CONGRESSIONAL JUSTIFICATION 

FY 2025

Department of Health and Human Services

National Institutes of Health

National Heart, 

Lung, and Blood 

Institute
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NHLBI-1 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute (NHLBI) 

FY 2025 Budget Table of Contents 

Director’s Overview .................................................................................................................... 3

IC Fact Sheet ............................................................................................................................... 9

Major Changes .......................................................................................................................... 11

Budget Mechanism Table ......................................................................................................... 13

Appropriations Language.......................................................................................................... 14

Summary of Changes ................................................................................................................ 15

Budget Graphs .......................................................................................................................... 15

Organization Chart .................................................................................................................... 17

Budget Authority by Activity Table ......................................................................................... 18

Justification of Budget Request ................................................................................................ 19

Appropriations History ............................................................................................................. 33

Authorizing Legislation ............................................................................................................ 34

Amounts Available for Obligation ............................................................................................ 35

Budget Authority by Object Class ............................................................................................ 36

Salaries and Expenses ............................................................................................................... 37

Detail of Full-Time Equivalent Employment (FTE) ................................................................ 38

Detail of Positions ..................................................................................................................... 39

General Notes

1. FY 2024 enacted levels cited in this document are based on the Continuing 

Resolution in effect at the time of budget preparation (Public Law 118-35) and do 

not include HIV/AIDS transfers.

2. Detail in this document may not sum to the subtotals and totals due to rounding.
NHLBI-2 

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NHLBI-3 

DIRECTOR’S OVERVIEW

Director’s Overview

The National Heart, Lung, and Blood Institute (NHLBI) supports research to prevent and treat 

heart, lung, blood, and sleep (HLBS) disorders, which continue to be the leading causes of death 

and disability in the United States. NHLBI’s portfolio has had a longstanding commitment to 

basic science, epidemiological (population) studies, clinical trials, implementation science, and 

health education and dissemination efforts. In recent years, the Institute’s portfolio has grown to 

include initiatives in emergent fields such as artificial intelligence/machine learning, precision 

medicine, and data science in order to translate fundamental science findings into new treatments 

for common and rare diseases and conditions within NHLBI’s purview. It is evident, now more 

than ever, that factors such as social determinants of health and environmental influences greatly 

impact HLBS health. Moving forward, NHLBI will continue to deepen and expand its focus on 

regional and rural HLBS health disparities using a community-based approach to engage 

underserved populations in the research endeavor in order to improve public health, health equity 

and healthier, more resilient communities. In FY 2025, NHLBI will support a robust spectrum 

of research and technology to spur the development of innovative, effective ways to prevent, 

diagnose, treat, and ultimately cure HLBS diseases and disorders.

Partnering with Under-Resourced Communities through Community-Engaged Research 

Initiatives

Working directly with communities and populations that have a high prevalence of HLBS

conditions necessitates partnering with trusted local community members and organizations. 

Every community has its own needs, priorities, and processes that researchers must understand in 

order to create positive change. NHLBI has a long history of outreach to rural, tribal, and other 

under-resourced communities with high rates of HLBS conditions to study the reasons for these 

disparities and develop health interventions specifically for their community or region.

Maternal morbidity and mortality have risen to crisis levels, an extremely troubling indicator of 

health in the United States. In 2021, the most recent year for which complete data are available, 

more than 1,200 women died of causes related to pregnancy in the United States.1

 These 

numbers have steadily increased in the last few years, with 754 and 861 deaths in 2019 and 2020, 

respectively.2

 Adverse pregnancy outcomes, including death, for Black women continue to be 

significantly higher than rates for other racial and ethnic groups. American Indian, Alaska 

Native, Native Hawaiian, and other Pacific Islander populations also experience increased risk.3 

NHLBI supports multiple programs in under-resourced communities designed to help people 

before, during, and after pregnancy. The Maternal Health Community Implementation 

Project (MH-CIP)4 is a community-driven initiative that uses evidence-based interventions, 

such as regular blood pressure readings, to help lower cardiac risk factors before and during 

pregnancy. Through this program, NHLBI supports four community coalitions, comprised of 

research organizations and community partners, to engage communities and pilot-test the 

1 www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates2021.htm#:~:text=In%202021%2C%20the%20maternal%20mortality,(Figure%201%20and%20Table).

2 www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm#ref2 3 jamanetwork.com/journals/jama/article-abstract/2806661 4 maternalhealthcip.org/
NHLBI-4 

implementation of proven interventions in vulnerable populations. In addition to community 

coalitions, MH-CIP includes patient advocacy groups and subject matter experts in both 

governance and guidance roles. 

Another initiative, Early Intervention to Promote the Cardiovascular Health of Mothers and 

Children (ENRICH),

5 is a partnership with other federal agencies (Health Resources and 

Services Administration, Administration for Children and Families), and certified local home 

visiting programs. The initiative promotes cardiovascular health in mothers and children up to

five years old. Launched in 2022, ENRICH researchers work directly with communities that 

have a high burden of cardiovascular disease; these include communities of lower socioeconomic 

status, tribal nations, and those who live and work in low-resource areas. The initiative includes 

seven clinical centers around the country that are investigating ways to lower the incidence of 

cardiovascular risk factors, including examining social determinants of health, obesity, 

hypertension, diabetes, and those at risk of developing pre-eclampsia or gestational diabetes.

Additionally, adverse pregnancy outcomes can continue to impact future health. NHLBI 

supports research that examines how to prevent or manage cardiovascular risk factors and 

disease in women across their lifespan. The nuMoM2b Heart Health Study, co-funded by the 

Eunice Kennedy Shriver National Institute of Child Health and Human Development, is studying 

the effects of pregnancy complications on future cardiovascular health, including social factors 

that correlate with the future heart health of new parents, especially in communities of color.6

The Community Engagement Alliance (CEAL)7 initiative was developed during the COVID-19 

pandemic to reach out to communities across the country that bore disproportionate burdens of 

COVID-19 infection. The goal was to create meaningful engagement within the community that 

would raise awareness of the risks of COVID-19 and the value of mitigation strategies, including 

vaccination. NHLBI learned valuable lessons about the important role that community-based health 

models play in addressing public health information gaps and developing interventions that lead to 

significant, sustainable change. CEAL created spaces for all—patients, advocates, community 

leaders, scientific partners, and others—to leverage the power of community involvement to 

enhance the public’s health. As a testament to its success, during the COVID-19 pandemic, CEAL 

teams recruited over 1,000 partners who worked to vaccinate over 300,000 people, host over 3,300 

community events, and recruit more than 675 participants to NIH clinical trials.

