Mr. HAMILTON. Thank you, Dr. Noble.

Dr. Vaughan.

STATEMENT OF MARTHA VAUGHAN, M.D., CHIEF, LABORATORY ON CELLULAR METABOLISM, DIVISION OF INTRAMURAL RESEARCH, NATIONAL HEART, LUNG, AND BLOOD INSTITUTE, NATIONAL INSTITUTES OF HEALTH

Dr. VAUGHAN. Thank you, Mr. Chairman, and members of the subcommittee. I am here to represent Dr. Claude Lenfant who is unable to appear because he is in the Soviet Union to meet with his counterpart in the cooperative agreement in Science and Public Health, Dr. Eugene I Chazov. Unfortunately his meeting could not be changed.

With regard to the United States-U.S.S.R. cooperative agreement for health, I am the National Heart, Lung, and Blood Institute liaison representative for program area 3, which is concerned with heart metabolism.

I welcome the opportunity to report on National Heart, Lung, and Blood Institute programs and activities pursued under government-to-government bilateral agreements between the United States of America and the Soviet Union. The first agreement, for cooperation in Medical Science and Public Health, was initiated by the U.S. Secretary of State and the U.S.S.R. Minister of Health in 1972. A second agreement, initiated in 1974, was for cooperation in Artificial Heart Research and Development.

Cooperation currently focuses on the eight cardiovascular areas highlighted below. Program accomplishments are reviewed periodically by both sides to assure that the resources are focused on important programs of mutual interest and benefit. In 1982 the two agreements were renewed for a period of 5 years and another review is now being conducted currently in anticipation of renewal of both agreements in 1987.

The National Heart, Lung, and Blood Institute of the National Institutues of Health has been designated to collaborate directly with its counterpart institution of the Soviet Academy of Medical Sciences, which is the National Cardiology Research Center in Moscow. Since the beginning, cooperation has been under the joint leadership of the directors of their respective national research institutes. Activities include exchanges of information and scientists, working meetings, symposia, development of protocols and research, and reporting of data.

These activities involve specific United States and U.S.S.R. health institutions. The scope of collaboration is broad, encompassing basic research, applied research and development, clinical investigation, population studies, prevention and education programs, and biobehavioral research. Overall, the cardiovascular programs provide a forum for cooperation on important medical and scientific problems, and are built on the Institute's programs and priorities.

Program area one is arteriosclerosis, the disease process that is directly or indirectly responsible for more deaths in both the United States of America and the U.S.S.R. than any other disease. Among recognized risk factors for development of arteriosclerosis,

elevated blood lipids have been implicated extensively and unequivocally, and are a major focus of this program area.

Nine United States Lipid Research Clinics sponsored by the NHLBI and two clinics supported by the U.S.S.R. Ministry of Health, one in Moscow and one in Leningrad, have cooperated in these epidemiological studies conducted according to common protocols. The study populations are representative of diverse ethnic, occupational, geographic, and age groups, making possible crosscultural comparisons of the differences in risk factors between the United States and Soviet populations. Data from these studies will be presented at the Second Joint United States-U.S.S.R. Lipoprotein Symposium in September 1986 in conjunction with the X World Congress of Cardiology in Washington.

Ischemic heart disease is the second program area. American and Soviet scientists have conducted a clinical study to systematically compare groups of cardiac patients and the effectiveness of different treatment modalities in the two countries.

This study has provided an opportunity for exchange of concepts and techiques in cardiovascular medicine among large numbers of United States and U.S.S.R. physicians and scientists. It is anticipated that this study will be completed in 1986.

The third program area, myocardial metabolism, involves basic research that provides new insights into the manner in which heart muscle cells obtain energy, coordinate their contraction, and respond to their environment. Joint studies have been conducted by United States and U.S.S.R. scientists in each others' laboratories and the findings published in scientific journals in both countries. Cooperation in area three has recently extended to basic research on the pulmonary endothelium, a research area of high priority in the NHLBI National Program.

Cooperation in program area four has emphasized congenital heart disease and explored new methods of diagnosis, surgical treatment, and postoperative care to reduce mortality. Congenital heart disease is an important disease of children and young adults in both the United States and U.S.S.R. Scientists in both countries have recently suggested broadening the scope of the program to encompass cardiovascular surgery in general. The continuation of the activity beyond 1986 is under consideration.

Program area five deals with sudden cardiac death, the cause of some 350,000 deaths annually in the United States. Cooperation has focused on pathological anatomy and electrophysiology which may lead to sudden cardiac death and on the development of possible prophylactic antiarrhythmic drugs. Recent research has dealt with the electrophysiology, pathology, pharmacology, and clinical aspects of sudden death.

Safe and effective blood and blood products is the concern in program area six because blood resources are closely related to surgery as well as to many other forms of cardiovascular therapy. Topics for collaboration have included: prevention of post-transfusion hepatitis, transfusion of blood and blood components, and the use of blood substitutes during cardiovascular surgery.

Currently, the major focus is on more effective separation and preservation of such blood components as platelets, red cells, and leukocytes.

