Office of Research & Development

 

Cardiovascular Disease

Cardiovascular Disease icon

Cardiovascular disease describes conditions ranging from high blood pressure to heart attacks and strokes. Cardiovascular disease is the number-one killer of Americans, and is the leading cause of hospitalization in the VA health care system.

In the early 20th century, most physicians did not understand that high blood pressure (or hypertension) was a problem for their patients, except in extreme cases.

A VA study conducted in the 1960s presented the first definitive evidence that treating moderate high blood pressure helped prevent and delay the illnesses it can cause. These illnesses include heart disease, kidney disease, stroke, and coronary artery disease.

Today, VA researchers are developing new treatments for cardiovascular disease and helping to improve existing treatments. They are looking at the genetic and lifestyle causes of the disease, and are finding new ways to help stroke victims and other patients recover as much function as possible.

VA is also making Veterans and their families aware of the risk factors for heart disease. Besides high blood pressure, these include smoking, high cholesterol, obesity, lack of physical activity, and uncontrolled diabetes. The department offers a number of evidence-based programs to help Veterans manage these conditions. VA researchers review these programs, evaluate their effectiveness, and make suggestions for improvements.

Selected Milestones and Major Events

Selected Major Accomplishments

  • VA researchers were first to find that drug treatment can effectively control blood pressure, and that controlling blood pressure can reduce heart attacks and strokes.
  • Two VA physicians and an engineer developed the first successful implantable cardiac pacemaker.
  • In the 1990s, a VA study established the value of aspirin therapy in improving heart health.
  • A 1998 VA clinical trial demonstrated the value of raising HDL ("good") cholesterol levels and lowering triglycerides in reducing heart attacks.
  • A VA treadmill study in 2008 confirmed the link between cardiovascular fitness and long life.

Overview

Cardiovascular disease, or heart disease, is the number-one killer in the United States. It is also a major cause of disability. Although there are many different forms of heart disease, one of the most common forms is a narrowing or a blocking of the blood vessels that supply blood to the heart. This is called coronary artery disease, and is the main reason people have heart attacks.

Heart disease is particularly important to Veterans, because it is associated with a number of other diseases that often affect them. These include diabetes, spinal cord injuries, and posttraumatic stress disorder. The fact that many Veterans smoke also leads to heart problems.

Historic involvement

VA established its first cardiovascular research unit at its Washington, DC. hospital in 1935, five years after the Veterans Administration (the predecessor agency to the Department of Veterans Affairs) was established.

In 1948, the unit's researchers began a study of some of the many young service members who had had heart attacks during their World War II service. The researchers found that the Veterans' blood pressures at the time of their enlistment were higher, on average, than the control group—men who were later treated by VA for amputations.

By the 1950s, a number of drugs were available to treat high blood pressure. The cardiovascular unit led a study to determine how well the newer drugs actually worked, and then, under the direction of Edward Freis, MD, led a study to find out whether using these drugs to control blood pressure actually led to the prevention of heart attacks, strokes, and other complications of heart disease. The study was organized by what would later become known as VA's Cooperative Studies Program.

From January 1964 through October 1969, 17 VA hospitals, and 523 patients with blood pressure above normal levels, participated in the study. Half of the patients received the best available regimen for treating moderate high blood pressure, and the other half received a placebo. The trial was quickly stopped for patients with significantly high blood pressure (above 115 mm/l), because the number of strokes and heart attacks in that group was so high that they simply had to be given medicine, and quickly.

In 1969, a senior VA medical official, Thomas Chalmers, MD, looked at the results for Veterans remaining in the study, and decided the data indicated that everyone receiving placebos needed to be started on medicine, thereby ending the trial. The results were written up in the Journal of the American Medical Association in August 1970, and presented the first definite and convincing proof that treating moderate high blood pressure was beneficial in preventing or delaying many of its catastrophic health complications.

On a separate track, during the 1950s William Chardack, MD; Andrew A. Gage, MD; and engineer Wilson Greatbach created an electronic device to regulate the human heart. Their device, called a pacemaker, was first successfully implanted in the Buffalo VA hospital on April 7, 1960, in a 77-year-old man. The man lived for 33 months after the implantation.

The device was patented, and an agreement to license production of the device to Medtronic in 1961 "effectively began the modern medical device industry," according to Seymour Furman, MD, a cardiologist who wrote the forward to the book "The Making of the Pacemaker," which was written by Greatbach in 2000.

Present-day research

In the years since, VA has continued its leadership in the study of heart disease. Today, VA researchers are conducting groundbreaking studies ranging from lab experiments to large clinical trials involving thousands of patients. Our investigators are evaluating existing treatments for cardiovascular diseases and developing new ones, while also looking at the genetic and lifestyle causes of heart disease.

The department is currently supporting a number of studies looking at the long-term associations between service in combat areas and mental health with a special evidence on heart outcomes. One recent study found a direct correlation between the degree of lifetime stress exposure and the level of inflammation in heart patients.

VA researchers are currently testing a disposable microchip that can diagnose a heart attack In minutes, by sensing molecules in saliva that are markers for a heart attack. They are developing new rehabilitation methods for those who have had strokes, using robots to help patients repeat movements that have been impaired by a stroke.

Through the CART-CL (Clinical Assessment Reporting and Tracking System for Cath Labs) program, VA researchers are focusing in on a process called cardiac catheterization. Cardiac catheterization, which involves having a tube inserted in the heart, allows cardiologists to investigate what's going on in the heart, or to open blocked arteries impeding blood flow. The CART-CL program collects data from all 77 VA cath labs. Researchers use that data to improve VA's clinical performance.