Because of this success, CEAL funding has been sustained in order to leverage it as a 

comprehensive research platform to address health disparities. Additional scientific initiatives 

have already been incorporated, and other NIH Institutes are also leveraging it to address other 

major issues of public health. Some examples include MH-CIP (mentioned above), the 

Implementing a Maternal Health and Pregnancy Outcomes Vision for Everyone 

(IMPROVE) initiative,8

 and the Climate Change and Health initiative.9 CEAL has become a 

powerful, strategic research resource that enables NHLBI and other NIH Institutes to work 

alongside and within communities to meet their missions.

5 www.nhlbi.nih.gov/grants-and-training/funding-opportunities/foa-ENRICH-FAQ 6 numom2b.org/

7 covid19community.nih.gov/

8 www.nichd.nih.gov/research/supported/IMPROVE

9 www.nih.gov/climateandhealth
NHLBI-5 

Research to Reduce High Rates of Health Disparities

NHLBI is committed to reaching out to communities with the highest rates of chronic HLBS 

diseases in the United States, which is often a function of social determinants and locality. Some 

communities encounter barriers to accessing services, lack familiarity with the health care 

delivery system, or face a shortage of readily available providers.10,11

Rural Health 

According to the U.S. Census Bureau, approximately 60 million people, or one in five 

Americans, live in rural areas.12 It is well established that there is no higher burden of disease 

and disparities than in rural America. A recent study conducted by the HHS Healthy People 

initiative found that health care quality and access was the top priority for health in rural 

America.13 This is especially true for heart health. NHLBI researchers have found that rural 

participants have an increased risk of heart failure compared with urban participants14 and appear 

to pass down that risk generationally because of health behaviors related to diet and smoking 

status.15 NHLBI strongly supports finding ways to bring care to where people are, which 

includes funding research to address disparities experienced by rural populations. A recent 

NHLBI-funded study showed that home blood pressure monitoring could not only prevent heart 

attacks, but also save people money spent on clinic visits. Another NHLBI researcher developed 

low-field magnetic resonance imaging (MRI) technology, which provides access to valuable 

high-quality imaging capabilities in communities with limited health care facilities.16

Blood Safety 

A pivotal part of the country’s public health is ensuring that the nation’s blood supply is safe. 

The goal of NHLBI’s Recipient Epidemiology and Donor Evaluation Study (REDS)

program,17 founded in 1989, is to improve the safety and effectiveness of blood transfusion 

therapies. Now in its fourth phase, the program also has a new focus on previously understudied 

populations, such as children, newborns, and pregnant women. Additionally, this phase also 

extends the Brazilian sickle cell disease cohort that was established in the previous phase to 

evaluate transfusion practices and associated clinical outcomes in sickle cell disease. 

Importantly, the Brazilian transfusion program continues its monitoring and surveillance efforts 

for Zika, chikungunya, dengue, and other emerging viral threats to the blood supply. 

Lung Disease Treatment

Distinctions between populations for assessing normal lung function or indicators of disease can 

have broad implications for health equity. Consequently, researchers have been studying how to 

optimize race-neutral equations for pulmonary functioning. For example, patients who are

10 www.hhs.gov/guidance/sites/default/files/hhs-guidancedocuments/006_Serving_Vulnerable_and_Underserved_Populations.pdf

11 toolkit.ncats.nih.gov/glossary/underserved-group/ 12 www.census.gov/library/stories/2017/08/ruralamerica.html#:~:text=About%2060%20million%20people%2C%20or,the%20official%20Census%20Bureau%20cla

ssification.

13 www.ncbi.nlm.nih.gov/pmc/articles/PMC10060738/ 14 jamanetwork.com/journals/jamacardiology/article-abstract/2800877?resultClick=1 15 www.ahajournals.org/doi/10.1161/JAHA.122.027881?url_ver=Z39.88-

2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed#d1e3398

16 www.nhlbi.nih.gov/science/mri-technology 17 www.nhlbi.nih.gov/science/recipient-epidemiology-and-donor-evaluation-study-reds-program
NHLBI-6 

recategorized as having elevated risks for lung disease may receive a diagnosis and be treated 

earlier for conditions such as chronic obstructive pulmonary disease (COPD). In other cases, 

they may meet criteria for or be more likely to be considered for receiving a lung transplant. 

However, overestimating impaired lung function could prevent people from receiving medical 

clearance to participate in physical activities. After comparing equations for pulmonary function 

tests, which assess lung function, researchers found that race-neutral equations were more likely 

to identify Black adults as showing early indicators of disease than when a race-specific equation 

was used.18 Conversely, the race-neutral equation identified fewer white adults as having signs 

of respiratory problems.

Continuing COVID-19 Research

The effects of COVID-19 will be felt around the world for decades to come. NHLBI is 

dedicated to researching long-term effects of the disease, including multisystem inflammatory 

disease in children (MIS-C), a rare condition associated with the virus that causes COVID-19 

and causes different internal and external body parts to become inflamed.19 A 2021 study 

conducted by the Centers for Disease Control and Prevention found that non-Hispanic Black and 

Hispanic children were 83 percent and 39 percent more likely to experience MIS-C, respectively, 

even after controlling for COVID-19 disparities and geographic variations.20 Most children 

recover from the condition, but researchers did not know if the children were able to be 

vaccinated against the virus that causes COVID-19 without increased risk of adverse reactions. 

In 2023, researchers with NHLBI’s Long-Term Outcomes after the Multisystem 

Inflammatory Syndrome In Children (MUSIC) study found that patients with a history of 

MIS-C were at no increased risk of adverse events following COVID-19 vaccination.21 NHLBI 

also continues to be a leader of NIH’s Researching COVID to Enhance Recovery 

(RECOVER) initiative, which studies the long-term effects of infection with the virus that 

causes COVID-19. 

