Institutes and Research Divisions
Heart, Lung, and Blood Institute

The National Heart, Lung, and Blood Institute (NHLBI):

  • Provides leadership for a national program in diseases of the heart, blood vessels, lungs, and blood; sleep disorders; and blood resources management.

  • Plans, conducts, fosters, and supports an integrated and coordinated program of basic research, clinical investigations and trials, observational studies, demonstration and education projects related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, blood diseases, and sleep disorders conducted in its own laboratories and by scientific institutions and individuals supported by research grants and contracts.


    Important Events in NHLBI History

    June 16, 1948--President Harry S Truman signed the National Heart Act, creating and establishing the National Heart Institute in PHS and the National Advisory Heart Council.

    July 7, 1948--The services of Dr. Paul Dudley White were secured under section 4b of the Heart Act "to be Executive Director of the National Advisory Heart Council and Chief Medical Advisor to the National Heart Institute."

    August 1, 1948--Surgeon General Leonard A. Scheele, by General Circular No. 36, Organization Order No. 14, established NHI as one of the National Institutes of Health to administer functions of heart research, training, and administration set forth in the National Heart Act. Intramural research projects in cardiovascular diseases and gerontology conducted elsewhere in NIH were transferred to NHI. The director of NHI was designated as the focal point of leadership and coordination for the total heart program of PHS.

    August 29, 1948--Surgeon General Scheele announced the names of the 16 members appointed to the first National Advisory Heart Council.

    September 8, 1948--The first meeting of the National Advisory Heart Council was held.

    January 1949--Cooperative research units were established at the University of California, University of Minnesota, Tulane University, and Massachusetts General Hospital, jointly financed by the institutions and NIH, pending completion of NHI's own research organization and the availability of further research facilities.

    July 1, 1949--A comprehensive plan for NHI's intramural research program was instituted, organized on three general research levels, with three laboratory sections, five laboratory-clinical sections, and four clinical sections.

    The Heart Disease Epidemiology Study at Framingham, Mass., was transferred from the Bureau of State Services, PHS, to NHI.

    January 18-20, 1950--The first National Conference on Cardiovascular Diseases, sponsored by NHI and the American Heart Association, was held in Washington, D.C.

    July 6, 1953--The first patient was admitted to the Clinical Center for heart disease research.

    July 1, 1957--The first members of NHI's Board of Scientific Counselors began their terms. It was established in 1956 "to provide advice on matters of general policy, particularly from a long-range viewpoint, as they relate to the intramural research program."

    February 19, 1959--A report to the Nation was presented by the American Heart Association and NHI on "A Decade of Progress Against Cardiovascular Disease," at Department of Commerce, Washington, D.C.

    April 21, 1961--The President's Conference on Heart Disease and Cancer, whose participants on March 15 were requested by President John F. Kennedy to assist "in charting the Government's further role in a National attack" on these diseases, convened at the White House and submitted its report.

    December 30, 1963--President Lyndon B. Johnson approved a joint resolution, unanimously passed by the Congress, to provide for designating the month of February in each year as "American Heart Month."

    November 22-24, 1964--The Second National Conference on Cardiovascular Diseases was held at Washington, D.C., under cosponsorship of the American Heart Association, NHI and Heart Disease Control Program of PHS, to appraise developments since the first conference in 1950 and to determine needs and opportunities for continued and accelerated progress against heart and blood vessel diseases.

    December 9, 1964--The President's Commission on Heart Disease, Cancer and Stroke, appointed by President Lyndon B. Johnson, March 7, 1964, to "recommend steps that can be taken to reduce the burden and incidence of these diseases," submitted its report.

    October 16, 1968--A Nobel Prize in Physiology or Medicine was awarded to Dr. Marshall W. Nirenberg, chief of NHI's Laboratory of Biochemical Genetics, for discovering the key to deciphering the genetic code. Dr. Nirenberg was the first NIH Nobel laureate and the first Federal employee to receive a Nobel Prize.

    October 26, 1968--NHI received the National Hemophilia Foundation's Research and Scientific Achievement Award for its "medical leadership ... tremendous stimulation and support of research activities directly related to the study and treatment of hemophilia."

    November 14, 1968--The 20th anniversary of NHI was commemorated at the White House, with President Johnson and a notable array of prominent figures associated with NHI, past and resent, participating.

    August 12, 1969--Major provisions of NHI reorganization plan established five program branches in extramural programs (arteriosclerotic disease, cardiac disease, pulmonary disease, hypertension and kidney diseases, and thrombosis and hemorrhagic diseases); a Therapeutic Evaluations Branch and an Epidemiology Branch under the associate director for clinical applications; and three offices in the Office of the Director (heart information, program planning, and administrative management).

    November 10, 1969--National Heart Institute was renamed the National Heart and Lung Institute, reflecting expansion of functions.

    February 18, 1971--In his Health Message to the Congress, the President identified sickle cell anemia as a high-priority disease target and called for increased Federal expenditures. Subsequently, the DHEW assistant secretary for health and scientific affairs, assigned the lead-agencies responsibilities for coordinating a National Sickle Cell Disease Program to NIH and NHLI.

    March 24, 1972--President Nixon named Dr. John S. Millis to head a 20-member panel "to determine why heart disease is so prevalent and so menacing and what can be done about it."

