Dr. Herman Taylor.

Renewed Through 2014, JHS Moving Beyond Basic Research

Last September, Herman A. Taylor, Jr., MD, stood before an international group of experts in heart disease and public health for the Jackson Heart Study (JHS) Scientific Conference 2010: Toward Resolution of Cardiovascular Health Disparities, to share an update at the 10-year mark of the largest study in history to investigate the genetic factors that affect high blood pressure, heart disease, stroke, diabetes and other important diseases in African-Americans.

Sponsored by the National Heart, Lung and Blood Institute and the Office of Research on Minority Health of the National Institutes of Health (NIH), the landmark project was designed to explore reasons for this disparity and uncover approaches to reduce it.

For starters, Taylor emphasized, the landmark project will continue at least through 2014, but is at somewhat of a crossroads on studies to pursue next. On the mission list: sharing scientific directions on cardiovascular disease risk factors and related areas that will expand science and significantly impact the resolution of health disparities; to promulgate a model for building research capabilities in minority institutions; and to disseminate a model for engaging the community in all aspects of the population-based longitudinal, epidemiological study.

“The JHS independent investigators, in consultation with some of the leading experts in epidemiology across the country, are in the process of coming up with the most fruitful avenues to explore,” said Taylor, a Princeton and Harvard Medical School-trained cardiologist who serves as principal investigator and director of the Jackson Heart Study University of Mississippi Medical Center (UMC) is the health sciences campus of the University of Mississippi (Ole Miss). Located in Jackson, Mississippi (USA), it houses the Schools of Medicine, Dentistry, Nursing, Health Related Professions, and Graduate Studies in the Health.

 “The important priorities for us as researchers on the ground must ultimately square with the research portfolio of the NIH. What we propose has to make sense in the evolution of the Jackson Heart Study and the knowledge base we’re creating. And ultimately, it must make sense in terms of the public health, not only of African-Americans, but all Americans.”

Ole Miss Chancellor Dan Jones, MD, the study’s inaugural principal investigator who spearheaded the JHS feasibility study in 1996-97, helped recruit Taylor from the University of Alabama in 1998 to lead the JHS. When he compared data in the mid-1990s, Jones had been disturbed to learn the extent that African-Americans suffer cardiovascular disease as compared to other ethnic groups. For example, 40-year-old black women had a likelihood of dying of cardiovascular disease four and a half times higher than the national average. Rates for black men the same age were three times above the national average. Even though rates have declined slightly, they remain disproportionate.

“We’re very interested in the earliest onset of cardiovascular risk, because we’re mainly focused on prevention, and in that mindset, we have to think about including children,” said Taylor. “We should be in a position in the next few months to launch a pilot—the JHS Kids Study—that will begin to look at risk factors in children who are related to individuals enrolled in the Jackson Heart Study. After seeing how that goes, it may give us strong footing for a longer-term project that specifically focuses on cardiovascular disease in the growing child.”

The JHS followed the heart health of 5,300 African-American adults in the metro Jackson area in the same manner as the renowned Framingham Heart Study (FHS), one of the nation’s longest-running population studies. The FHS has followed some 10,000 Massachusetts residents spanning three generations since 1948, yet has lacked racial diversity. Another large-scale population study, the Atherosclerosis Risk in Communities (ARIC) Study, began in 1987 with four groups of 4,000 people each, representing four quadrants of the country. African-Americans comprised the entire Jackson cohort and symbolized a well-defined starting point for the JHS, which has taken into account diversity among participants by analyzing lifestyle factors such as diet, income, education levels, and community and church involvement.

After a decade of research, many interesting lines of investigation are wide open to explore in-depth, said Taylor.

“A particularly intriguing finding is that we know obesity is tied to higher risk of high blood pressure, bad cholesterol, and even cancer,” he said. “Our observation comparing blacks with normal BMI versus whites in the Framingham study with normal BMI is that those blacks have substantially higher rates of high blood pressure, above normal cholesterol, and diabetes. The question becomes: what differences are at play? Genetics naturally arises as a factor, but environmental differences are also important. This is where lifestyle factors play a role into higher cardiovascular risk.”

Taylor pointed to a study that was conducted under fairly ideal circumstances in which diet and exercise habits were manipulated.

“There were good outcomes in terms of managing blood pressure and other important risk factors,” he said. “We’d like to look at a real-world example of people going about their everyday lives to find out: What are the effective interventions to lower cardiovascular risk?”

Sleep patterns may also affect risk for cardiovascular disease.

“Data suggests that African-American men get less sleep on average than other groups,” he said. “How does that play into differences we see in blood pressure—and survival, for that matter?”

Housed in the Jackson Medical Mall, the Jackson Heart Study represents a unique collaborative model among the Jackson community, NIH, and three institutional partners—University of Mississippi Medical Center, Jackson State University and Tougaloo College.

“We’ve learned so much with this type of study design,” said Taylor, who holds appointments at all three institutions. “With specific adjustments to our design, the benefits of the JHS will only multiply.”

Among many benefits, the JHS has served as a springboard for community health outreach and provided training opportunities to undergraduate students interested in science, medical and public health careers.

“The JHS has hosted a collection of spinoff studies, such as how circulation abnormalities may predict cardiac disease,” said Jackson. “These parallel studies extend beyond cardiovascular disease, for example, to diabetic influences on eyesight. It’s also spun off a multitude of genetics studies that should lend insight into why African-Americans might have different outcomes for different diseases than other groups. Together, the footprint of the Jackson Heart Study has grown substantially from its early days by providing more opportunities for scientific exploration right here in Jackson and working collegiately with world leaders in the fields of heart disease and prevention.”

Editor’s Note: The feature on the unprecedented Jackson Heart Study is the third article in a series highlighting Jackson Medical Mall’s 15^th anniversary in 2011.

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