Investigators at the Larner College of Medicine are receiving a $10.1 million multi-year grant from the National Institutes of Health to continue their 23-year program studying stroke and cognitive disorders in the United States.
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Investigators at the Larner College of Medicine are receiving a $10.1 million multi-year grant from the National Institutes of Health (NIH) to continue their 23-year program studying stroke and cognitive disorders in the United States.
It is well documented that both race and zip code can influence one’s health, yet many questions remain as to why. The REasons for Geographic and Racial Differences in Stroke (REGARDS) project, funded by the NIH since 2001, is a national study aimed at uncovering the factors that increase an individual’s risk of stroke and cognitive disorders. Specifically, the study seeks to understand why certain regions of the country have higher stroke rates and why Black individuals experience more strokes and more cognitive impairment, cognitive decline, and dementia than white individuals.
The study followed 30,239 Black and white adults over the age of 45 from the lower 48 states. The findings have been significant, resulting in over 750 academic papers based on REGARDS data. One striking discovery revealed that Black people under age 75 are more than twice as likely to die from stroke than white people. Another key finding showed that people living in the South had a 40 percent higher risk of stroke-related death compared to those in other parts of the U.S. It also noted that Alzheimer’s Disease and Related Dementia (ADRD) occur more frequently in Black Americans. While REGARDS investigators have uncovered a litany of reasons for these differences, unfortunately, trends in adverse health in Black Americans seem to be worsening over time.
Due to the remarkable success of this study, the NIH has renewed its grant, allocating $16.4 million in the next two years, and $37.1 million over the next five years, to support this multi-institutional project. Of this, the University of Vermont (UVM) will receive $4.3 million in the initial two years, and more than $10 million by the end of the fifth year. This next step will focus on investigating factors contributing to worsening health disparities among Black Americans, the rise in stroke mortality since 2014, and effects of these trends on dementia and brain health.
“It is alarming that our population’s health is worsening, and that Black Americans continue to have poorer health outcomes than others,” said Mary Cushman, M.D., M.Sc., University Distinguished Professor at UVM and co-leader of the REGARDS collaboration. “This new research will help provide answers to narrow the gap. Here at the UVM Larner College of Medicine, REGARDS has been an engine for our faculty and students conducting research in these areas for over 20 years, and I am excited that we will be able to continue this and improve the health of our country.”
Even before the COVID-19 pandemic, stroke mortality began increasing—as did dementia, high blood pressure (hypertension), and diabetes. This was partly driven by racial disparities in these conditions, as Black Americans have experienced a persistently higher risk of stroke, hypertension, diabetes, and dementia compared to white Americans. REGARDS plans to recruit a new group of 12,000 Black and white adults ages 45–64 and will continue to follow 8,000 original participants of the study. The study will compare people born in 1908–1960 and enrolled in middle age in 2003–07 with people born in 1961–1980 and enrolled in middle age now. This will allow researchers to understand how the uptick in obesity and risk factors have impacted brain health, specifically related to stroke and dementia. The team will also address increasing health disparities affecting Black Americans.
Since REGARDS started in 2001, led by Dr. Cushman, the UVM Larner College of Medicine’s Laboratory for Clinical Biochemistry Research (LCBR) has served as the central analysis lab and biorepository, with samples dating back over 20 years stored in 38 industrial freezer chests. LCBR will continue to play a critical role in this new study phase. The LCBR will receive blood and urine samples from all 20,000 participants, measure key blood tests for health assessment, and store samples for future use. They will provide participants with timely feedback on potentially life-threatening lab results. Over time, UVM investigators and students will continue to use the study data to publish new research finding.
The study’s infrastructure has supported the research careers of Larner faculty like Neil Zakai, M.D., Tim Plante, M.D., and others. More than 35 trainees, including post-doctoral fellows, graduate students, residents, and medical students, have also benefited from the mentorship and research opportunities provided through UVM’s involvement with the REGARDS study.
Cushman adds, “Studies like REGARDS generate a lot of data, which we can leverage to teach our students how to do research. For example, students develop a research question that can be addressed in the study, then learn how to perform statistical analyses to answer that question and publish their findings in the medical literature. It is very impactful, real-world experience for our students, and many stay in research after the experience.”
Cushman also highlighted that REGARDS currently supports 133 active ancillary studies, funded outside of the primary study grant. These include grants awarded to Larner faculty members, such as Nels Olson, Ph.D., and Debora Kamin Mukaz, Ph.D. To date, UVM faculty working in REGARDS have secured over $33 million in funding for the university—not including the current award.
The REGARDS study would not be possible without the work of the faculty above, as well as key staff members at the Larner College of Medicine, including Elaine Cornell, Rebekah Boyle, Jill Sanders, and Nicole Gagne. The co-leaders at other integral institutions are Suzanne Judd, Ph.D., Virginia Howard, Ph.D., George Howard, Dr.PH., and their research team at the University of Alabama–Birmingham, and Columbia University’s Jennifer Manley, Ph.D.