    March 27-31, 1972--First meeting of U.S.-U.S.S.R. Joint Committee for Health Cooperation was held to develop and plan an approach to the health exchange program in several specific areas, including the cardiovascular field. The NHLI director is a member of the committee.

    May 23, 1972--A 5-year agreement for a Cooperative Health Program was signed by W. P. Rogers, U.S. secretary of state, and B. V. Petrovsky, U.S.S.R. minister of health. The agreement calls for cooperative studies in pathogenesis of arteriosclerosis; management of ischemic heart disease; myocardial metabolism; congenital heart disease; sudden death; and blood transfusions, blood components, and the prevention of hepatitis.

    June 12, 1972--HEW Secretary Richardson approved a nationwide program of hypertension information and education. The secretary appointed the Hypertension Information and Education Advisory Committee, chaired by the director, NIH; and the Interagency Working Group, chaired by the director, NHLI, to implement the national effort. A High Blood Pressure Information Center was established within the NHLI Office of Information to collect and disseminate public and professional information about this disease.

    July 1972--The NHLBI launched the National High Blood Pressure Education Program.

    July 14, 1972--HEW Secretary Richardson approved a reorganization of NHLI, elevating the institute to bureau status within NIH, with seven division-level components: Office of Director, Division of Heart and Vascular Diseases, Division of Lung Diseases, Division of Blood Diseases and Resources, Division of Intramural Research, Division of Technological Applications, and Division of Extramural Affairs.

    July 24, 1973--The 5-volume National Heart, Blood Vessel, Lung and Blood Program was transmitted to Congress. The comprehensive, 5-year plan of attack against heart, blood vessel, lung and blood diseases and research and management of blood resources was developed by the director, NHLI, with the advice of the National Heart and Lung Advisory Council, in accordance with a provision of the National Heart, Blood Vessel, Lung and Blood Act of 1972 (P.L. 92-423).

    April 5, 1974--The HEW assistant secretary for health released the Report to the President by the President's Advisory Panel on Heart Disease. The report surveys the problem of heart and blood vessel disorders and recommends how illness and death from these disorders may be reduced.

    August 2, 1974--Regulations were approved governing the establishment, support, and operation of National Research and Demonstration Centers for heart, blood vessel, lung, and blood diseases. The regulations concern the implementation of section 415(b) of the PHS act, as amended by the National Heart, Blood Vessel, Lung and Blood Act of 1972, which authorized the establishment and support of National Research and Demonstration Centers.

    June 25, 1976--NHLI was redesignated the National Heart, Lung, and Blood Institute by an amendment to Public Health Service Act (P.L. 94-278). This further enlarged institute authority to advance the national attack on heart, blood vessel, lung, and blood diseases and the conduct of research in the use of blood and blood products and in the management of blood resources.

    July 1, 1976--The National High Blood Pressure Education Program releases the first Joint National Committee Report on the Detection, Evaluation, and Treatment of High Blood Pressure.

    October 28, 1977--The U.S.-U.S.S.R. Cooperative Health Program was renewed for another 5 years with the signing of an agreement by Dr. Julius B. Richmond, HEW assistant secretary for health, and Dr. Dmitri D. Venedictov, U.S.S.R. deputy minister of health.

    February 1978--The NHLBI and American Heart Association jointly celebrated their 30th anniversary.

    September 1979--The Task Force on Hypertension, established in September 1975 to assess the current state of hypertension research, completed its in-depth survey and recommendations for improved prevention, treatment, and control in 14 major areas. These recommendations are intended to guide the NHLBI in its future efforts.

    November 1979--The results of the Hypertension Detection and Followup Program, a major clinical trial started in 1971, provided evidence that tens of thousands of lives are being saved through treatment of mild hypertension and that perhaps thousands more could be saved annually if all people with mild hypertension were under treatment.

    November 21, 1980--The Albert Lasker Special Public Health Award is presented to the institute for its Hypertension Detection and Followup Program, "which stands alone among clinical studies in its profound potential benefit to millions of people."

    September 8, 1981--A Working Group on Arteriosclerosis, convened in 1978 to assess present understanding, to highlight unresolved problems, and to emphasize opportunities for future research in arteriosclerosis, completed its report. Volume I presents conclusions and recommendations in nontechnical language. Volume II provides in-depth substantial basis for the conclusions and recommendations contained in volume I.

    October 2, 1981--The Beta-Blocker Heart Attack Trial (BHAT) demonstrated benefits to those in the trial who received the drug propranolol compared with the control group.

    October 26, 1983--The Coronary Artery Surgery Study (CASS) results were released. They demonstrated that mildly symptomatic patients with coronary artery disease can safely defer coronary artery bypass surgery until symptoms worsen. Results of this clinical trial will help patients and their physicians decide whether and when bypass surgery should be undertaken. They can base their decisions on firmer scientific footing.

    January 12, 1984--The Lipid Research Clinics Coronary Primary Prevention Trial established conclusively that reducing total blood cholesterol reduces the risk of coronary heart disease in men at increased risk because of raised cholesterol levels. Each 1 percent decrease in cholesterol can be expected to reduce heart attack risk by 2 percent.

    April-September 1984--The Tenth Report of the Director, NHLBI, commemorated the 10th anniversary of the passage of the National Heart, Blood Vessel, Lung, and Blood Act. The publication reviews 10 years of research progress and presents a 5-year research plan for the national program.

