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VA Research Spotlight

Highlights of VA research on complex chronic disease

March 13, 2019

This month, in honor of National Kidney Month, our focus is on research into complex chronic diseases like kidney disease, diabetes, and heart disease.

Kidney Disease

Kidney Disease Fact Sheet

VA has a comprehensive research portfolio aimed at preventing and improving the treatment of chronic kidney disease. There are many causes of chronic kidney disease, but the two main causes—accounting for up to two-thirds of all cases—are diabetes and high blood pressure.

Diabetes

Diabetes Fact Sheet

VA researchers are studying innovative strategies and technologies, including group visits, telemedicine, peer counseling, and Internet-based education and case management, to enhance access to diabetes care and to improve outcomes for patients.

Cardiovascular Disease

Cardiovascular Disease Fact Sheet

VA researchers are developing new treatments for cardiovascular disease and working to improve existing treatments. They are conducting studies ranging from lab experiments to large clinical trials involving thousands of patients. Heart disease is the leading cause of hospitalization in the VA health care system.

VA Research in Action

A web platform to diagnose and manage sleep apnea A web platform to diagnose and manage sleep apnea
Obstructive sleep apnea is a serious sleep disorder in which breathing repeatedly stops and starts while a person is sleeping. To conclusively diagnose the condition, many people are referred to a center for a sleep study.

VA Research Quarterly Update

Coaching healthy behaviors in Veterans at risk for heart disease Coaching healthy behaviors in Veterans at risk for heart disease
In a study published in the Journal of General Internal Medicine, VA investigators examined the effectiveness of two interventions to help patients reduce their risk for heart disease. They found that an online health risk assessment was more effective at motivating Veterans to address modifiable risk factors like smoking, when combined with telephone health coaching. (December 2018) Read more



Older Veterans with advanced kidney disease fare better with treatment at VA Older Veterans with advanced kidney disease fare better with treatment at VA
Investigators at the VA Palo Alto Health Care System in California and colleagues conducted a study of more than 11,000 Veterans aged 67 years or older who had kidney failure. Despite receiving dialysis less often, the study found that Veterans treated through VA were less likely to die than those who received care through Medicare. (August 2018) Read more



Staying heart healthy: The importance of phosphorus for Vets with kidney disease Staying heart healthy: The importance of phosphorus for Vets with kidney disease
Kidney specialist and clinical researcher Dr. Anna Jovanovich works at the VA Eastern Colorado Health Care System in Denver. The thrust of her clinical research is investigating the effects of kidney disease on the body—specifically cardiovascular or heart disease. Veterans and others with chronic kidney disease are at a much higher risk of developing heart disease, compared with the general population. (May 2018) Read more



VA Research Currents

VA study links antibiotics with diabetes risk VA study links antibiotics with diabetes risk
A study from the VA New York Harbor Healthcare System found that Veterans with a history of antibiotic use were more likely to develop Type 2 diabetes.... (02/14/2019)



Large genome study leads to better understanding of high blood pressure Large genome study leads to better understanding of high blood pressure
A large, international genetic study using Million Veteran Program data has identified more than 200 gene variants that could contribute to high blood pressure. The study also identified over 200 drugs currently used to treat other diseases that could potentially be repurposed to treat high blood pressure.... (02/06/2019)



Study: Online program helps Veterans lose weight, potentially prevent diabetes Study: Online program helps Veterans lose weight, potentially prevent diabetes
VA researchers compared an online version of the Diabetes Prevention Program to an in-person DPP and to MOVE!, VA's flagship weight management program.... (02/05/2019)



No 'legacy effect' No 'legacy effect'
Long-term follow-up of a major VA diabetes study shows that patients who received intensive therapy to lower blood sugar did not see a significant drop, on average, in heart attacks, strokes, and other cardiovascular events... (10/24/2018)



MVP study on cholesterol genetics could lead to new treatments for heart disease, diabetes MVP study on cholesterol genetics could lead to new treatments for heart disease, diabetes
Using data from VA's Million Veteran Program, a team led by VA and Stanford researchers has identified three genetic mutations that govern cholesterol levels.... (10/24/2018)



Many patients show signs of chronic kidney disease before diabetes diagnosis Many patients show signs of chronic kidney disease before diabetes diagnosis
Many patients who will later be diagnosed with diabetes show signs of chronic kidney disease even before their diabetes diagnosis, according to a study by VA researchers and colleagues in Tennessee.... (03/13/2018)



VA Research News Briefs

Melamine promotes kidney stone formation

Melamine promotes kidney stone formation - Photo: ©iStock/XsandraPhoto: ©iStock/Xsandra

(02/06/2019)
Researchers with the Washington DC VA Medical Center explored how melamine can contribute to the formation of kidney stones. Melamine is a type of plastic that can sometimes find its way into the body through products such as plastic tableware. The researchers showed that melamine can promote the forming of crystals of calcium phosphate and calcium oxalate—two substances that commonly make up kidney stones—through chemical reactions. The results will add to the knowledge of how kidney stones form and help scientists understand how melamine acts as an environmental toxin, say the researchers. (Scientific Reports, Jan. 29, 2019)



Chronic kidney disease care varies widely in VA system

Chronic kidney disease care varies widely in VA system - Photo: ©iStock/Natali_MisPhoto: ©iStock/Natali_Mis

(01/16/2019)
Chronic kidney disease treatment in VA facilities varied widely and was often suboptimal, found a study including Michael E. DeBakey VA Medical Center researchers. The study looked at nearly 300,000 patients with both CKD and diabetes receiving care in 130 VA facilities. They found that rates of laboratory test ordering and nephrology referral scheduling varied widely. Only 13 percent of patients met all outcomes measuring recommended care for chronic kidney disease. The results show that further efforts are needed to standardize CKD care within VA, say the researchers. They did note in an interview with the health website Healio.com that “these rates are similar [to, if not better than those of] other health care systems.” (Clinical Journal of the American Society of Nephrology, Dec. 7, 2018)



Adding fish oil to a statin did not lead to better cardiovascular health in Veteran study

Adding fish oil to a statin did not lead to better cardiovascular health in Veteran study -  Photo: ©iStock/solidcolours Photo: ©iStock/solidcolours

(12/26/2018)
Adding fish oil to statin treatment did not improve cardiovascular outcomes in a Fargo VA Health Care System database study that included nearly 1,000 patients. Statins are the standard drugs prescribed for high cholesterol. Past research has shown that fish oil could help prevent major coronary events in patients with high cholesterol. The researchers looked at data for Veterans prescribed either a statin alone or statins and fish oil together. They did not find any difference between the group in number of cardiovascular events—such as heart attack or stroke—or in rates of any-cause death. The results suggest that adding fish oil to statin treatment does not lower the risk of cardiovascular problems. (Federal Practitioner, October 2018)



Lab study suggests heart benefits from widely used diabetes drug

Lab study suggests heart benefits from widely used diabetes drug - Photo: iStock/dra_schwartzPhoto: iStock/dra_schwartz

(12/20/2018)
An international lab study that included a VA San Diego Healthcare System researcher showed that congenital heart disease (CHD) and obesity can lead to heart failure, but treatment with metformin, a widely used diabetes drug, can prevent the condition. CHD is the most frequent birth defect worldwide. Researchers found that the combination of CHD and a high-fat diet in mice led to heart failure. Giving mice the drug metformin prevented this heart dysfunction. Early treatment with metformin may prevent or delay the onset of heart failure in patients with CHD, say the researchers. (Molecular Metabolism, Nov. 15, 2018)



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