Building a research career on ancillary studies

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

2. Outline • Intro - goals of junior faculty researchers • My experience and lessons learned • 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 • Heart failure in HERS • BNP in Heart and Soul • 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. But are ancillary studies really fundable? PA-08-167NIAAA R01 Secondary Analysis of Existing Alcohol Epidemiology Data (R01) RFA-HL-09-001NHLBI Ancillary Studies in Clinical Trials (R01) PAR-09-252NEI Research Grant for Secondary Data Analysis (R21) PA-09-131 NIDDK Secondary Analyses in Obesity, Diabetes and Digestive and Kidney Diseases (R21) PAR-09-247R01 Ancillary Studies to Major Ongoing Clinical Research Studies to Advance Areas of Scientific Interest within the Mission of the NIDDK (R01)

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]."