Project Office Update November 7, 2013 Jacques E Rossouw

Renewal proposal approved for further development (i.e., developing Acquisition Plan) Budget subject to availability of funds --sequester, etc. Initial approval for 3 year period --period could be adjusted depending on outcome of BEE/Council WG Renewal

 By 2050 number of US women aged >65 will have doubled to 49 million.  CVD deaths account for 36% of total deaths in older women  By 2016 WHI projects to have 85,000 participants with mean age 83 (range ), N=52K or 58% age >80.  In MRC project 21K women (including 5.8K AA, 2.2K Hispanic) by 2016 Unique Strengths of WHI

 Expand knowledge about the determinants of CVD in older women (and conversely determinants of successful aging with absence of CVD)  Particular focus on understudied conditions of heart failure, atrial fibrillation, periperal arterial disease, aortic stenosis  Fully utilize the new data and bloods from the LLS subcohort Current and Future Mission

 Expand the study as a scientific resource for the research community  GWAS=32K, ExomeChip=25K, Metabochip=15K  Mentor young investigators  ~150 mentored during current renewal  2010 Chicago Workshop to date has led to 21 approved manuscript proposals and 5 published papers  Facilitate a new generation of large simple trials  Cocoa and multivitamin (Manson)  Physical Activity (Stefanick/LaCroix)  Vitamin D (Jackson)  Continue research into utility of CMS data Current and Future Mission

 Determine whether race/ethnic differences in CVD risk are explained by SES, risk markers, genomics, life habits, medical coverage, or environmental factors  Determine influence of risk factors (including genomic) and exposures on heart failure (including HF with preserved systolic function), AF, AS, PAD  Create CVD survivor cohort by following up incident events through CMS for recurrence, morbidity/mortality, quality of care, healthcare utilization and expenditures Selected Research Examples

 Integrate gene variants, methylation, expression, regulation, metabolome, and biomarkers in systems biology approach to CVD pathways  Determine influence of baseline LTL on successful aging/absence of CVD and the determinants of attrition in LTL and its association with CVD risk Selected Research Examples

Some Initial Results: Dissemination and Mentoring  Total ancillary studies = 225 (April, 2013) Before % led by new investigators After % led by new investigators  Publications = 814 (April, 2013) Before % led by new investigators Since % led by new investigators

 WHI cohort study  Increasingly productive  Cost-effective  High impact (~2400 cites per year since 2010)  Mentoring and dissemination efforts are showing results  Need more focus on CVD in older women Conclusions