Elizabeth Cooney , 2025-04-25 21:43:00
Vasan Ramachandran is baffled. A cardiologist and veteran of the famed Framingham Heart Study, he is struggling to understand why a similar study he brought to life in 10 rural counties across four Southern states is facing elimination. The RURAL Cohort Study, set in motion six years ago, was nearing its recruitment goal of 3,300 people, a sign that it was winning the trust of people in remote areas of Alabama, Mississippi, Louisiana and Kentucky.
Participants don’t walk into a brick-and-mortar building for this study. The research team travels to them, working in a mobile examination unit housed in a 50-foot trailer weighing about 50,000 metric tons and carrying a CT scanner plus a cardiac ultrasound machine that uses AI. “We take the science to the people,” he said.
The RURAL (Risk Underlying Rural Areas Longitudinal) Cohort Study follows a trail blazed by the Framingham Heart Study, intended at its outset to study the origins and causes of coronary heart disease. Its findings defined how cholesterol causes heart disease; how high blood pressure drives heart disease, heart failure, and stroke; and how diabetes, diet, and smoking contribute to heart disease. Newer studies have widened the lens to focus on different populations in different parts of the country than the largely white, middle-class people living in Massachusetts when the Framingham study launched in 1948.
The RURAL Cohort Study was similarly meant to provide insight into cardiovascular and other chronic illness. But on April 11, Ramachandran received a formal email citing an executive order for cost efficiency informing him that the study’s federal funding was “canceled in its entirety and will no longer be considered for award under the contract mechanism.”
The earth shifted under the investigators, who pivoted to seeking a one-year cost extension while preparing to ease the uncertainty and disappointment in the communities they served. Solving chronic disease has been a platform in the Make America Healthy Again movement espoused by Health Secretary Robert F. Kennedy Jr.
“It would be most unfortunate if because of budget cuts or whatever, what is put on the chopping block are things which are likely to actually improve the health of the people, including for chronic disease,” Ramachandran told STAT on Friday. “That’s what the dissonance is for me: You talk about chronic disease, you talk about the rural people, but then why do you cut the RURAL study?”
The RURAL Cohort Study is one of many research programs whose once-secure funding is in question. The requirement for the National Institutes of Health to cut 35% in contract spending, ordered by the Trump administration’s federal government-shrinking task force known as the U.S. DOGE Service, can potentially affect many other studies.
Earlier this week the Women’s Health Initiative informed its regional centers that their grants would run out in September, but on Thursday it appeared not to be the case, based on a post on X by Kennedy. Other researchers are eyeing Washington carefully, mindful of quick and unpredictable changes in policy and financing.
The Jackson Heart Study, the country’s largest investigation into the causes of cardiovascular disease in African Americans, is one of them. A spokeswoman for the study at the University of Mississippi Medical Center told STAT on Friday there would be no comment at this time about the research, which involves more than 5,300 men and women in Jackson, Miss.
While praising the Jackson study as foundational in understanding heart disease in this population and responsible for valuable discoveries, an NIH statement later sent to STAT referred to Kennedy’s ordering NIH to target $2.6 billion in contract reductions.
“This guidance was conveyed to all the NIH Institutes with an aim toward a 35% reduction across NIH contracts. These reductions are undergoing further review, at which point HHS will determine funding decisions related to these programs.”
A similar query to the Framingham Heart Study, seen as a model for long-term cohort studies to identify risk factors for cardiovascular disease, garnered a complicated answer. Yes, the study has felt only minimal effects on its funding, but only after “true heroism” from NIH employees, Donald Lloyd-Jones, Framingham’s principal investigator, told STAT.
“The people who funded our contract, and I gather about 100 other grants, got them out the door in that very narrow window when they could, were ultimately either fired or resigned because they knew they were going to be fired,” he said.
The Framingham study’s six-year contract expired on Jan. 31, but its renewal was held up by executive orders related to funding issued in the following days. Come Feb. 14 that renewal was secure, but Lloyd-Jones takes nothing for granted. He’d returned to Framingham, where he had been a research fellow, after 20 years at Northwestern. He did not want to take over as the PI of Framingham only to be “the guy who one month later turned out the lights.” He’s still on alert.
“We’re concerned. Every day and every hour we have to keep our finger on the pulse because we don’t know if there might be new orders that could affect us,” he said. “And we are constantly on our toes to make sure we’re going to be here for our incredible participants and for the people whose livelihood is to make sure that we are advancing science.”
No one at NIH managed to pull off another six years for the rural study. In its first year and a half of funding, the team had focused on community listening projects, understanding the people, and partnering with them to build engagement.
Come November of last year the study team had submitted thousands of pages to extend the study’s original grant, but shifting requirements at the National Heart, Lung, and Blood Institute moved the application to a different pool with different criteria for obtaining a contract with an upper limit of $50 million. A review was canceled just before it was about to be conducted, Ramachandran was told by the study’s program officer, all following NIH’s mandate to reduce costs.
“We already wrote a response but now we have to write an entirely new grant hoping it gets funded in time to renew the operation,” he said.
If the cost extension to the current grant comes through, it would take the study from May 1 through April 2026. The scientists are waiting, simply hoping that the contract is restored.
“I’m enthused about the Women’s Health Initiative — kudos to them,” Ramachandran said.
He’s keeping the participants in mind, remembering that 20% or more of them are considered economically challenged. Many of them feel forgotten by the medical system and mainstream science.
“It’s not just about the funding for the investigators. It’s not just about the fact that good science will come out. This is also about an opportunity for the rural people to contribute to that science, to engage,” he said. “We have had a tremendous response in these rural counties because when they find out, they say, ‘Wow, you guys are studying us?’”
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.