    April 1984--The Division of Epidemiology and Clinical Applications was created. The reorganization provides the institute with a focus on clinical trials; prevention, demonstration, and education programs; behavioral medicine; nutrition; epidemiology; and biometry. It also provides opportunities to examine the interrelationships of cardiovascular, respiratory, and blood diseases.

    April 1985--Results of phase I of the thrombolysis in myocardial infarction (TIMI) trial comparing streptokinase (SK) with tissue plasminogen activator (rt-PA) produced by recombinant means were published. The new thrombolytic agent rt-PA is approximately twice as effective as SK in opening thrombosed coronary arteries.

    October 1985--The NHLBI Smoking Education Program was initiated.

    November 1985--The National Cholesterol Education Program was inaugurated.

    June 1986--Results of the prophylactic penicillin trial were released. They demonstrate the efficacy of propylactic use of penicillin in reducing the morbidity and mortality associated with pneumococcal infections in children with sickle cell disease.

    Major national efforts to prevent early death in the at-risk pediatric population are now possible.

    October 1986-September 1987--The NHLBI celebrated its 40th anniversary and the NIH centennial with a year-long series of events. Activities included scientific symposia and conferences, commemorative publications and exhibits, and a reunion of former NHLBI directors.

    October 1987--The NHLBI established the National Blood Resource Education Program.

    March 1989--The NHLBI initiated the National Asthma Education Program.

    September 1990--NHLBI and NCI scientists began the first gene therapy trial in a human patient, a 4-year-old girl with an inherited immune dysfunction.

    January 1991--The NHLBI Obesity Education Initiative began to educate the public and health professionals about obesity as an independent risk factor for cardiovascular disease and its relationship to other risk factors such as high blood pressure and high blood cholesterol.

    February 1991--Expert panel of the National Asthma Education Program released "Guidelines for Diagnosis and Management of Asthma" report to educate physicians and other health care providers in asthma management.

    June 11, 1991--The NHLBI initiated a National Heart Attack Alert Program to reduce premature morbidity and mortality from acute myocardial infarction and sudden death. The program emphasizes rapid disease identification and treatment.

    July 1991--Results of the Systolic Hypertension in the Elderly Program (SHEP) were released. They demonstrate that low-dose pharmacologic therapy of isolated systolic hypertension in those over age 60 significantly reduces stroke and myocardial infarction.

    August 1991--Results of the Studies of Left Ventricular Dysfunction were released. They demonstrated that the use of the angiotensin converting enzyme inhibitor enalapril causes significant reduction in mortality and hospitalization for congestive heart failure in patients with symptomatic heart failure.

    October 30, 1992--The National High Blood Pressure Education Program celebrated is 20th anniversary. The fifth Joint National Committee Report on the Detection, Evaluation, and Treatment of High Blood Pressure and the first report on the Primary Prevention of Hypertension were released.

    June 15, 1993--The Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults was released.

    January 30, 1995--Results of the Multicenter Study of Hydroxyurea were released through a clinical alert. They demonstrate that hydroxyurea reduced the number of painful episodes by 50 percent in severely affected adults with sickle cell disease. This is the first effective treatment for adult patients with this disorder.

    September 21, 1995--Results of the Bypass Angioplasty Revascularization Investigation were released through a clinical alert. They demonstrate tht patients on drug treatment for diabetes who had blockages in two or more conronary arteries and were treated with conronary artery bypass surgery (CABG) had, at 5 years, a markedly lower death rate than similar patients treated with angioplasty. The clinical alert recommends CABG over standard angioplasty for patients on drug therapy for diabetes who have multiple coronary blockages and are first-time candidates for either procedure.


    NHLBI Legislative Chronology

    June 16, 1948--The National Heart Act (P.L. 80-655) authorized NHI. The purpose of the act was "To improve the health of the people of the United States through the conduct of researches, investigations, experiments, and demonstrations relating to the cause, prevention, and method of diagnosis and treatment of diseases of the heart and circulation; assist and foster such researches and other activities by public and private agencies, and promote the coordination of all such researches and activities and the useful application of their results; provide training in matters relating to heart diseases, including refresher courses for physicians; and develop, and assist States and other agencies in use of the most effective methods of prevention, diagnosis, and treatment of heart diseases."

    June 25, 1948--The Second Deficiency Appropriation Act of 1948 (P.L. 80-785) appropriated "For an additional amount, Fiscal year 1949 for `National Institute of Health, operating expenses,' $500,000: Provided, that appropriations under said head for the Fiscal year 1949 shall be available for carrying out the purposes of the National Heart Act, including erection of temporary structures for storage of equipment and supplies and housing of animals."

    June 29, 1949--The Labor-Federal Security Appropriation Act 1950 (P.L. 141) appropriated $10,725,000 for expenses necessary to carry out the purposes of the National Heart Act, including grants-in-aid for drawing plans, erection of buildings, and acquisition of land therefor, and, in addition to the amount appropriated, authorized "the Surgeon General, upon recommendations of the National Advisory Heart Council, to approve applications for research and training grants, including grants for drawing plans, erection of buildings, and acquisition of land therefor, not to exceed a total of $5,350,000, for periods beyond the current Fiscal year, and such grants shall, if approved during the current Fiscal year, constitute a contractual obligation of the Federal Government."

    August 15, 1950--The Omnibus Act of 1950 (P.L. 81-692) provided for the termination of all appointments to the heart and other councils on September 30, and for appointment of a full new membership on October 1, 1950. The act established uniformity in composition of membership and term of office for all councils.

