Advisory Highlights:
- A new American Heart Association Presidential Advisory lays out five principles to optimize the future of U.S. biomedical research through the National Institutes of Health (NIH).
- The advisory cites the NIH's critical importance as the world's premier biomedical research organization and cautions against abrupt, haphazard and disruptive measures that will have unintended consequences for public health.
- The advisory adds that the NIH would be strengthened by thoughtfully and collaboratively adapting our national research enterprise to better meet today's rapidly evolving heath needs.
DALLAS, February 19, 2025 — Groundbreaking achievements in science and medicine have contributed to reductions in cardiovascular disease (CVD) and stroke mortality over several decades. Many of these advances were enabled by strong bipartisan support in Congress for investments in the National Institutes of Health (NIH), the global leader in biomedical research.
But the future of America's global leadership in research is at risk. The state of NIH funding and the nation's biomedical research workforce are the subject of intensive discussion among federal elected officials and the medical research community. A new presidential advisory from the American Heart Association, which is devoted to a world of healthier lives for all, offers five principles to strengthen the future of U.S. biomedical research and preserve the NIH's leading role in accelerating scientific discovery that yields medical breakthroughs and economic benefits nationwide. The advisory, Principles for the Future of Biomedical Research in the United States and Optimizing the National Institutes of Health, was prepared over the past several months by a volunteer committee of research leaders and published today in the Association's flagship scientific journal Circulation.
"Now more than ever, we must recognize that our country's leadership in groundbreaking medical research spurs scientific innovation, improves public health and creates new innovations that save and improve lives nationwide," said Joseph C. Wu, M.D., Ph.D., FAHA, the Association's immediate past volunteer president, chair of the presidential advisory writing committee, director of the Stanford Cardiovascular Institute and the Simon H. Stertzer Professor of Medicine and Radiology at Stanford School of Medicine. "There is an imperative to avoid unnecessary disruption that threatens our global leadership as we look to adapt our nation's research enterprise to better meet today's rapidly evolving heath needs. We must be thoughtful and deliberate in considering opportunities to improve efficiency and transparency to ensure the NIH continues as the world's preeminent biomedical research entity."
The public investment in the NIH produces significant economic returns, including supporting more than 400,000 jobs and roughly $93 billion in economic activity in the U.S. Every $1 increase in publicly funded research from the NIH leads to an additional $8.38 of industry research and development investment. Public investment in disease prevention research has the potential to extend the years people live in good health and reduce health care costs.
As Congress and the administration reassess the funding, staffing and operations of the NIH, the Association offers five principles to optimize its future:
- The U.S. should continue to prioritize high-quality biomedical research that is innovative and impactful. A coordinated strategy for prioritizing research questions and streamlining funding – involving patients and communities, researchers, clinicians, public health professionals and health and disease-specific organizations – could optimize productivity, effectiveness and impact.
- The NIH should continue to improve efficiency and transparency in its peer review process. The Association believes the composition of review panels should continue to be multidisciplinary and recommends the NIH enhance peer-review discussions by having funded researchers fulfill a service responsibility to review grants. The NIH also should work to reduce the administrative burden for grant applications.
- The NIH, in coordination with other federal agencies, should play a larger role in the translation of evidence into practice, including more funding for implementation research. The NIH would advance the translation of science into therapies by strengthening its partnerships with federal health agencies, health care and public health professionals, patients, health systems, payors, industry partners and community-based organizations.
- The NIH should continue to build and support the biomedical research workforce with funding and training opportunities. The NIH must support researchers with different expertise and backgrounds throughout their careers. In addition, the U.S. should, must implement new, data-driven programs to help retain talented mid-career researchers, who can be tempted to leave academia for more competitive research funding and salaries.
- Predictable, robust and sustained public investments in biomedical research should be a national priority. To compete with other countries and ensure a timely pipeline for groundbreaking discoveries, translation, clinical evaluation and implementation, the U.S. must make sustained public investment in biomedical research a national priority.
The Association projects that an older, more heterogeneous population and significant increases in risk factors including high blood pressure and obesity will result in more than 184 million people, or more than 61% of the U.S. population, having some type of CVD by 2050. Over that same time, total CVD-related costs are expected to triple to $1.8 trillion, according to estimates the Association published last year. Robust investments in biomedical research and public health programs are vital to preventing these dire projections from becoming reality.
"The American Heart Association encourages and supports thoughtful efforts to assess the effectiveness of NIH-funded investments to ensure they achieve the greatest impact," Wu said. "Our principles are intended to guide efforts to ensure the NIH and other federal agencies funding of biomedical and population-based research effectively and efficiently support today's urgent needs and future health challenges."
The Association is the largest funder of cardiovascular research outside the federal government, investing more than $5.9 billion since it began issuing scientific grants in 1949. In 2024, the Association funded approximately 1,800 active research awards totaling nearly $500 million. The NIH, with a total budget of roughly $47 billion in fiscal year 2024, funds basic, clinical and population-based research that furthers research findings for transformative discovery. As the Association looks to the future, a well-resourced NIH is essential to addressing projected increases in cardiovascular disease.
This presidential advisory was prepared by the volunteer writing group on behalf of the Association. Presidential advisories promote greater awareness of key topics about cardiovascular disease and stroke. Co-authors and their disclosures are listed in the manuscript.