Leveraging Cutting-edge Technologies and Data to Tackle Chronic Conditions

In addition to these population-based approaches, NHLBI also leverages innovative technology 

and data collection techniques to understand, diagnose, treat, and prevent complex health issues. 

The goal is to deeply explore the underlying biomolecular mechanisms of HLBS conditions and 

the complex interaction with individual biology, genetic inheritance, environment, and lifestyle. 

NHLBI is prioritizing advancing data science, including enabling integration of multidimensional datasets across multiple research studies and health-care systems (the latter of which 

provides a rich resource of electronic health record data), as well as the development and use of 

novel analytic tools and machine-ready technologies in developing predictive models and 

embedded diagnostics and clinical decision support. Additionally, researchers use a cloud-based 

ecosystem that offers researchers data, analytic tools, applications, and workflows in secure 

workspaces—all toward ensuring that people across the lifespan are able to access the right 

treatment at the right time.

18 jamanetwork.com/journals/jamanetworkopen/fullarticle/2805470

19 www.cdc.gov/mis/misc.html#:~:text=MIS%2DC%20causes%20different%20internal,get%20better%

20with%20medical%20care.

20 www.ncbi.nlm.nih.gov/pmc/articles/PMC8505134/ 21 jamanetwork.com/journals/jamanetworkopen/fullarticle/2799939
NHLBI-7 

At the heart of these efforts are NHLBI’s vast data science and sharing capabilities. The TransOmics for Precision Medicine (TOPMed) Program22 generates scientific resources that 

improve the understanding of HLBS disorders and advance precision medicine. The TOPMed 

program integrates whole-genome sequencing and other -omics data (e.g., metabolic profiles, 

epigenomics, protein and RNA expression patterns) with molecular, behavioral, imaging, 

environmental, and clinical data. TOPMed data are available in BioData Catalyst,

23 a cloudbased ecosystem that allows researchers to share scientific data from NHLBI-funded research so 

they and others can reproduce findings and reuse data. By increasing access to data and 

innovative analytic capabilities, the NHLBI is accelerating the reproducibility of biomedical 

research to drive scientific advances.

A detailed and comprehensive understanding of organs and tissues is critical to identifying novel 

treatment strategies tailored to each individual. NHLBI’s Molecular Atlas of Lung 

Development Program (LungMAP) uses cutting-edge technology and precision medicine to 

create an open-source molecular atlas of the lung that consists of both molecular and cellular 

maps of the organ. This flagship program enables better understanding of human lung 

development and will lead to novel therapeutic targets for lung diseases.

Another key to preventing disease progression is using biomarkers to detect people who are at 

increased risk for a number of diseases and disorders. By sequencing the DNA of blood samples 

from individuals who were in remission from a specific type of leukemia, NHLBI researchers 

recently found that the detection of unique gene variants in the blood could predict which 

patients were more likely to relapse and have worse survival outcomes.24 This minimally 

invasive technology to detect trace levels of residual disease has great potential as a precision 

diagnostic tool to prevent and treat non-malignant chronic conditions, such as sickle cell disease.

NHLBI believes that a comprehensive, multifaceted approach is required to prevent disease and 

improve health outcomes in the United States. The Institute’s proactive approach empowers 

communities by making health care easier to access, promoting resilience, and utilizing the latest 

data to promote health. Despite the many advances NHLBI-supported research has made, we 

continue to strive toward the betterment of health for everyone in the United States.

22 topmed.nhlbi.nih.gov/ 23 biodatacatalyst.nhlbi.nih.gov/ 24 jamanetwork.com/journals/jama/fullarticle/2802059?guestAccessKey=9e9d4fbc-d6f8-4dfa-993cf1ca98c07380&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl

&utm_term=030723
NHLBI-8 

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IC Fact Sheet

NHLBI-11 

MAJOR CHANGES

Major Changes in the Budget Request

Major changes by budget mechanism and/or budget activity detail are briefly described below. 

Note that there may be overlap between budget mechanisms and activity detail; and these 

highlights may not sum exactly to the total change for the FY 2025 budget request for the 

National Heart, Lung, and Blood Institute (NHLBI), which is $3,997.1 million, an $11.9 million 

increase compared to the FY 2023 Final level of $3,985.2 million. NHLBI is committed to the 

continuous support for key strategic priorities along with other scientific areas of the Institute’s 

research portfolio. Within the framework of the Administration’s fiscal policy goals for the 

Federal Government, NHLBI will continue to pursue its highest research priorities through 

strategic investments and careful stewardship of the appropriated funds. 

Research Project Grants (RPGs) ($9.6 million; total $2,705.0 million):

NHLBI will slightly increase funding for RPGs in FY 2025, supporting 925 competing RPGs, 

2,912 noncompeting RPG awards, and 181 awards to small businesses to stimulate research 

technology in key strategic areas. The total funding will provide continuous support of major 

initiatives and a strong focus on the investigator-initiated research submitted in response to the 

NIH Parent Announcements. 

Research Centers (-$0.7 million; total $13.3 million):

NHLBI will decrease funding for Research Centers by 5.0 percent, which is a $0.7 million 

decrease compared to the FY 2023 Final level of $14.0 million. These funds requested will 

support several specialized centers that conduct large-scale analysis that leads to prevention, 

diagnosis, and treatment of heart, lung, blood, and sleep diseases and disorders. 

Other Research (-$19.2 million; total $333.6 million):

NHLBI will decrease funding for Other Research by 5.4 percent, which is a $19.2 million 

decrease compared to the FY 2023 Final level of $352.8 million. These funds requested will 

support many of important NHLBI initiatives that have high impact cutting-edge research 

fostering scientific creativity that leads to prevention, diagnosis, and treatment of heart, lung, 

blood, and sleep diseases and disorders. 

Research Training ($3.4 million; total $119.8 million):

NHLBI will increase funding for Research Training by 2.9 percent, which is a $3.4 million 

increase compared to the FY 2023 Final level of $116.4 million. These increases are to support 

general annual adjustments for trainees, and to continue stimulating research training focused on 

strategic priorities and programmatic goals.