    December 30, 1963--House Joint Resolution 848 (P.L. 88-254) of the 88th Congress was approved, which authorized and requested the President to issue an annual proclamation designating February as American Heart Month, inviting governors of states and territories to issue similar proclamations.

    October 6, 1965--P.L. 89-199 provided supplemental appropriations for FY 1966 to implement recommendations of the President's Commission on Heart Disease, Cancer, and Stroke that fall within existing legislative authorities. NHI received funds to expand training programs and plan research centers.

    May 16, 1972--The National Sickle Cell Anemia Control Act (P.L. 92-294) established a national program for the diagnosis, control, and treatment of and research in sickle cell anemia. The act does not mention NHLI but has special pertinence because NHLI has been designated to coordinate the National Sickle Cell Disease Program.

    September 19, 1972--The National Heart, Blood Vessel, Lung, and Blood Act of 1972 (P.L. 92-423) enlarged the authority of the institute to advance the national attack on heart, blood vessel, lung, and blood diseases. The act provides for expanded, intensified, and coordinated institute activities in accordance with a comprehensive, specified National Heart, Blood Vessel, Lung, and Blood Disease Program to be planned by the director and the National Heart and Lung Advisory Council.

    Other provisions include the establishment of prevention and control programs; development of 15 new centers for basic and clinical research, training, demonstration, and prevention programs for heart, blood vessel, and blood diseases; and development of 15 such centers for chronic lung diseases.

    June 25, 1976--Title I of the Health Research and Health Services Amendments of 1976 (P.L. 94-278) redesignated NHLI as National Heart, Lung, and Blood Institute to advance the national attack on heart, blood vessel, lung, and blood diseases, and to conduct research in the use of blood and blood products and in the management of blood resources. The NHLBI director with the aid of the institute's Advisory Council continues to plan the national program under the basic P.L. 92-423 provisions with some refinements.

    August 1, 1977--The Biomedical Research Extension Act of 1977 (P.L. 95-83) reauthorized NHLBI, with continued emphasis on both the national program and related prevention and dissemination activities.

    December 17, 1980--The Health Programs Extension Act of 1980 (P.L. 96-538) reauthorized NHLBI, with continued emphasis on both the national program and related prevention programs.

    September 20, 1988 and November 4, 1988--The National Bone Marrow Donor Registry (P.L. 100-436, P.L. 100-607) was established. With the enactment of these authorization and appropriation measures, NHLBI is given the task of developing an implementation plan for the voluntary bone marrow registry.

    November 4, 1988--The Health Omnibus Extension Act of 1988 (P.L. 100-607) reauthorized NHLBI, with $1.4 billion for programs other than control and $101 million for control programs for FY 1989. In addition, it allocated such sums as are necessary for FY 1990.

    June 10, 1993--The NIH Revitalization Act of 1993 (P.L. 103-43) established the National Center on Sleep Disorders within NHLBI.


    Biographical Sketch of NHLBI Director

    Claude Lenfant, M.D.

    Dr. Lenfant was appointed NHLBI director on July 6, 1982. He was born on October 12, 1928, in Paris, France. He received his B.S. degree in 1948 from the University of Rennes, France, and his M.D. in 1956 from the University of Paris.

    Upon completing his medical studies, he assumed the position of director of the Laboratory of Experimental Surgery, Centre Marie Lannelongue, in Paris. While there he directed research into extracorporeal oxygenation of blood and the use of deep hypothermia in cardiac surgery.

    In 1957 Dr. Lenfant was appointed postdoctoral fellow at the University of Buffalo, and the following year continued that appointment at Columbia University in New York. His postdoctoral interests were directed to respiratory and circulatory physiology.

    Returning to France, he assumed a teaching position as assistant professor of physiology at the University of Lille. He soon returned to the U.S., however, where he was appointed to a joint position in the departments of medicine and of physiology and biophysics at the University of Washington, Seattle. He rose to the rank of professor in both departments. He published extensively on the dynamics of blood-gas exchange in humans and various other species under normal conditions and under conditions of altitude and pressure. Respiratory adaptation to hypoxia, anemia, alkalosis and acidosis also were investigated.

    In 1970 Dr. Lenfant was appointed the first associate director for lung programs of the then National Heart and Lung Institute, and also assumed the position of acting associate director for collaborative research and development programs. This program evolved into the Division of Lung Diseases, formed in 1972, with Dr. Lenfant as its director. For his accomplishments he was awarded the HEW Superior Service Honor Award in 1974. The Division of Lung Diseases continued to grow and to coordinate a strong and diverse program of research into the prevention, diagnosis and treatment of lung diseases.

    He became NIH associate director for international research and director of the Fogarty International Center in 1981, positions he held until his appointment as director of NHLBI. In 1983 he was elected member of the Institute of Medicine, NAS. He was named Distinguished Executive of the Senior Executive Service in 1991 and Federal Executive of the year for 1992 by the institute alumni association.

    Dr. Lenfant received the Surgeon General's Exemplary Award in 1993, the American Academy of Allergy and Immunology and the Giovanni Lorenzi Foundation Prize for the Advancement of Biomedical Science in 1994, and the Laura Graves Award--National Marrow Donor Program and the Consortium of Southeastern Hypertension Centers' Excellence in Leadership Award in 1995

    He holds honorary degrees from the universities in Taipei, Taiwan; Lima, Peru; and from the University of New York at Buffalo (D.Sc., 1988).

