Pankaj Arora, M.D., received this grant to study how increasing natriuretic peptides through the use of FDA-approved medications can help improve cardiometabolic health among Black Americans.
Photography: Andrea MabryResearchers from the University of Alabama at Birmingham Division of Cardiovascular Disease were awarded a $3.7 million grant from the National Heart, Lung, and Blood Institute to study how increasing natriuretic peptides through the use of FDA-approved medications can help improve cardiometabolic health among Black Americans.
This grant is being used to fund the first-of-its-kind and largest clinical study in the United States to perform deep metabolic phenotyping and will exclusively recruit Black adults to study the use of FDA-approved medications and their role in improving cardiometabolic health.
Pankaj Arora, M.D., associate professor of medicine and director of the Cardiovascular Clinical and Translational Research Program and the UAB Cardiogenomics Clinic, received the grant.
“Poor cardiometabolic health is disproportionately higher among Black individuals living in the U.S. due to the combination of social determinants of health and clinical risk factors,” Arora said. “These health inequities are further worsened by the absence of inclusivity of Black adults in cardiovascular clinical and translational research.”
An estimated 37 million adults in the United States have diabetes, and an additional 96 million adults have prediabetes, which predisposes them to a higher risk of potentially fatal cardiovascular events such as heart attack, stroke and heart failure.
NPs are hormones produced by the heart that regulate cardiometabolic health. These hormones are released in response to changes in pressure inside the heart. Scientists believe that by improving the levels of NPs, they can help improve metabolic health among Black individuals.
“With FDA-approved NP-increasing medications available, this is an exciting era for using physiological principles for preventing and treating cardiometabolic diseases in at-risk populations,” Arora said. “Despite the overrepresentation of Black adults with cardiovascular disease, there is an unacceptably low representation of Black adults in cardiology clinical research. In the last few decades, approximately 70 percent of participants in cardiology clinical trials were white males. UAB is uniquely positioned to overcome this. Our compassionate, well-educated and respectful clinical research team is highly motivated to mitigate the health inequities and improve cardiometabolic health in Black adults. UAB provides the infrastructure and leadership to pursue such a complex unparalleled clinical research initiative among Black individuals with ease.”
The study is the result of decades of interdisciplinary research conducted by UAB scientists in collaboration with investigators across the country. Through past research, Arora and other investigators have shown that, among thousands of adults in the United States, Black adults have 20-30 percent lower circulating levels of NPs. The lower levels of NPs can begin very early in life and manifest even among healthy young adults.
Individuals with lower circulating NP levels are predisposed to a higher risk of cardiometabolic diseases such as diabetes, high blood pressure, heart attacks, stroke and heart failure. Unfortunately, these cardiometabolic diseases are more prevalent in Black adults; but with lifesaving medications, such as sacubitril-valsartan, that can improve NP levels now available, Arora and his colleagues are studying how the use of these medications may improve the circulation of NP levels in individuals with low NP levels to improve their cardiometabolic health and reduce their risk of potentially fatal cardiac events in the future. This has led to the conception, design and implementation of the Effect of Natriuretic Peptide Augmentation on Cardiometabolic Health in Black Individuals (NCT04055428), or NAUTICAL trial.
Arora believes that studies like the NAUTICAL trial will help advance inclusivity in clinical research and ensure that the most effective treatments reach the populations that need them most.
“The UAB Cardiovascular Institute has been advancing initiatives for the inclusion of underrepresented individuals in clinical research and helps improve our understanding of what drives the development of diabetes in the community through the UAB Cardiovascular Research Biobank,” Arora said. “UAB physician-scientists are leading several such initiatives to enhance the participation of underrepresented communities in medical research.”