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 focuses on arteriosclerosis, the disease process that is directly or indirectly responsible for more deaths in both the USA and the USSR than any other disease. Among recognized risk factors for development of atherosclerosis, elevated blood lipids have been implicated extensively and unequivocally, and are a major focus of this program area. The cooperative effort involves large-scale epidemiological studies conducted according to common protocols. These joint studies are an extension of the US Lipid Research Clinics (LRC) Program sponsored by the NHLBI. Nine US LRC's and two clinics supported by the USSR Ministry of Health in Moscow and Leningrad have cooperated in these epidemiological studies. The study populations, which are representative of diverse ethnic, occupational, geographic and age groups, make possible cross-cultural comparisons of the differences in risk factors between the US and Soviet populations. Data on these studies will be presented at the Second Joint US-USSR Lipoprotein Symposium in September 1986 in conjunction with the X World Congress of Cardiology in Washington.

Ischemic heart disease is the second program area of cooperation. 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.

The US cases are

those from our domestic Coronary Artery Surgery Study that met joint

study criteria coronary bypass surgery in the US and extensive pharmacological regimen in the USSR. These studies have provided an

opportunity for exchange of concepts and techniques in cardiovascular medicine among large numbers of US and USSR physicians and scientists through the development of common plans, methods, and protocols. It is anticipated that this study will be completed in 1986.

The third program area, myocardial metabolism, involves basic research and provides new insights into the manner in which heart muscle cells obtain energy, coordinate their contractions, and respond to alterations in their environment.

Joint studies have been conducted by

US and USSR scientists in each others' laboratories and the findings published in scientific journals in both countries. It is anticipated that these studies will contribute to development of therapies that will enable a greater proportion of heart muscle to survive an acute heart attack, and to development of new and improved methods of preventing cardiac disease. Cooperation in area three has recently included joint 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 of complex heart defects to reduce mortality from these conditions. Congenital heart disease is an important disease of children and young adults in both the US and the USSR. 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 US.

Exchanges of scientists, delegations

and joint symposia have focused on pathological anatomy and electrophysiology which may lead to sudden cardiac death and on the pharmacology of possible prophylactic antiarrhythmic drugs. Recent research has dealt with the electrophysiology, pathology, pharmacology and clinical aspects of sudden death.

The importance of safe and effective blood and blood products is the topic of concern in program area six because blood resources are closely related to surgery as well as to many other forms of cardiovascular therapy. Some of the themes of collaboration in this area have been: prevention of post-transfusion hepatitis in cardiovascular surgery; transfusion of blood and blood components, and blood substitutes during cardiovascular surgery; and the preservation of blood and its cellular elements. Currently, the major thrust in this program area is on more effective separation and preservation of such blood components as platelets, red cells, and leukocytes.

Cooperation in program area seven focuses on hypertension, a public health problem affecting almost 30 percent of the US adult population, and also a serious problem in the USSR. Although the prevalence of

hypertension is high in both countries, the patterns of the disease differ. Comparative studies are addressed to development of better prevention and control of the potentially lethal sequelae of stroke, heart failure, and kidney failure. Areas of collaboration include basic research, biobehavioral research, and studies on the primary prevention of hypertension. To date, exchanges have focused on US and USSR programs for the control of hypertension and research on the role of biobehavioral and neuro-physiological factors in 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 for this cooperation were the development of better circulatory assist devices, and the study of the complex physiology of assisted circulation. 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 US-USSR cooperation are highlighted below:

O In a large number of basic studies, Soviet scientists have contributed state-of-the-art technology in cooperation with US 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.

o A number of US methodological techniques, when combined with

Soviet research resources, have facilitated important

pathological studies that might gives clues to the factors
responsible for sudden cardiac death.

Joint epidemiological studies of US and Soviet populations have
revealed that patterns of cardiovascular disease differ in the
two countries. The reasons for these differences are being

studied to better understand how diet, life-styles, ethnic,
occupational, geographic and age factors may influence the
development of atherosclerosis.

o Joint research has focused on fundamental electrophysiological phenomena and the mechanism of action of antiarrhythmic drugs potentially effective in the prevention of sudden cardiac

death. Drugs studied include new agents developed in the Soviet Union and now licensed to and marketed by a major US pharmaceutical company.

o 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 for studies of hypertension. The study examines how hypertension develops and how it may be controlled through biobehavioral approaches. By combining the USSR animal resources with US methodological techniques, both sides