    His memberships include the Soviet Union's Academy of Medical Sciences and of the National French Academy of Medicine. He is a fellow of the Royal College of Physicians (London) and an honorary member of the Royal Society of Medicine.

    Dr. Lenfant is a member of a number of professional societies including the American and French Physiological Societies, the American Society for Clinical Research, the American Society for Clinical Investigation, and the Association of American Physicians. He has served on the editorial board of American Journal of Physiology, Journal of Applied Physiology, American Review of Respiratory Disease, Revue Francaise des Maladies Respiratories and the American Journal of Medicine. He is the chief editor of a series of monographs, Lung Biology in Health and Disease that includes 92 volumes. He has published more than 225 papers in his areas of research interest.

    Director's of NHLBI

    NameDate of Birth Dates of Office
    Cassius James Van SlykeDec. 1, 1900 Aug. 1, 1948Nov. 30, 1952
    James WattApr. 28, 1911Dec. 1, 1952Sept. 10, 1961
    Ralph E. Knutti1901Sept. 11, 1961July 31, 1965
    William H. Stewart1921Aug. 1, 1965Sept. 24, 1965
    Robert P. GrantSept. 17, 1915Mar. 8, 1966Aug. 15, 1966
    Donald S. FredricksonAug. 8, 1924Nov. 6, 1966March 1968
    Theodore CooperDec. 28, 1928Mar. 15, 1968Apr. 19, 1974
    Robert L. Ringler (Acting)Mar. 27, 1922Apr. 19, 1974July 14, 1975
    Robert I. LevyMay 3, 1937Sept. 16, 1975September 1981
    Claude LenfantOct. 12, 1928Sept. 6, 1982


    NHLBI Programs

    Heart and vascular diseases affect at least 50 million people and continue as the leading cause of death in the United States. Important progress in the reduction of morbidity and mortality from these diseases has been achieved since 1963, when coronary heart disease mortality was at its peak.

    The NHLBI uses research grants, program project grants, specialized center grants, cooperative agreements, research contracts, research career development awards, and institutional and individual national research service awards to support research and research training. The four program divisions and one center of the NHLBI offer support in the following areas.

    Division of Heart and Vascular Diseases

    The Division of Heart and Vascular Diseases plans and directs a program of fundamental and clinical research in heart and vascular diseases. AIDS-associated cardiovascular disorders are also included. The division provides training and career development for research in these areas; specific programs foster career development for minority students and scientists. Among these programs are minority institutional research training awards, minority school faculty development award, research development award for minority faculty, and short-term training for minority students program.

    The division is divided into two program areas: heart research and vascular research. The heart program area oversees research in arrhythmias, bioengineering, ischemic heart disease, congenital and infectious diseases, heart failure, and interventional cardiology. The vascular program supports research in molecular genetics and medicine, atherosclerosis, hypertension; vascular biology, vascular medicine, and cardiovascular homeostasis and bionutrition.

    Arteriosclerosis, coronary heart disease, and hypertension are among the major areas of emphasis within the division's research program. Examples of newly supported projects include:

    Quality-of-life endpoints have become important measures in clinical trials. The division initiated a multicenter, randomized clinical trial to test the efficacy of interventions that provide social support and ameliorate depression in post-MI patients in FY 1995. Coronary heart disease death and reinfarction are the primary endpoints. Secondary outcomes include health-related quality of life and adherence to medical and lifestyle change regimens.

    Another clinical trial recently begun will compare the impact on total mortality of a strategy of attempting to maintain sinus rhythm with antiarrhythmic drugs to a strategy of merely controlling the heart rate. Important secondary endpoints will include quality of life and cost of therapies.

    Several trials have suggested that beta-blockers improve ventricular function in congestive heart failure and may also reduce mortality. While a reasonable theoretical basis and suggestive clinical studies exist, the concept that beta-blockers reduce mortality in congestive heart failure patients remains unproven. The division has initiated a clinical trial to determine whether the addition of a beta-blocking agent to standard therapy reduces the total mortality of patients with moderate to severe congestive heart failure.

    In FY 1995 the division supported Specialized Centers of Research on the genetic determinants of high blood pressure and ischemic heart disease in blacks. Solicitations of applications were issued for research on elucidation of mechanisms responsible for myocardial dysfunction, specifically, those involved in the transition from cardiac hypertrophy to overt heart failure; and for research on atherosclerotic lesions using human tissues.

    Division of Epidemiology and Clinical Applications

    In FY1995 the division continued to give special attention to minority health issues. Obesity prevention in young Native Americans, CHD risk factors in middle-age black adults, and hypertension care among inner city minorities are a few examples. A study associated with atherosclerosis in larger arteries was extended to include the effect of hypertension on smaller arteries in the eyes and brains of blacks and whites.

    A clinical trial to determine whether the combined incidence of nonfatal myocardial infarction (MI) and fatal CHD differs between hypertensives receiving alternative antihypertensive pharmacological treatment was initiated. A subset of hypercholesterol-emic patients will be studied to determine whether reducing serum cholesterol levels with a lipid-lowering drugh decreases the incidence of nonfatal MI and fatal CHD. The effects of selected diet patterns on blood pressure will be examined in another group of patients.