Intramural Research (IR) ($12.6 million; total $266.8 million):

NHLBI will increase funding for Intramural Research by 4.9 percent, which is a $12.6 million 

increase compared to the FY 2023 Final level of $254.3 million. These increases accommodate 

proposed pay increases for IR staff, changes in NIH-wide assessments on the IR program, and 

other inflationary costs.
NHLBI-12 

Research Management and Support (RMS) ($6.6 million; total $164.1 million):

NHLBI will increase funding for Research Management Support by 4.2 percent, which is a 

$6.6 million increase compared to the FY 2023 Final level of $157.4 million. These increases 

accommodate proposed pay increases for RMS staff, changes in NIH-wide assessments on the 

RMS program, and other inflationary costs. 
NHLBI-13 

BUDGET MECHANISM TABLE

NATIONAL INSTITUTES OF HEALTH

NATIONAL HEART, LUNGS, AND BLOOD INSTITUTE

BUDGET MECHANISM*

(Dollars in Thousands)

Mechanism

FY 2023 Final FY 2024 CR FY 2025 President's 

Budget FY 2025 +/- FY 2023

Number Amount Number Amount Number Amount Number Amount

Research Projects: - - - - - - - -

Noncompeting 2,905 $1,940,568 2,908 $1,944,269 2,912 $1,947,645 7 $7,076

Administrative Supplements (233) $33,502 (165) $23,669 (166) $23,802 -(67) -$9,700

Competing: - - - - - - - -

Renewal 110 $83,314 113 $85,679 114 $86,459 4 $3,146

New 798 $514,275 802 $518,347 811 $524,557 13 $10,282

Supplements 0 $0 0 $0 0 $0 0 $0

Subtotal, Competing 908 $597,588 915 $604,027 925 $611,016 17 $13,428

Subtotal, RPGs 3,813 $2,571,658 3,823 $2,571,964 3,837 $2,582,463 24 $10,805

SBIR/STTR 183 $123,789 182 $123,361 181 $122,535 -2 -$1,255

Research Project Grants 3,996 $2,695,447 4,005 $2,695,326 4,018 $2,704,998 22 $9,550

Research Centers - - - - - - - -

Specialized/Comprehensive 5 $13,527 5 $12,837 5 $12,828 0 -$699

Clinical Research 0 $0 0 $0 0 $0 0 $0

Biotechnology 0 $0 0 $0 0 $0 0 $0

Comparative Medicine 0 $450 0 $450 0 $450 0 $0

Research Centers in Minority 

Institutions 0 $0 0 $0 0 $0 0 $0 

Research Centers 5 $13,977 5 $13,287 5 $13,278 0 -$699

Other Research: - - - - - - - -

Research Careers 807 $130,304 805 $130,504 804 $131,219 -3 $915

Cancer Education 0 $0 0 $0 0 $0 0 $0

Cooperative Clinical Research 26 $6,389 15 $3,700 15 $3,690 -11 -$2,699

Biomedical Research Support 0 $0 0 $0 0 $0 0 $0

Minority Biomedical 

Research Support 0 $1,471 0 $1,433 0 $1,422 0 -$49 

Other 69 $214,604 157 $198,903 156 $197,233 -13 -$17,371

Other Research 1,002 $352,769 977 $334,540 975 $333,564 -27 -$19,205

Total Research Grants 5,003 $3,062,193 4,987 $3,043,153 4,998 $3,051,840 -5 -$10,353

Ruth L Kirschstein Training 

Awards: FTTPs - FTTPs - FTTPs - FTTPs - 

Individual Awards 493 $23,660 495 $24,089 493 $24,317 0 $657

Institutional Awards 1,344 $92,773 1,345 $94,142 1,342 $95,466 -2 $2,693

Total Research Training 1,837 $116,434 1,840 $118,231 1,835 $119,784 -2 $3,350

Research & Develop. 

Contracts 898 $394,844 883 $393,501 866 $394,580 -32 -$264 

SBIR/STTR (non-add) (10) ($12,208) (4) ($5,985) (6) ($8,500) -(4) -($3,708)

Intramural Research 463 $254,255 473 $264,706 473 $266,812 10 $12,557

Res. Management & Support 480 $157,433 493 $162,755 493 $164,071 13 $6,638

SBIR Admin. (non-add) - ($193) - ($198) - ($258) - ($65)

Construction - $0 - $0 - $0 - $0

Buildings and Facilities - $0 - $0 - $0 - $0

Total, NHLBI 899 $3,985,158 966 $3,982,345 966 $3,997,086 23 $11,928

*All items in italics and brackets are non-add entries
NHLBI-14 

APPROPRIATIONS LANGUAGE

NATIONAL INSTITUTES OF HEALTH

NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

For carrying out section 301 and title IV of the PHS Act with respect to cardiovascular, lung, 

and blood diseases, and blood and blood products, $3,997,086,000. 
NHLBI-15 

SUMMARY OF CHANGES

NATIONAL INSTITUTES OF HEALTH

NATIONAL HEART, LUNGS, AND BLOOD INSTITUTE

SUMMARY OF CHANGES

(Dollars in Thousands)

CHANGES

FY 2023 Final FY 2025 

President’s Budget

Built-In Change 

from FY 2023 

Final

FTEs Budget 

Authority FTEs Budget Authority FTEs Budget Authority

1. Intramural Research: - - - - - -

A. Built-in cost changes: - - - - - -

a. FY 2024 effect of FY 2023 pay and benefits increase - $107,454 - $116,708 - $1,267

b. FY 2024 effect of FY 2024 pay and benefits increase - $107,454 - $116,708 - $4,181

c. FY 2024 paid days adjustment - $107,454 - $116,708 - $414

d. Differences attributable to FY 2024 change in FTE - $107,454 - $116,708 - $2,415

e. FY 2025 effect of FY 2024 pay and benefits increase - $107,454 - $116,708 - $1,419

f. FY 2025 effect of FY 2025 pay and benefits increase - $107,454 - $116,708 - $1,952

