1. Building a research career on ancillary studies Kirsten Bibbins-Domingo, PhD, MD Associate Professor of Medicine and of Epidemiology and Biostatistics

2. Outline I.Intro - goals of junior faculty researchers II.My experience and lessons learned III.Pros and cons of ancillary studies and additional thoughts on building your career

3. Goals of junior faculty researchers Acquire skills in clinical research Publish papers (lots of them!) Gain recognition as an “expert” in a content area Get grants funded (hopefully big ones!) Accomplish all of this in a defined period of time Ancillary studies can be an efficient way to accomplish these goals

4. My experience Goal: to identify individuals at risk for heart failure in order to modify this risk to improve heart failure care in the outpatient general medicine practice 1.Heart failure in HERS 2.BNP in Heart and Soul 3.Heart failure, cystatin C, BNP and more in CARDIA

5. Heart failure in HERS My question as a resident: which women are at risk for heart failure? In HERS: – What clinical factors are associated with incident heart failure in women with coronary disease and no heart failure? – What other clinical factors increase the risk of death among women with heart failure and coronary disease? – Does estrogen increase the risk of death among women with heart failure and coronary disease? Learned analyses through biostats courses 3 publications - Circulation, others

6. Heart failure in HERS What worked? Studying an outcome that others are not studying What was gained? Achieved some goals (skills, papers, reputation?) Collaborate with senior clinical researchers at UCSF Pitfalls?

7. Potential pitfalls Data not collected for this research question Some secondary questions work, some don’t – Self-report of heart failure Don’t force it just because data available to you.

8. BNP in Heart and Soul My question as a fellow: can BNP be used in the outpatient setting to manage heart failure more effectively? An RCT In Heart and Soul: – Is BNP as a useful screening test to detect LV dysfunction? X-sectional study Analyses in biostatistics course 2 papers (Circulation, Am J Med) Received intramural grant for more assays (REAC) 5 papers (JAMA, others)

9. BNP in Heart and Soul What worked? Switch from a project not feasible to a related project that was feasible

10. BNP in Heart and Soul What was gained? More goals accomplished Continue to expand collaborators at UCSF Adding new measures– a gift that keeps on giving!

11. Potential pitfalls? Who’s the boss? Service to the parent study Gaining independence

12. Heart failure in CARDIA My question as a junior faculty: Why are my heart failure patients so young?

13. CARDIA NHLBI-funded cohort study designed to examine how heart disease develops in young adults 5115 young adults age 18-30 yrs in 1985 Men and women Black and white Low and high SES Followed nearly 25 years (exams at years 0, 2, 5, 7, 10 15, 20, new 25) Medical history, psychosocial variables, blood tests, diet and exercise, subclinical CHD, clinical cardiovascular endpoints

14. Heart failure in CARDIA My question as a junior faculty: Why are my heart failure patients so young? In CARDIA – Incidence of heart failure in young and middle aged black and white adults – Clinical antecedents of premature heart failure – Chronic kidney disease and cardiovascular risk – Cumulative exposure to cardiovascular risk factors (blood pressure, lipids) and subclinical cardiovascular disease – Biochemical (BNP) and genetic precursors – Social factors and heart failure risk Several paper (NEJM, Annals, Archives, others in progress) R01 from NIDDK (other grants planned).

15. Heart failure in CARDIA What worked? – Exactly the right dataset to answer research question What has been gained? – Continue to work on goals – Local and national collaborators – NIH interest – Broad base from which to explore multiple questions

16. Other examples of ancillary studies Using publicly available data – NHANES/NHIS/NHDS/NAMCS/ Vital Statistics Adding a new measure – Incarceration in CARDIA – ABI in CARDIA Analyzing data in new ways – Interactions in genetic studies – Decision and cost-effectiveness analyses

17. Potential pitfalls So many research questions, so little time…. Big family Bureaucracy Service Independence

18. But I’m interested in collecting my own data… Ancillary studies may Lay the foundation (papers, reputation) for more competitive grant application – Submitted RO1 for RCT Keep publications, reputation going during start-up phase of primary data collection

19. PAR-09-252PAR-09-252 NEI Research Grant for Secondary Data Analysis (R21) PA-09-131PA-09-131 NIDDK Secondary Analyses in Obesity, Diabetes and Digestive and Kidney Diseases (R21) PA-08-167PA-08-167 NIAAA R01 Secondary Analysis of Existing Alcohol Epidemiology Data (R01) PAR-09-247PAR-09-247 R01 Ancillary Studies to Major Ongoing Clinical Research Studies to Advance Areas of Scientific Interest within the Mission of the NIDDK (R01) RFA-HL-09-001RFA-HL-09-001 NHLBI Ancillary Studies in Clinical Trials (R01) But are ancillary studies really fundable?

21. Thoughts on building your career Be true to your interests Be flexible and recognize opportunities Re-evaluate your career development plan frequently and seek out ways to enhance

22. Thoughts on building your career Concentrate on a few big ideas and the other stuff will follow Develop, nurture, and expand your circle of collaborators

23. Mission Statements

24. Mission Statement templates "To... [what you want to achieve, do or become]... so that... [reasons why it is important]. I will do this by... [specific behaviors or actions you can use to get there].“ "To be known by...[an important person/group]... as someone who is...[qualities you want to have]...; by...[some other person/group]... as someone who is...[other qualities]...;...“ "I value...[choose a value]... because...[reasons why these values are important to you]. Accordingly, I will...[what you can do to live by these values]."