    Behavioral studies are an important component of clinical trials and have been included in several intervention projects. A few examples supported by the division include:

    Office of Prevention, Education, and Control

    OPEC, located in the NHLBI Office of the Director, is the institute's technology transfer arm, relaying the results of heart, lung, and blood research to health care professionals, their patients, and the public. Its function is to disseminate and translate up-to-date research findings that will help practitioners be more effective, and provide scientific knowledge to patients and the public that will enable them to make "healthy decisions."

    The institute has targetted six areas for educational emphasis with OPEC. They include: high blood pressure; cholesterol; asthma; heart attack alert; sleep disorders; and obesity. Three of these (high blood pressure, cholesterol, and obesity) address major modifiable risk factors for CVD.

    The National High Blood Pressure Education Program (NHBPEP) was established in 1972 with a goal of reducing death and disability related to high blood pressure through professional, patient, and public education. Strategies to achieve this goal include stimulating education and information programs to increase public awareness about the disease, promoting activities encouraging detection of the disease especially for underserved groups, encouraging hypertensive patients to seek medical care and follow their doctor's advice, providing education programs and materials for health professionals, and providing technical support to community health programs so they may carry these activities to their geographic areas.

    Since its creation, the NHBPEP has released five joint national committee (JNC) reports on the detection, evaluation, and treatment of high blood pressure. Each report has been based on the latest scientific research related to hypertension control and reflects the state-of-the-art regarding hypertension management.

    The fifth JNC report, issued in 1992, includes and updates earlier recommendations for both pharmacologic and nonpharmacologic therapies for high blood pressure.

    NHBPEP also released the Hypertension and Chronic Renal Failure Report, which gives an overview of this mounting public health problem; a Report on High Blood Pressure in Pregnancy, which affects about 10 percent of all pregnancies; and a new Report on Primary Prevention of Hypertension.

    The National Cholesterol Education Program (NCEP) was launched in 1985. Its goal is to reduce illness and death from coronary heart disease in the United States by lowering the prevalence of high blood cholesterol. Through its educational efforts directed at the public, patients, and health professionals, the NCEP aims to raise awareness and understanding about high blood cholesterol as a risk factor for coronary heart disease and the benefits of lowering high blood cholesterol as a means of preventing coronary heart disease. Success of program efforts is demonstrated by the results of cholesterol awareness surveys conducted in 1983, 1986, and 1990 that show dramatic improvements in cholesterol-related knowledge, attitudes, and practices among physicians and the public

    In 1992 the NCEP convened a new adult treatment panel to update the existing guidelines for detecting and treating high blood cholesterol in adults. The panel's report was completed in June 1993. The NCEP published the report of the children and adolescents panel and developed booklets to help parents and children adopt heart healthy eating patterns. The program endorsed the expert panel recommendations for heart healthy eating by the general population to lower average cholesterol levels, and it developed methods to improve the accuracy of cholesterol measurement. In its educational activities, the NCEP is pursuing a dual strategy to encourage blood cholesterol reduction by high-risk individuals and by the general population.

    The National Asthma Education Program (NAEP) was initiated in March 1989 to raise awareness of asthma as a serious, chronic disease and to promote more effective management of asthma through professional and patient education. The NAEP released two expert panel reports on asthma, International Guidelines on Diagnosis and Management of Asthma and Asthma and Pregnancy Report, in 1992. The international guidelines were developed by asthma experts from several countries and will be translated and distributed throughout the world.

    The NAEP initiated activities to help health professionals and patients implement the recommendations of the expert panel's report on diagnossis and management of asthma. Examples include developing a speaker's kit for use by health care professionals in workshops or training sessions on dissemination of panel recommendations, preparing and asthma management kit to aid health professionals working with patients on disease control, producing a pamphlet for patients emphasizing that asthma can be controlled, and distributing information to schools that will enable the staff to develop skill related to asthma management and control.

    The National Heart Attack Alert Program (NHAAP) was initiated in June 1991 to reduce morbidity and mortality from acute myocardial infarction (AMI) and sudden death through the education of physicians, nurses, emergency medical service personnel, and other health professionals about the importance of rapid identification and treatment of individuals with heart attack, symptoms and signs. To date, the program has developed recommendations for emergency department management of individuals with characteristic signs of AMI. In addition, it has prepared background papers on 911 emergency telephone systems; acquisition of emergency medical services systems, including staff and equipment; emergency medical dispatching procedures; and factors associated with patient/bystander delays in seeking care.

    The NHLBI Obesity Education Initiative (OEI) was launched in 1991 to educate the public and health professional about the risk factors associated with obesity. Obesity is not only an independent risk factor for CVD, but also a contributor to high blood pressure and high blood cholesterol and is related to sleep apnea. The program is using both high-risk and population based strategies to educate those groups about the relationship of overweight with heart disease and impaired lung function. The first targets persons with adverse health effects and medical complications associated with obesity. An expert panel will convene to address issues such as identification, evaluation, and treatment of obesity. A strategy development workshop was held in September 1992 to plan the population-based effort for the general public as well as special subgroups.

    All of OPEC's education programs work in partnership with a wide range of organizations--governmental, professional, voluntary, community, private, industry, and educational--that have focused their activities on NHLBI-related health information and education. OPEC collaborates with these organizations to help achieve its program goals, disseminate educational materials, and obtain feedback for new program development. Mass media are used to achieve program goals.


