How to Become a Cardiovascular Investigator Careers in Clinical Trials and Epidemiology

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How to Become a Cardiovascular Investigator
Careers in Clinical Trials and Epidemiology

• Thomas A. Pearson, MD, MPH, PhD
• University of Rochester School of Medicine and
  Dentistry
• Rochester, New York, USA

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Death Rates for Major Cardiovascular Diseases
U.S., 1900-1997
Rates are age-adjusted to 2000 standard.
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Patterns of Cardiovascular Disease in the United
States 1990 to Present

• Coronary mortality declining more slowly 1.5
  decline per year vs. 2.6 decline per year,
  1968-1990.
• Continued reduction in case-fatality rates for
  acute coronary syndromes.
• Surveillance studies suggest no decline in
  incidence.
• Stroke has stopped declining.
• Congestive heart failure may be the only disease
  whose mortality, morbidity, incidence and
  prevalence has increased annually for the past 25
  years.

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U.S. Heart Disease Prevalence Is Projected to
Double in the Next Half Century
24.6
12.4
Sources ACC/AMA Guidelines 2001, NHLBI Chartbook
2000 and Adapted from Foot et al (JACC 2000)
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Quality Assurance in Preventive Cardiology
Basic Science Epidemiology Clinical
Trials Economic Analysis
Guidelines Performance Studies Removal of
Barriers
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Prevention Versus Treatment in CVD Prognosis

• Prevention
• Smoking Cessation
• Blood Pressure Control
• Lipid Management
• Physical Activity
• Weight Management
• Diabetes Management
• Antiplatelet Agents
• ACE Inhibitors
• Beta Blockers

• Treatment
• Defibrillation
• Supportive Care (Oxygen)
• Anti-Ischemic Drugs
• Thombolysis
• Primary PTCA
• Coronary Artery Bypass
• Antiarrhythmic Therapy
• Antithrombotics/Anticogulants
• Beta Blockers (Acute)
• ACE Inhibitors (Acute)

Smith et al. Circulation 2001 104-1577 Ryan
et al. Circulation 1999 100-1016
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Examples of Epidemiology Applied to Health Policy

• NIH National Cholesterol Education Programs
• CDC Recommendations for Use of Inflammatory
  Markers in Clinical Practice
• AHA Secondary, Primary and Community- Level
  Prevention Guidelines
• FDA Labeling of Aspirin for Primary
  Prevention of Coronary Disease
• WHF Global Guidelines for CVD Prevention

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AHA Guidelines for Prevention of Heart Disease
and Stroke

• Guideline Target Audience
  Reference
• Secondary Prevention
• CVD Cardiologist, Primary Care Circulation
  20011041577
• Stroke Neurologist, Primary Care Stroke
  1999301991
• Primary Prevention
• CVD Primary Care Provider Circulation
  2002106388 Stroke Primary Care Provider
  Circulation 2001103163
• Primordial Prevention Healthcare Providers,
  Circulation 2003107645
• Public Health Practitioners,
• Policy Makers, Leaders

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The Crisis in Clinical Research

• Original Role of National Institutes of Health
• The ultimate purpose is to help provide the
  practicing physicians of this nation and of the
  world with better means of alleviating physical
  suffering and emotional imbalance, for prolonging
  human life, and for making all the years of that
  span more useful both to the individual and to
  society.

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NIH Roadmap for Medical Research
NIH
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URMC Clinical Research Programs

• Patient-Oriented Translational Research
• Patient-Oriented Experimental Therapeutics
• Population-Based Research
• Outcomes/Health Services Research
• Ethics/Law/Policy Research

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Clinical Research Projects at URMC in 2003
(N1159) Categorized by Type of Clinical Research
1 Projects can be counted under more than one
category
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NIH Roadmap Research Teams of the Future Scale
and complexity of 21st C research require new
organizational models for scientific teams

• Multi-disciplinary and Inter-disciplinary Teams
• Larger, coordinated, resource sharing Teams
• Preserve the investigator(s)-initiated strategy

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Training and Career Developmentin Clinical
Research (K30 Program)

• Didactic Coursework
• Skill-building Workshops
• Mentored Research
• Clinical Research Seminar Series

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Clinical Research Resources Identified by 83
Units Performing Clinical Research at URMC in
2003
1 Units consisted of Departments, Centers, and in
larger Departments, Divisions which perform
clinical research. 2 Minority groups use standard
NIH definition for underrepresented minorities.
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Shared Clinical Research Support Units

• General Clinical Research Center
• Clinical Research Informatics
• Clinical Pharmacology Program
• Biostatistics Consultation Service
• Epidemiology Consultation Service
• Study Coordination Office
• Practice-Based Research Networks
• Research Services Group
• Population Data Laboratory
• Community Laboratories

Planned
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Conclusions

• Epidemiology and clinical trials are essential
  tools in evidence-based cardiology.
• Population sciences and experimental therapeutics
  must be part of the research teams of the future.
• Training in clinical research has been formalized
  to include didactic coursework, skill-building,
  and mentored research.
• Institutional resources are increasingly
  available to support new clinical investigators.