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The NIH dedicates a lot of money for research into heart disease and stroke, but it still might not be enough, a new study suggested.

In recent years, , more than is spent on the other diseases on the nation's list of top killers, according to the NIH.

But when you weigh the disease burden against the amount of research funding received, cardiovascular disease appears to be getting short-changed.

, a PhD student in the departments of pediatrics and pharmacology/toxicology at the University of Utah Health Sciences Center, told MedPage Today that he wanted to look into the issue after reading a study published last year detailing the leading causes of death and disability in this country.

Cardiovascular disease -- including ischemic heart disease and stroke -- was at the top, both in 1990 and 2010. Rounding out the list of 10 were breast cancer, diabetes, cirrhosis, lower respiratory tract infection, colorectal cancer, Alzheimer's disease, lung cancer, and COPD.

As Stockmann and his colleagues reported in the International Journal of Cardiology, the NIH dedicated $6 billion to those conditions combined in 2010. ($1.56 billion) and COPD got the smallest ($133 million). Considering ischemic heart disease and stroke together, cardiovascular disease received $2 billion.

Dividing those figures by the number of deaths caused by each condition, however, moved cardiovascular disease far down the ranking. Breast cancer received $19,342 in research funding per death, whereas cardiovascular disease received a comparatively meager $2,659 per death.

A similar trend was seen for hospitalizations: breast cancer received $10,653 per hospitalization, Alzheimer's disease received $4,698, and cardiovascular disease received just $878.

"Regrettably, we -- as members of the medical community -- have failed to articulate the need for public funding into the basic causes of cardiovascular disease and the clinical trials needed to understand how best to treat and prevent it," Stockmann said in an email to MedPage Today. "Although heart disease and stroke kill nearly one out of every two Americans and consume one out of every $6 spent on healthcare in this country, we have underestimated the challenge in understanding the basic pathophysiology of these diseases and in helping the public to understand how to live and enjoy the benefits of a heart-healthy lifestyle."

, chief of cardiology at UT Southwestern Medical Center and co-chair of the American College of Cardiology’s Academic Section Advisory Council, said in an interview that he wasn’t surprised by the findings, and pointed to a couple reasons why cardiovascular research might not get as much funding -- relative to disease burden -- as some other conditions.

First, he said, the significant reductions in heart disease mortality in recent decades might have left some people with the impression that the problem has been solved. "That, of course, is far from the truth."

And second, a perception that heart disease is a self-inflicted disorder -- caused by eating poorly, becoming obese, and smoking, for example -- might result in some people thinking that not as much funding needs to go into understanding its causes.

"There certainly is a lifestyle component that contributes importantly, but half of the problem is out of people's control," Hill said.

While admitting her bias as a cardiologist and the president of the American Heart Association, , of the University of Pennsylvania also agreed that cardiovascular research is under-funded and said that it's not clear what goes into the NIH's decisions about where its money should go.

The solution to the funding problem, she told MedPage Today, is to increase the overall NIH budget rather than to advocate for money to be taken from one disease and moved to another.

"If there's a single message," she said, "it's that we as a country -- if we want to keep our place in the world as the fountain of research and as the originator of major medical strides -- have to fund to a higher level all research from the NIH – in addition to cardiovascular disease and stroke research."

Hill pointed out that the current study was a snapshot of funding from 2010 and that NIH funding has been declining for the past decade. At the same time, some other countries around the world have been increasing their investment in medical research.

"We are pulling back when many other countries are ramping up," he said. "And so the historic advantage and lead that we have had in this country is diminishing."

The study did not take into account funding from industry or foundations, and Stockmann noted that metrics other than those used in the study could be used to guide decisions about how to allocate funds for research.

"Our hope in publishing this study is to spark a national dialogue on the funding of biomedical research and to provide information that may be useful as a starting point in the discussion of how to fund biomedical research in the years to come," he said.

The NIH did not respond to a request for comment.

CardioBuzz is a blog by Todd Neale for readers with an interest in cardiology.

From the American Heart Association:

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