    NHLBI Appropriations -- Grants and Direct Operations
    [Amounts in thousands of dollars]

    Total Grants1
    Direct Operations
    1950 8,634 2,09110,725
    1962 114,18218,730132,912
    1969128,840 38,087166,927
    1982 420,545139,092559,637
    1989825,686 219,8221,045,508
    1991870,662 255,2531,125,915
    1Since 1973 includes research grants and research manpower development awards; and excludes contracts.

    Division of Lung Diseases

    Lung diseases are among the leading causes of death and disability in the United States. Excluding cancer, it accounts for 224,000 deaths annually, and is a contributing cause to perhaps an equal number of additional deaths.

    More than 25 million persons suffer from chronic bronchitis, emphysema, asthma, or other obstructive or interstitial lung diseases. In 1993, pulmonary diseases accounted for 27 percent of all hospitalizations of children under 15 years of age.

    The division plans and directs research in lung diseases, encompassing basic and targeted research, clinical trials and demonstration trials, national pulmonary SCORs, technological development, and application of findings. The division assesses the national need for research in the causes, prevention, diagnosis, and treatment of lung diseases; in technological development; and for manpower training in these areas.

    Minority training is an important priority within the division. The Minority National Research Service Award, the Minority School Faculty Development Award, the Research Development Award for Minority Faculty, and the Short-Term Research Training for Minority Students Award are among the research career and training programs it supports.

    The NHLBI established six centers for gene therapy in FY 1993. Presently, the centers are focusing mainly on cystic fibrosis (CF) research but include other areas associated with gene therapy for heart, lung, and blood diseases. Basic, preclinical, and clinical studies are directed toward developing safe, efficient, and efficacious vehicles for delivering genes to appropriate target cells. Basic science and clinical findings are identifying new directions needed to generate improved gene transfer vectors, to manage the inflammatory and immune consequences of vector transfer, and to develop alternative vector systems.

    Asthma research is an important area of support for the division. In FY 1995, major focus was directed towards:

    The division is very active in public education programs that increase awareness of asthma and its public health consequences, that promote study of the association between asthma and the environment, and that reduce asthma morbidity and mortality throughout the world. In collaboration with the World Health Organization, itrecently published a report entitled Global Strategy for Asthma Management and Prevention. Presently, it is preparing a report on the diagnosis and management of asthma in the elderly.

    Smoking-related diseases are a major cause of mortality and morbidity in the United States. The division has an ongoing randomized trial that examines the effect of inhaled corticosteroids on the natural history of lung function in continuing smokers.

    The division supports efforts associated with acquired immunodeficiency syndrome (AIDS) and tuberculosis (TB) research. Specific programs include:

    Division of Blood Diseases and Resources

    Blood diseases, including both acute and chronic disorders, resulted in 271,000 deaths in 1994; 262,000 of them were due to thrombotic disorders and 9,000 were due to diseases of the red blood cells and bleeding disorders.

    The division develops, administers, and coordinates programs that will reduce morbidity and mortality caused by blood diseases and lead to their primary prevention. These programs include hemophilia, Cooley's anemia, sickle cell disease, and disorders of hemostasis and thrombosis. The division also has a major responsibility to ensure the adequacy and safety of the Nation's blood supply. A full range of activities, including studies of transmission of disease through transfusion, development of methods to inactivate viruses in donated blood, improvement of blood donor screening procedures, research to reduce human error in transfusion medicine, and studies of emerging diseases that may be transmitted by blood transfusion, are used to achieve this goal.

    The division's overall responsibilities are met by an integrated and coordinated program of grants, contracts, training and career development awards, and academic awards. Special emphasis is given to training and career development programs targeting minority students, faculty members, and investigators at minority schools.

    Stem cell biology was an area of major focus in FY 1995. Advances in characterization and purification of hematopoietic stem cells enabled investigators to begin to examine different sources of the cells and to pursue strategies designed to hasten the translation of basic research into clinical application. Among the areas studied were:

    The new SCORs in hematopoietic stem cell biology were initiated to develop improved treatments for both inherited and acquired hematologic disorders found in blood cell production and other blood diseases.

    Thalassemia is another research area within the division. Ongoing studies examine:

    Sickle cell research is another high priority area and is supported through Comprehensive Sickle Cell Centers. A mutidisciplinary approach is directed towards membrane function, red cell rheology, and adherence of red cells to vascular endothelium.

    Unrelated-donor marrow transplantation and pathogenesis, prevention, diagnosis, and treatment of complications of transplantation are current areas of investigation. Special attention is directed to studies of transplantation of stem cells from marrow, peripheral, and cord blood.

    The division to has been very active in disseminating its research findings to the medical community through workshops, meetings, and consensus development conferences. Topics have included plasma transfusion, platelet transfusion therapy, diagnosis of deep-vein thrombosis, impact of routine HIV antibody testing of blood and plasma donors on public health, infectious disease testing for blood transfusions, stem cell therapy, and immune function in sickle cell disease.

    National Center on Sleep Disorders Research

    The National Center on Sleep Disorders Research (NCSDR) plans, directs, and supports a program of basic, clinical, and applied research; health education; and prevention-related research in sleep and sleep disorders. It maintains surveillance over developments in its program areas; assesses the national need for research on the causes, diagnosis, treatment, and prevention of sleep disorders; and coordinates sleep research activities across the Federal Government.