Program area seven deals with hypertension, which affects almost 30 percent of the U.S. adult population, and is also a serious public health problem in the U.S.S.R. Although the prevalence of hypertension is high in both countries, the patterns of the disease differ. Comparative studies address the development of better prevention and control of the potentially lethal sequelae of stroke, heart failure, and kidney failure. Areas of collaboration include basic research, biohehavioral research, and studies on the primary prevention of hypertension.

The eighth program area addresses the need to develop devices to support heart function in patients with severely compromised or fatally impaired function. The original objectives were the development of better circulatory assist devices, and recently, the focus of the cooperation has been on biomaterials development for circulatory devices.

Some specific benefits that have resulted from the special features of United States.-U.S.S.R. cooperation may be mentioned.

In a large number of basic studies, Soviet scientists have contributed state-of-the-art technology in cooperation with United States scientists. One example is targeting drugs to damaged areas of the heart after a heart attack, and simultaneously imaging the areas of the heart that have been damaged.

In other studies, several United States methodologies when combined with Soviet research resources, have facilitated important pathological studies that might give clues to factors responsible for sudden cardiac death.

Joint epidemiological studies of United States and Soviet populations have revealed different patterns of cardiovascular disease in the two countries. Reasons for these differences are being studied to better understand how diet, lifestyles, ethnic, occupational, geographic and age factors may influence the development of arteriosclerosis.

Joint research has focused on the mechanism of action of antiarrhythmic drugs as I mentioned earlier. Drugs studied include new agents developed in the Soviet Union and now licensed to and marketed by a major United States pharmaceutical company.

Finally, resources at the Soviet primate research center in Sukhumi have been used in the development of a joint study which requires a large baboon colony to examine how hypertension develops and how it may be controlled through biobehavioral approaches. By combining the U.S.S.R. animal resources with United States methodological techniques, both sides have benefited. This study has implications for United States and U.S.S.R. efforts to treat hypertension through nonpharmacologic means.

Overall, the United States-U.S.S.R. cooperative agreement in the eight cardiovascular areas has been very productive. Twenty-nine joint symposia have been held and the proceedings of most of these have been published jointly [or are in press] in both English and Russian. Research results have been published in more than 600 scientific papers.

In conclusion, Mr. Chairman, a great deal of joint research has been accomplished by United States and U.S.S.R. scientists participating in the cardiovascular exchanges coordinated by the National

Heart, Lung, and Blood Institute. I believe that the prospects are excellent for continued productive cooperation in the future.

[The prepared statement of Dr. Vaughan follows:]

PREPARED STATEMENT OF MARTHA VAUGHAN, M.D., CHIEF OF THE LABORATORY OF CELLULAR METABOLISM, DIVISION OF INTRAMURAL RESEARCH, NATIONAL HEART, LUNG, AND BLOOD INSTITUTE, NATIONAL INSTITUTES OF HEALTH

Mr. Chairman and Members of the Subcommittee:

I am Dr. Martha Vaughan of the Intramural Research Division of the National Heart, Lung, and Blood Institute, National Institutes of Health, where I am Chief of the Laboratory of Cellular Metabolism. I am here to represent Dr. Claude Lenfant who is unable to appear because he is in the Soviet Union to meet with his counterpart in the cooperative agreement in Science and Public Health, Dr. Eugene I Chazov. Unfortunately his meeting could not be changed. With regard to the US-USSR cooperative agreement for health, I am the National Heart, Lung, and Blood Institute liaison representative for Area three, which is concerned with heart metabolism.

I welcome the opportunity to report on National Heart, Lung, and Blood Institute programs and activities pursued under government-to-government bilateral agreements between the United States of America and the Soviet Union. The first agreement, for cooperation in Medical Science and Public Health, was initiated by the U.S. Secretary of State and the U.S.S.R. Minister of Health in 1972. A second agreement, initiated in 1974, was for cooperation in Artificial Heart Research and Development. Cooperation currently focuses on the eight cardiovascular areas highlighted below. Program accomplishments are reviewed periodically by both sides to assure that the resources focus on important programs of mutual interest and benefit. In 1982 the two agreements were renewed for a period of five years and another review is being conducted currently in anticipation of renewal of both agreements in 1987, for an additional five-year period.

Cooperation in the area of cardiovascular disease research is in keeping with the Memorandum of Understanding signed at the US Department of Health, Education, and Welfare-USSR Ministry of Health level during the first meeting in Moscow of the US-USSR Joint Committee for Health Cooperation in 1973. This memorandum stated: "both Parties will develop mutual cooperation in the fields of health and medical science which are of greatest significance, firstly the program of cardiovascular diseases." The agreement also stressed: "the Parties agree to direct their initial joint efforts toward combating the most widespread diseases, such as cardiovascular... diseases, because of the major threat that they pose to man's health."

The National Heart, Lung, and Blood Institute of the National Institutes of Health has been designated to collaborate directly with its counterpart institution of the Soviet Academy of Medical Sciences, which is the National Cardiology Research Center in Moscow. Since the beginning, cooperation has been under the joint leadership of the directors of their respective national research institutes. The NHLBI cooperates through such joint activities as exchanges of information and scientists, working meetings, symposia, development of protocols and research, and reporting of data. These activities involve specific US and USSR health institutions. Eight program areas have been selected, and the scope of collaboration is broad. It encompasses basic research, applied research and development, clinical investigation, population studies, prevention and education programs, and biobehavioral research.