g. FY 2025 paid days adjustment - $107,454 $116,708 $0

h. Differences attributable to FY 2025 change in FTE - $107,454 $116,708 $0

i. Payment for centrally furnished services - $26,524 $28,441 $1,916

j. Cost of laboratory supplies, materials, other expenses, and 

non-recurring costs - $120,277 $121,663 $7,933 

Subtotal, IR built-in cost changes - - - - - $21,497

2. Research Management and Support: - - - - - -

A. Built-in cost changes: - - - - - -

a. FY 2024 effect of FY 2023 pay and benefits increase - $85,053 - $92,364 - $1,006

b. FY 2024 effect of FY 2024 pay and benefits increase - $85,053 - $92,364 - $3,309

c. FY 2024 paid days adjustment - $85,053 - $92,364 - $327

d. Differences attributable to FY 2024 change in FTE - $85,053 - $92,364 - $2,304

e. FY 2025 effect of FY 2024 pay and benefits increase - $85,053 - $92,364 - $1,118

f. FY 2025 effect of FY 2025 pay and benefits increase - $85,053 - $92,364 - $1,533

g. FY 2025 paid days adjustment - $85,053 - $92,364 - $0

h. Differences attributable to FY 2025 change in FTE - $85,053 - $92,364 - $0

i. Payment for centrally furnished services - $2,215 - $2,375 - $160

j. Cost of laboratory supplies, materials, other expenses, and 

non-recurring costs - $70,165 - $69,332 - $3,607 

Subtotal, RMS built-in cost changes - - - - - $13,365

CHANGES No. Amount No. Amount No. Amount

B. Program: - - - - - -

1. Research Project Grants: - - - - - -

a. Noncompeting 2,905 $1,974,070 2,912 $1,971,447 7 -$2,623

b. Competing 908 $597,588 925 $611,016 17 $13,428

c. SBIR/STTR 183 $123,789 181 $122,535 -2 -$1,255

Subtotal, RPGs 3,996 $2,695,447 4,018 $2,704,998 22 $9,550

2. Research Centers 5 $13,977 5 $13,278 0 -$699

3. Other Research 1,002 $352,769 975 $333,564 -27 -$19,205

4. Research Training 1,837 $116,434 1,835 $119,784 -2 $3,350

5. Research and development contracts 898 $394,844 866 $394,580 -32 -$264

Subtotal, Extramural - $3,573,470 - $3,566,203 - -$7,267

6. Intramural Research 463 $254,255 473 $266,812 10 -$8,940

7. Research Management and Support 480 $157,433 493 $164,071 13 -$6,727

8. Construction - $0 - $0 - $0

9. Buildings and Facilities - $0 - $0 - $0

Subtotal, Program 943 $3,985,158 966 $3,997,086 23 -$22,934

Total built-in and program changes - - - - - $11,928
NHLBI-16 

BUDGET GRAPHS

History of Budget Authority and FTEs: 

Distribution by Mechanism:

Change by Selected Mechanisms:

3,653.7 3,810.4 3,985.2 3,982.3 3,997.1

Funding Levels by Fiscal Year

(Dollars in Millions)

2021 2022 2023 2024 2025

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

$4,500

863 899 943 966 966

FTEs by Fiscal Year

2021 2022 2023 2024 2025

0

200

400

600

800

1000

1200

Research Project 

Grants

$2,704,998

68%

Research Centers

$13,278

0%

Other Research

$333,564

8%

Research Training

$119,784

3%

R&D Contracts

$394,580

10%

Intramural 

Research

$266,812

7%

RMS

$164,071

4%

FY 2025 Budget Mechanisms

(Dollars in Thousands)
NHLBI-17 

ORGANIZATION CHART
NHLBI-18 

BUDGET AUTHORITY BY ACTIVITY TABLE

NATIONAL INSTITUTES OF HEALTH

NATIONAL HEART, LUNGS, AND BLOOD INSTITUTE

BUDGET AUTHORITY BY ACTIVITY*

(Dollars in Thousands)

Activity FY 2023 Final FY 2024 CR FY 2025 

President's Budget

FY 2025 +/- FY 

2023 Final

Extramural Research FTE Amount FTE Amount FTE Amount FTE Amount

Detail NA NA NA NA NA NA NA NA

Center for Translation Research and

Implementation Science NA $126,856 NA $126,177 NA $126,586 NA -$270 

Heart and Vascular Diseases NA $2,137,727 NA $2,126,771 NA $2,133,478 NA -$4,249 

Lung and Sleep Health NA $815,926 NA $811,565 NA $814,193 NA -$1,733 

Blood Diseases and Resources NA $492,962 NA $490,370 NA $491,947 NA -$1,015 

Subtotal, Extramural NA $3,573,470 NA $3,554,884 NA $3,566,203 NA -$7,267 

Intramural Research 463 $254,255 473 $264,706 473 $266,812 10 $12,557 

Research Management & Support 480 $157,433 493 $162,755 493 $164,071 13 $6,638 

TOTAL 943 $3,985,158 966 $3,982,345 966 $3,997,086 23 $11,928 

*Includes FTEs whose payroll obligations are supported by the NIH Common Fund.
NHLBI-19 

JUSTIFICATION OF BUDGET REQUEST

National Heart, Lung, and Blood Institute

Authorizing Legislation: Section 301 and Title IV of the Public Health Service Act, as amended. 

Budget Authority (BA):

FY 2023 Final

FY 2024 

Enacted

FY 2025 

President's 

Budget FY 2025 +/- FY 2023

BA $3,985,158,000 $3,982,345,000 $3,997,086,000 $11,928,000

FTE 943 966 966 23

Program funds are allocated as follows: Competitive Grants/Cooperative Agreements; 

Contracts; Direct Federal/Intramural and Other.