And VA researchers are refining guidelines to help providers determine whether or when to prescribe cholesterol-lowering medications for their patients. Instead of basing the decision on a patient's low density lipoprotein (LDL) level—the "bad" cholesterol that can lead to heart attack or stroke—new guidelines suggest that providers calculate their patients' risk of having a heart attack over the next ten years. This calculation should be based on factors including age, cholesterol, blood pressure medication use, diabetes status, and smoking status.

More on our Website

Research advances in cardiovascular disease

Link between cholesterol, heart disease, not so clear, VA Research Currents, winter 2013-2014

Testosterone therapy associated with higher risk of death, heart attack, or stroke , VA Research Currents, winter 2013-14

Study sheds light on best fix for dangerous aorta, VA Research Currents, December 2012-January 2013

Study of 10,000 Veterans with lipid problems confirms benefits of fitness, statins , VA Research Currents, December 2012-January 2013

The family factor: Can supportive spouses help Veterans improve their cholesterol? VA Research Currents, December 2012-January 2013

Cardiovascular Disease and Stroke Research , VA video

A Selection of Scientific Articles by Our Researchers

Historic:

Effects of treatment on morbidity in hypertension. Results in patients with diastolic blood pressures averaging I. 115 through 129 mm. II. 90 through 114 mm Hg.(No authors listed). Studies demonstrate that treating moderate hypertension is beneficial in preventing or delaying many of its catastrophic health complications. JAMA 1967;202;1028-1034 and JAMA 1970 Aug 17;213(7);1143-52.

Collaborative overview of randomised trials of antiplatelet therapy--I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. In a study of 100,000 patients, antiplatelet therapy such as aspirin was found to be protective against heart attacks, strokes, and other diseases. BMJ. 1994 January 8;308(6921): 81-106.

Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group. Rubins HB, Robins SJ, Collins D, Fye CL, Anderson JW, Elam MB, Faas FH, Linares E, Schaefer EJ, Schectman G, Wilt T, Wittes J. Findings suggesting that the rate of coronary events is reduced by raising HDL cholesterol levels and lowering levels of triglycerides without lowering LDL cholesterol levels. N Engl J Med, 1999 Aug 5;241(6):410-8.

Recent:

Objective evidence of myocardial ischemia in patients with posttraumatic stress disorder. Turner JH, Neylan TC, Schiller NB, Li Y, Cohen BE. Of 663 Veteran study participants, ischemia was present in 17 percent of patients with PTSD versus 10 percent of patients without the disorder. The association remained significant after adjustments for potential confounders. Biol Psychiatry, 2013 Dec 1; 74(11:851-6.

Association of Testosterone Therapy With Mortality, Myocardial Infarction, and Stroke in Men With Low Testosterone Levels . Vigen R, O'Donnell C, Baron A, Grunwald G, Maddox T, Bradley S, Barqawi A, Woning G, Wierman M, Plomondon M, Rumsfeld J, Ho PM. Among a cohort of men in the VA health care system who underwent coronary angiography and had a low serum testosterone level, the use of testosterone therapy was associated with increased risk of adverse outcomes. JAMA, 2013;310(17):1829-1836.

Risk of Major Adverse Cardiac Events Following Noncardiac Surgery in Patients with Coronary Stents , Hawn MT, Graham LA, Richman JS, Itani KM, Henderson WG, Maddox TM. Emergency surgery and advanced cardiac disease are risk factors for major adverse cardiac events after noncardiac surgery in patients who have recently had coronary stents implanted.JAMA, 2013 Oct 9;310(14):1462-72.

Correlates of repeat lipid testing in patients with coronary heart disease . Virani SS, Woodard LD, Wang D, Chitwood SS, Landrum CR, Urech TH, Pietz K, Chen GJ, Hearts B, Murawsky J, Ballantyne CM, Petersen LA. Cholesterol measurements may be obtained too frequently in patients with known heart disease. JAMA Intern Med. 2013 Aug 12; 173(15):1439-44.

Gender differences in the prospective associations of self-reported sleep quality with biomarkers of systemic inflammation and coagulation; Findings from the Heart and Soul Study. Prather AA, Epel ES, Cohen BE, Neylan TC, Whooley MA. Poor sleep appears to play a significant role in raising unhealthy levels of inflammation among women with coronary heart disease. J Psychiatr Res. 2013 Sep;47(9);1228-35/

VA AND OTHER U.S. GOVERNMENT ONLINE RESOURCES

Ischemic Heart Disease and Agent Orange, U.S. Department of Veterans Affairs

Chronic Heart Failure Quality Enhancement Research Initiative, U.S. Department of Veterans Affairs

Stroke QUERI Center, U.S. Department of Veterans Affairs

Ischemic Heart Disease Quality Enhancement Research Initiative, U.S. Department of Veterans Affairs

Heart Disease, Centers for Disease Control and Prevention

Heart Disease and Stroke, healthypeople.gov

NINDS Stroke Information Page, National Institute of Neurological Disorders and Stroke

VA RESEARCH IN THE NEWS

Increased risk for cardiac ischemia in patients with PTSD, ScienceDaily, Dec. 2, 2013

Testosterone treatments linked to heart risks, USA Today, Nov. 5, 2013

Targeting different forms of enzymes gives hope for new heart medications , University of Utah press release, Nov. 20, 2013

Text message from your heart doc: 'Take Your Medicine ," Medline plus, Nov. 18, 2013

Study could lead to revisiting of non-cardiac surgery stent guidelines , UAB News, Oct. 7, 2013

Unnecessary repeat cholesterol tests common: study, Reuters Health, Jul. 1, 2013

Sleep Study finds Important Gender Differences Among Heart Patients, University of California, San Francisco, press release June 5, 2013