Notice Number: NOT-HL-19-711

Key Dates
Release Date: October 9, 2019
First Available Due Date: February 5, 2020
Expiration Date: January 8, 2022

Issued by
National Heart, Lung, and Blood Institute (NHLBI)

Purpose

Purpose: The purpose of this initiative is to stimulate and support novel epidemiological research that assesses cardiovascular health, its trajectory during childhood and its relationship to adult disease. Currently there is evidence that CVD starts early in life, however metrics for ideal cardiovascular health (ICVH) during key pediatric developmental periods is limited. This critical information is severely limited or absent particularly in underrepresented populations. This initiative will help to define those metrics and lay a foundation to support integration of clinical, population, and mechanistic behavioral studies to provide early information on the predictors of CVH. Such information could inform the design of interventions that would preserve or promote optimal cardiovascular health in the pediatric population. Research supported by this initiative will leverage existing resources, address disparities in cardiovascular health and enhance the careers of early stage investigators by supporting focused analytic and ancillary study collaborative opportunities.

Background: Although trends in cardiovascular disease (CVD) have declined over the years, recent evidence indicates an increase in CVD risk factors at younger ages. Though there is evidence from many studies including NHLBI supported studies in children (e.g., International Childhood Cardiovascular Consortium) that atherosclerosis, which ultimately results in hard cardiovascular outcomes, begins in childhood and progresses through adolescence into adulthood, these trends are poorly understood. Most of these studies have been performed in children of European ancestry, further emphasizing the need for research in underrepresented groups. The concept of ICVH and its seven metrics (no smoking, healthy diet and physical activity behaviors, normal BMI; and normal blood pressure, total cholesterol, glucose) identified in adults has been described by many researchers, but studies at younger stages of life have been more limited. It has been reported that for adults with ICVH, there is low lifetime risk of CVD and longer life span with improved quality of life. Recent evidence suggests that promoting ICVH in childhood and averting its loss thereafter are critical components of strategies to improve population CVH. Given that poor cardiometabolic health progresses from childhood and can lead subsequently to CVD in adulthood, additional research is urgently needed to better define the relationships between CVH in childhood, its maintenance and adult CVD outcomes, particularly in diverse populations including race, ethnicity, income, educational and geographic diversity. Additionally, the ICVH cut points for the pediatric population need to be refined to include measures such as second-hand smoking, sleep patterns, percent body fat, information on food access, antenatal history, and food and physical activity environments and other factors that may modify the trajectories of ICVH.

Research Objectives: The objectives of this initiative are to advance research in pediatric CVH to 1) characterize ICVH and its trajectories in diverse groups of children and (2) determine the relationship between ICVH trajectories and adult CVD outcomes in diverse populations.

Investigators would leverage existing studies or data sets (from clinics, epidemiologic studies, trials, community health programs, etc.) with pediatric exam data to address these goals; applicants could propose collection of additional childhood measures (i.e., analysis of stored biospecimens) and/or adult outcome data. Individual proposals could address one or both objectives. Additional information on the social determinants of health (SDoH) and/or resilience factors as well as how CVH is moderated by these factors is strongly encouraged from all applicants.

Selected Research Examples

• Studies that employ a socio-ecological framework to examine the interrelations of individual-level factors (physiological, genetic, behavioral) with SDoH indicators (i.e., HealthyPeople 2020 SDoH areas) in influencing CVH.
• Studies that examine the CVH trajectories tracked across developmental periods and assess the nature and extent of variation in these trajectories across population groups, including studies using electronic medical records.
• Studies that best assess age- and developmentally-appropriate definitions and criteria for ICVH and their association with adult outcomes.
• Studies that assess whether CVH metrics by continuous rather than categorical analysis increase sensitivity for identifying meaningful change over time.
• Studies that provide data to develop CVH growth curve analogous to that for height, weight, and BMI.
• Studies on epigenetic response to early life stress and the impact on CVH.
• Studies that address scientific gaps identified in pediatric clinical practice guidelines related to cardiovascular health (including but not limited to the American Academy of Pediatrics' Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents and the Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents (https://pediatrics.aappublications.org/content/128/Supplement_5/S213..info).

Application and Submission Information

This notice applies to due dates on or after February 5, 2020, and subsequent receipt dates through January 8, 2022.

Applications in response to this Notice must be submitted through the NIH Parent Announcement PA-19-056: NIH Research Project Grant (Parent R01 Clinical Trial Not Allowed).. All instructions in the SF424 (R&R) Application Guide and PA-19-056 must be followed, with the following additions:

IMPORTANT: For funding consideration, applicants must include NOT-HL-19-711 in the Agency Routing Identifier field (Box 4b) of the SF424 (R&R) Form. Applications without this information in Box 4b will not be considered for this initiative.

Applications nonresponsive to the terms of this Notice will be not be considered for this initiative.

Investigators planning to submit an application in response to this NOSI are strongly encouraged to contact and discuss their proposed research/aims with an NHLBI Program Officer listed on this NOSI well in advance of the grant receipt date.

Inquiries

Please direct all inquiries to:

Cashell E. Jaquish, PhD
National Heart, Lung, and Blood Institute (NHLBI)
Telephone: 301-435-0447
Email: jaquishc@nih.gov

Charlotte Pratt, PhD
National Heart, Lung, and Blood Institute (NHLBI)
Telephone: 301-435-0382
Email: prattc@nhlbi.nih.gov