Overall Budget Policy: The FY 2025 President’s Budget request is $3,997.1 million, an increase 

of $11.9 million or 0.3 percent compared with the FY 2023 Final level. Included in this amount 

is funding to sustain the FY 2023 Enacted increase of $30.0 million for continued support of the 

NIH Community Engagement Alliance (CEAL) Against COVID-19 Disparities program so that 

it can operationalize a community engagement plan to reduce research participation hesitancy, 

address misinformation and mistrust of science, and promote diverse inclusion in NIH clinical 

trials and research. The Alliance for Community Engagement- Climate and Health’s goal is 

to reduce health threats across the lifespan and build health resilience in individuals, 

communities, and nations around the world, especially among those at highest risk. NHLBI is 

also targeting sleep research to improve the negative health impacts of climate change on heart, 

lung, and blood health. Also included in this request is funding for the Cardiovascular 

Advances in Research and Opportunities Legacy (CAROL) Act for $20.0 million in support 

of valvular heart disease to improve information on, and understanding of, causation and risk 

factors related to this disease. This funding will continue to advance technological imaging and 

other relevant methods to generate data, assessing potential risk factors for sudden cardiac arrest 

or sudden cardiac death from valvular heart diseases.
NHLBI-20 

Program Descriptions

Heart and Vascular Diseases

During pregnancy, the heart works harder to 

pump blood to the body and to the fetus. The 

extra stress to the heart may exacerbate heart 

health risks that existed before pregnancy but 

can also cause new problems to emerge 

during pregnancy (e.g., high blood 

pressure/hypertension, diabetes, or 

preeclampsia). Additionally, adverse 

pregnancy outcomes, such as hypertension 

during pregnancy, preterm delivery, and 

gestational diabetes, are associated with 

increased risk of future cardiovascular 

disease.25 A recent analysis found a positive 

association between the number of live births 

and reduced heart health among women. 

An additional, larger analysis in the same 

study found that having more live births was 

associated with a higher risk of developing 

heart failure with lower cardiac function 

compared to those who had never experienced 

a live birth. Specifically, left ventricles of 

women who experienced three or more live 

births did not function as well. Additionally, 

greater numbers of live births were associated 

with increased risk of heart failure with 

reduced ejection fraction (HFrEF, a type of 

heart failure when the heart's left ventricle 

does not pump blood out to the body as well 

as it should) as compared to those without 

histories of live births. Importantly, women 

with five live births had a nearly two-fold 

increased risk of future HFrEF compared with 

women who hadn’t experienced a live birth, 

although risk of another form of cardiac 

failure called heart failure with preserved 

ejection fraction (HFpEF, a type of heart 

failure where heart output is maintained) was 

reduced. Further research is needed to 

understand better the factors that may 

contribute to these conditions in order to improve the long-term care of women who have 

multiple children.

25 www.ahajournals.org/doi/full/10.1161/JAHA.120.017216#d1e4774

Valvular Heart Disease Research

Each year, approximately 25,000 people in the 

United States die from valvular heart disease 

(VHD),1 a condition in which one or more of the 

heart’s valves do not open or close correctly. Many 

of these deaths are due to underdiagnosis and 

under-treatment of the condition. VHD can develop 

congenitally (before a baby is born) or can be 

acquired as one ages. Risk factors include: age, 

family history, lifestyle habits, and sex, among 

others.2

 As part of its broader commitment to 

research on heart and vascular diseases, the 

NHLBI leads and supports research and programs 

on heart valve diseases in the United States and 

around the world.

In December 2022, Congress authorized $100 

million over five years to NIH to support more 

research into the causation of and risk factors for 

valvular heart disease via the Cardiovascular 

Advances in Research and Opportunities Legacy 

(CAROL Act).3

 NHLBI is supporting expanded 

valvular heart disease research, including on risk 

factors for sudden cardiac arrest or sudden cardiac 

death from valvular heart disease, most commonly 

associated with mitral valve prolapse (MVP) and 

use of advanced imaging techniques. Research 

activities include basic science research aimed at 

addressing current knowledge gaps in valvular 

heart disease, development of artificial intelligence 

or machine learning techniques for comprehensive 

risk assessment and improved phenotypic 

characterization of individuals with MVP, and 

studies to establish ideal intervals for imaging and 

electrophysiological monitoring. In addition, the 

Institute supports studies which assess VHD 

treatment and interventions and on addressing 

disparities in equitable access, diagnosis, 

management, and treatment for individuals with 

MVP and valvular heart disease from diverse 

communities.

1 https://wonder.cdc.gov/ucd-icd10.html

2 https://www.nhlbi.nih.gov/health/heart-valvediseases/causes

3

 www.govinfo.gov/content/pkg/CRPT117hrpt212/html/CRPT-117hrpt212.htm
NHLBI-21 

Cardiovascular disease (CVD) continues to be the leading cause of death worldwide.26 In 2019, 

more than 870,000 deaths in the United States were attributable to heart disease.27 Family 

history of CVD is often used as a marker of future CVD risk in offspring.28 This risk can be 

further compounded by shared environments and adverse behaviors such as smoking, sedentary 

lifestyle, and poor diet. Until recently, it was previously not known whether modifiable risk 

factors in parents (such as smoking, obesity, and diabetes) contributed to risk of CVD in their 

children or was simply a marker of future risk.29 In 2023, a study funded by NHLBI 

demonstrated that parental history of obesity and smoking were associated with a higher risk of 

future CVD in offspring.30 However, some of the other parental modifiable risk factors (such as 

parental history of hypertension, diabetes, and high cholesterol) were not associated with 

offspring CVD risk. These findings suggest that the presence of parental obesity should prompt 

a focus on disease prevention in offspring of parents with CVD and/or obesity. Future research 

should develop and test interventions before conception and during pregnancy to treat parental 

obesity and smoking to prevent obesity and CVD risk in the offspring. 

