Shattuck lecture--clinical research to clinical practice--lost in translation?

uring the 20th century, enormous progress was made in improving the health and therefore the life span of all Americans. The average life expectancy at birth increased by nearly 30 years between 1900 and 2000. Although the largest gains were made in the early part of the century, we still managed to add another 1.5 years between 1990 and 2000. Much of our continued success in extending life expectancy over the past several decades is almost certainly due to research supported by the National Institutes of Health (NIH) and generously funded by the American public. NIH-supported research has not only made possible the development of new and improved treatments for a wide range of human diseases; it has also provided the knowledge of disease risk factors needed to formulate effective approaches to prevent them. For example, research supported by the National Heart, Lung, and Blood Institute has identified important cardiovascular risk factors, has established the effectiveness of approaches to prevent or control them, and has assessed the effectiveness of treatment interventions for established disease. As director of the National Heart, Lung, and Blood Institute, I am especially gratified to be able to point out that the lion’s share of our recent gains in life expectancy in the United States has come from reductions in rates of death from heart disease and stroke. According to data provided by the National Center for Health Statistics, life expectancy increased by six years between 1970 and 2000, and nearly two thirds of that increase can be attributed to reductions in mortality due to cardiovascular disease (Fig. 1). And although primary prevention has played an important part in the reductions, it appears, at least for coronary heart disease, that secondary prevention and other treatments have had a significantly greater effect. According to one analysis of the decline in mortality due to coronary heart disease that occurred between 1980 and 1990, the reduction was due largely to secondary prevention and other improvements in treatment, with primary prevention accounting for only one quarter of the decline. 1