    Since its inception, the NCSDR has initiated several activities. A study that involves existing epidemiological cohorts is being conducted to determine if sleep apnea is an independent or contributing risk factor for the development of cardiovascular and cerebrovascular disease. The center, in collaboration with NICHD, established the Back to Sleep campaign to reduce the risk of SIDS. In FY 1995, the NCSDR coordinated and released a NIH-wide program announcement in Basic and Clinical Research on Sleep and Wakefulness.

    In collaboration with the National Aeronautics and Space Administration (NASA) the center supports research on sleep and microgravity as part of the Neurolab Project. A new initiative for a sleep academic award was approved and will soon be released. The NCSDR collaborated and coordinated a number of NIH- and Governmentwide activities including an NIH Workshop on Molecular Biology and Genetic Approaches to Sleep Control, and joint activities with the National Sleep Foundation and the Department of Transportation on the Drive Alert Arrive Alive Program.

    The center works closely with the NHLBI Office of Prevention, Education, and Control on the sleep education program which includes conducting some focus group research. A number of professional and public/patient education publications were released along with the start of a Sleep Apnea Mass Media Campaign. The center recently published a summary of the report of the Stately Development Workshop on Sleep Education.

    Division of Intramural Research

    The 16 Bethesda-based laboratories and branches conduct clinical research on the normal and pathophysiologic functioning of the cardiac, pulmonary, blood and endocrine systems and basic research on normal and abnormal cell behavior at the molecular level. A brief synopsis of current research follows.

    The Cardiology Branch focuses on the processes involved in microvascular mediated myocardial ischemia, the genetic basis and clinical treatment of hypertrophic cardiomyopathy, and molecular and cellular mechanisms of angiogenesis and restenosis.

    The Hematology Branch conducts research on the pathogenesis of hematological diseases at the molecular and cellular levels and on the development of novel therapeutic strategies, including gene therapy. Other activities include research on the pathogenesis and treatment of aplastic anemia and B19 parvovirus-induced disease.

    Vasoactive substances regulating blood pressure and hypertension, the molecular events leading to vascular hypertrophy and hyperplasia, and studies of pheochromocytoma are the principal interests of the Hypertension-Endocrine Branch.

    The Molecular Disease Branch is concerned with elucidating the molecular mechanisms involved in lipid transport and metabolism in normal individuals and patients with disorders of lipid metabolism and atherosclerosis. The branch also conducts clinical studies on the effects of drugs and diet.

    The principal goal of the Molecular Hematology Branch is to develop the understanding and technology necessary to carry out human gene therapy. Targeted diseases include genetic and cardiovascular disease and cancer. Mechanisms and regulation of gene expression are also studied.

    Research in the Pulmonary/Critical Care Medicine Branch is directed toward understanding basic mechanisms of inflammatory and immune processes in the pathogenesis of the human lung. Techniques from cellular and molecular biology, with special emphasis on genetic strategies, have been applied in the treatment of cystic fibrosis.

    The Laboratory of Animal Medicine and Surgery studies intracardiac flow dynamics with digital acquisition and analysis of color Doppler ultrasound imaging techniques.

    The Laboratory of Biochemical Genetics studies the molecular mechanisms that regulate gene expression during embryonic development. Interests include homeobox genes and neuron-specific enhancer sequences.

    The Laboratory of Biochemistry is concerned with the elucidation of various mechanisms of metabolic regulation. Special interests include the physiologic and pathologic effects of oxidation, signal transduction, and protein chemistry.

    The Laboratory of Biophysical Chemistry investigates physical and chemical properties of molecules in relation to their biochemical functions. Techniques used include nuclear magnetic resonance (NMR), mass spectrometry, and x-ray crystallography.

    The goal of the Laboratory of Cardiac Energetics is a better understanding of the cellular processes involved in the performance of work in vivo by the heart. State-of-the-art noninvasive NMR and optical spectroscopy are used and include a 1-meter bore, 4.D tesla NMR for imaging, and spectroscopic studies.

    The Laboratory of Cell Biology investigates diverse problems on the molecular basis of cell motility, bioenergetics, heat-shock proteins, and protein structure through a variety of techniques from molecular biology to time-resolved fluorescence spectroscopy.

    The Laboratory of Cell Signaling studies the mechanisms by which signal activated phospolipases like phospho-inositide-specific phospholipase C and phosphocholine-specific phospholipase D are modulated and the role these enzymes have in human disease.

    Objectives of the Laboratory of Kidney and Electrolyte Metabolism are to understand renal function at the molecular and cellular levels. Areas of interest include epithelial transport, cellular osmoregulation, transport metabolism and hormonal regulation.

    The Laboratory of Molecular Cardiology investigates the regulation, expression, and function of contractile proteins in vertebrate muscle and nonmuscle cells. The tools of molecular genetics, protein chemistry, and video-enhanced microscopy are used. Research in the pulmonary and molecular immunology section focuses on topics related to the T-cell activation process, with particular emphasis on the three classes of interleukin-2 receptors.

    The Laboratory of Molecular Immunology does research in the T-cells activation process--studies with importance for immunodeficiency, cancer, and autoimmune diseases; the mast cells activation process--an important area for asthma and other allergic diseases; and the mechanisms of drug-induced toxicities, with particular emphasis on the mechanisms of hepatitis resulting from inhalation anesthetics and nonsteroidal anti-inflammatory drugs.