According to the Centers for Disease Control and Prevention,31 nearly 1 out of 2 adults in the 

United States—around 108 million—have high blood pressure, and only 1 in 4 with the 

condition have it under control. Additionally, approximately one in five U.S. adults with high 

blood pressure are unaware that they have the condition.32 Left undiagnosed or uncontrolled, 

high blood pressure can lead to serious health problems like aneurysm, stroke, heart failure, heart 

attack, and vascular dementia. Home blood pressure monitoring is more convenient and 

effective than clinic-based monitoring in diagnosing and managing hypertension, especially in 

regions with reduced access to clinical care, but there is limited evidence of the health and 

economic impacts of home monitoring. A recent study by NHLBI-supported researchers used 

cardiovascular disease modeling to estimate the long-term impact of adopting home blood 

pressure monitoring versus usual care on myocardial infarction, stroke, and healthcare costs.33 

Compared with usual care, adopting home blood pressure monitoring was estimated to reduce 

myocardial infarction cases by 4.9 percent and stroke cases by 3.8 percent, as well as saving an 

average of $7,794 in healthcare costs per person over 20 years. Women, non-Hispanic Black 

people, and rural residents had more averted cardiovascular events and greater cost savings 

related to home blood pressure monitoring when compared with men, non-Hispanic White 

people, and urban residents. The study provides compelling evidence for healthcare systems and 

payers to support the broader implementation of this intervention.

More than 6.2 million adults in the United States have heart failure.34 Roughly half of them have 

HFpEF, a condition in which the heart muscle contracts normally, but the walls of the heart’s 

lower chambers (ventricles) are thicker and stiffer than usual and cannot relax enough between 

26 www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death 27 www.ahajournals.org/doi/10.1161/CIR.0000000000001052#d1e1489 28 www.ncbi.nlm.nih.gov/pmc/articles/PMC7854782/

29 www.nhlbi.nih.gov/health/heart-healthy-living/risks 30 www.ahajournals.org/doi/10.1161/JAHA.122.027881?url_ver=Z39.88-

2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed%22%20\l%20%22d1e3398 31 www.cdc.gov/bloodpressure/facts.htm 32 www.sciencedirect.com/science/article/abs/pii/S0749379710002072?via%3Dihub 33 www.ajpmonline.org/article/S0749-3797(23)00232-5/fulltext#seccesectitle0005 34 www.nhlbi.nih.gov/health/heart-failure
NHLBI-22 

heart beats to adequately fill with blood.35 Unfortunately, much is still unknown about this 

condition and no effective treatments that convincingly reduce mortality are available. To 

optimally pump blood, the human heart uses fatty acids as its primary energy source, but 

research has shown that HFpEF patients have decreased fatty acid utilization. NHLBI-funded 

researchers investigated which myocardial energy sources HFpEF patients with severe obesity or 

diabetes use, as people with these conditions tend to have elevated myocardial fatty acid use.36 

By evaluating metabolites (molecules which are part of metabolic reactions and are required for 

normal cell function) and RNA expression in blood plasma and from biopsies, researchers 

determined that these patients appear to have metabolic defects from both heart failure and their 

underlying conditions (obesity, diabetes), creating a syndrome with substantial fuel inflexibility. 

This inflexibility means that the heart is not effectively utilizing fuel, implying it cannot function 

optimally. This ineffective fuel utilization may be a factor in why HFpEF is so challenging to 

treat, and researchers indicate some important features worthy of future study, which may 

ultimately lead to therapies.

Significant cardiac events can lead to lasting heart damage. Various conditions, including heart 

attack, hypertensive heart disease (changes in the heart resulting from chronic blood pressure 

elevation), diabetic hypertrophic cardiomyopathy (damage to nerves and blood vessels that 

control the heart), and idiopathic dilated cardiomyopathy (the thinning, stretching, and 

elongation of the heart muscle), can cause cardiac fibrosis, or a scarring of the heart muscles.37 

Researchers are interested in learning more about how the heart heals after such injuries. 

Cardiac fibroblasts are cells that are responsible for maintaining the cardiac microenvironment.38 

During an injury, these fibroblasts transition into myofibroblasts, cells that restore tissue and 

their surrounding structures after the damage is sustained.39 However, chronic myofibroblast 

activity can lead to cardiac fibrosis. A recent animal study funded by NHLBI found that the 

increased activity of human antigen R (HuR), an RNA-binding protein that influences the 

expression of targeted genes, leads to the cardiac fibroblasts transitioning into myofibroblasts. 

Further research is needed to understand how HuR influences myofibroblast activity and may 

ultimately lead to a mechanism that reduces fibrosis.

Dilated cardiomyopathy is a type of heart disease in which the chambers of the heart thin and 

stretch, becoming enlarged.40 The enlargement affects the ability of the heart to sufficiently pump 

blood to the rest of the body and can ultimately lead to heart valve problems, arrhythmias, blood 

clots, and heart failure. Current treatments aim to reduce symptoms and prevent further heart 

damage through medications or surgically implanted devices.41 Implanted myocardial 

remodeling devices use a tether wrapped around a ventricle to reduce the chamber size and wall 

35 www.nih.gov/research-training/accelerating-medicines-partnership-amp/heart-failure 36 pubmed.ncbi.nlm.nih.gov/36856044/ 37 www.sciencedirect.com/science/article/pii/S0169409X19300614#:~:text=Fibrotic%20scars%20of%20the%

20cardiac,cardiomyopathy%20%5B4%2C5%5D.

38 www.ncbi.nlm.nih.gov/pmc/articles/PMC5588900/#:~:text=Typically%2C%20a%20cardiac%20fibroblast%

20is,%2C%20and%20glycoproteins5%2C6.

39 www.ncbi.nlm.nih.gov/pmc/articles/PMC2891362/#:~:text=In%20injured%20tissues%2C%20fibroblasts%

20are,connective%20tissue%20wound%20healing%20(Fig.

40 www.nhlbi.nih.gov/health/cardiomyopathy/types#:~:text=All%20rights%20reserved%20.-

,Dilated%20cardiomyopathy,makes%20your%20heart%20work%20harder.&text=Another%20type%20of%20cardi

omyopathy%20%E2%80%94%20called,occur%20during%20or%20after%20pregnancy.

41 www.nhlbi.nih.gov/health/cardiomyopathy/treatment
NHLBI-23 

stress, but these surgeries have several significant limitations. NHLBI-funded researchers have 

developed a new approach to reduce the circumference of the heart’s left ventricle to overcome 

previous surgical limitations and increase survival rates, an approach known as MIRTH 

(Myocardial Intramural Remodeling by Transvenous Tether).42 The new method allows 

researchers to steer a guidewire through the coronary vein and uses EDEN (Electrocardiographic 

Radial Depth Navigation) electrocardiograms to direct the user to any location within the 

ventricular walls, increasing procedural accuracy and speed and allowing the user to integrate the 

tether within the heart’s walls. MIRTH was performed on swine (some with heart muscle 

damage, some without), which resulted in positive measures of left ventricle performance, 

including increased contractility, efficiency, and reduced oxygen demand in cardiomyopathic 

animals. Additional research and clinical trials will be required to test this method in humans, but 

the technique may also have uses in the treatment of certain forms of acute myocardial infraction.

