundred Years of the AHA: Looking Back to Focus on the Future

The American Heart Association (AHA) is celebrating its centennial today with a sage and inspiring history offered by Eugene Braunwald: I have a few additional thoughts. Allow me to further expound on this celebration. After all, a centennial only happens once every 100 years.

It is of paramount importance that we describe these 100 years as journeys in discovery science, the transition from observation and anecdote to hypothesis-driven rigorous randomized trials, the evolving and now refined science of cardiovascular disease prevention, the overt inclusion of stroke as a bona fide cardiovascular disease responsive now to state-of-the-art evidence-based interventions, the paradigm shift in biology from physiology to cell and molecular biology then genomics and now data science. Most recently our focus addresses the intersectionality of disease and communities and the recalcitrant burden of health inequities on manifest display in our CVD space if only because of the ubiquity of heart disease.

We also should highlight the unwavering commitment of the AHA to science. The organization has and continues to fund exploratory science in the billions of dollars, second only to the National Institutes of Health. This commitment is paralleled by our indefatigable support of early-career investigators. How many cardiology leaders and investigators received a first grant-in-aid from the AHA? I certainly did. Consider the scientific discoveries aligned with the AHA: the importance of atherosclerosis; the LDL hypothesis; the etiology of myocardial infarction; the first-ever definition of health (Life’s Simple 7, expanded to be Life’s Essential 8 in 2022); and myriad programs dedicated to enabling better health beginning in childhood, now focused also on the attainment of health equity.

As a volunteer not-for-profit organization with more than 30 million members, our resolve to change the burden of CVD has led to extraordinary advocacy efforts. These have resulted in reduced tobacco use, increased hypertension awareness, as well as radical shifts in dietary patterns increasingly attuned to diabetes, social determinants of health, and most recently obesity—a predominant theme at our AHA 2023 Scientific Sessions. The aggregate outcome of our strident advocacy is reflected in the remarkable 50% reduction in death due to heart disease and stroke over the past several decades. No other disease entity associates with such a remarkable response to a portfolio of advocacy, prevention, and treatment.  
Like any organization, we are imperfect. We continue to face the recalcitrant prominence of modifiable risk factors; there remain major health inequities; and while we celebrated the introduction of the Affordable Care Act (AHA), we must acknowledge that ideal, equitable access to healthcare remains an unrequited goal. Over 10 years since implementation, the ACA remains a work in progress, with political and fiscal vulnerabilities. Our advocacy must continue.

Nevertheless, we are unceasingly hopeful for the future. As we contemplate how far we’ve come in the past 100 years, imagine where we might go in the next. We launched the “One Brave Idea” intended to find the solution—a cure—for coronary artery disease. Even to articulate the resolve and grit to tackle this is noteworthy. We are well within our exciting research framework of Strategically Focused Research Networks that address and solve our most compelling cardiovascular questions. Just recently we launched Food Is Medicine, which radically reconsiders how we view nutrition. And, again at our 2023 meeting, we were inspired by our current president, Joseph Wu, with a true view into a future where adaptation not to space travel but life in space was the focus.

This was and is our AHA: from Dr. Braunwald’s riveting review of our history to where we are today. There is reason to pause and say “wow.” Today we stand on our foundational pillars of discovery science, prevention science, cohort discoveries, and precise observational science derived from a sterling portfolio of registry data, rigorous randomized clinical trials, and a soaring embrace of population health, population science, and most recently data science. We have a well-earned voice and use advocacy to drive our change. No matter if you are an investigator, physician, nurse, early-career professional, student, heart disease survivor, caregiver, healthcare system, or an academic medical center, we are present in your world for good.

We persist, we thrive, as a relentless force, not only to explore great science, treat disease, and reduce the burden of death and disability, but also as an inspired health organization focused on providing best health, best health outcomes, and best health span to all, now and in the future.

Off Script is a first-person blog written by leading voices in the field of cardiology. It does not reflect the editorial position of TCTMD.