Budget Policy: The FY 2025 President’s Budget request for NHLBI heart and vascular disease 

research is $2,133.5 million, a decrease of $4.2 million or 0.2 percent compared with the FY 

2023 Final level. 

Lung and Sleep Health

COPD affects more than 15 million U.S. adults and is a major cause of disability.43 Women are 

slightly more likely to be diagnosed with COPD than men. However, COPD remains 

underdiagnosed in primary care settings, particularly amongst African American patients and 

current or former smokers.44 Underdiagnosed patients experience impaired health and a greater 

risk of acute respiratory events and mortality. The diagnostic test for COPD is spirometry, an 

exam that measures the volume and speed at which someone breaths, which can detect COPD 

before symptoms become apparent.45 However, disease symptoms of COPD are more complex 

and informative. They include airway inflammation, airflow obstruction, emphysema, shortness 

of breath, and exercise intolerance, among others.46 Systematic failure to diagnose the disease 

may hamper understanding of disease manifestations and progression in populations more at-risk 

of deprivation, as well as perpetuate health disparities.47 NHLBI-funded researchers have been 

working on new tools to mitigate missed COPD diagnoses.48 A recent NHLBI-funded study 

found that participants with tobacco exposure and preserved spirometry (TEPS) and symptoms 

(symptomatic TEPS) had a similar rate of decline in lung function and similar incidence of 

COPD defined by spirometry as those with TEPS without symptoms (asymptomatic TEPS), but 

participants with symptomatic TEPS experienced significantly more respiratory exacerbations 

over 2 to 10 years of follow-up.49

42 pubmed.ncbi.nlm.nih.gov/37014015/ 43 www.nhlbi.nih.gov/health/copd 44 www.nhlbi.nih.gov/health/copd/causes 45 www.nhlbi.nih.gov/health/copd/diagnosis#:~:text=The%20main%20test%20for%20COPD,much%20air%

20you%20breathe%20out.

46 www.nhlbi.nih.gov/health/copd/symptoms 47 link.springer.com/article/10.1007/s11606-023-08185-5 48 jamanetwork.com/journals/jama/article-abstract/2801317?resultClick=1

49 jamanetwork.com/journals/jama/fullarticle/2807747
NHLBI-24 

More than 1.5 million Americans use supplemental oxygen for a range of medical conditions.50 

Supplemental oxygen increases their oxygen intake and helps them feel better and be more 

active, so that these individuals live fuller 

lives. Yet some patients have found that 

portable oxygen creates challenges with daily 

activities, exercise, socialization, work, and 

travel.51 When asked, people consistently 

express a desire for a lighter, more portable 

oxygen supply that lasts longer and has flow 

rates that supply the necessary amounts of 

oxygen for their needs. Through the Air You 

Wear Challenge prize competition, NHLBI 

aimed to broadly stimulate the research and 

development of processes and technologies 

designed to improve the accessibility, 

efficacy, and usability of supplemental 

oxygen.52 The Air You Wear Challenge had 

two phases, one that focused on the concepts 

and feasibility of solutions, and a 30-week 

second phase during which teams developed 

working prototypes of their solutions. During 

the second phase, the NHLBI helped finalists 

engage with subject matter experts from NIH, 

the NHLBI Catalyze Program,53 the National 

Science Foundation, the U.S. Food and Drug 

Administration (FDA), and the Centers for 

Medicare & Medicaid Services. In February 

2023, NHLBI named three winning teams and 

one honorable mention.54 Since then, two 

teams successfully completed the competitive 

National Institute of Biomedical Imaging and 

Bioengineering Spring 2023 Concept to Clinic 

Commercialization program,

55 and all three 

winners have submitted small business 

applications to help conduct pre-clinical 

and/or clinical feasibility studies. The Air 

You Wear Challenge helped teams advance their innovations, bringing them closer to a time 

when they may help supplemental oxygen users live fuller lives. 

50 www.atsjournals.org/doi/full/10.1513/AnnalsATS.201809-627WS 51 www.atsjournals.org/doi/epdf/10.1513/AnnalsATS.202005-487OC 52 www.nhlbi.nih.gov/grants-and-training/air-you-wear-challenge 53 www.nhlbi.nih.gov/grants-and-training/funding-opportunities-and-contacts/NHLBI-Catalyze-Program 54 www.nhlbi.nih.gov/grants-and-training/air-you-wear-challenge 55 seed.nih.gov/aboutseed/news/concept-clinic-commercializing-innovation-c3i-educationprogram#:~:text=C3i)%20%E2%80%93%20Education%20Program,Concept%20to%20Clinic%3A%20Commercial

izing%20Innovation%20(C3i)%20%E2%80%93%20Education%20Program,to%20the%20market%20(clinic).

LungMAP

The NHLBI-supported LungMAP Consortium1 

unites teams of researchers at universities and 

institutions across the country that are devoted to 

a better understanding of human lung 

development. The consortium continues to build 

an open-access reference resource of a 

comprehensive, dynamic, 3-dimensional 

molecular atlas of the late-stage developing 

human lung with data and reagents available to 

the research community. Technological 

advancements, such as single-cell multi-omics 

have revealed novel cell types and enriched 

functional properties of existing cell types in the 

lung. Recently, members of the LungMAP 

Consortium, along with experts in the lung 

biology community, synthesized current data into 

a comprehensive and practical cellular census of 

the lung, called CellCards.2 Identities of cell 

types in the normal lung are captured in 

individual CellCards with delineation of function, 

markers, developmental lineages, heterogeneity, 

regenerative potential, disease links, and key 

experimental tools. This is the starting point of a 

live, up-to-date guide for lung research, meant to 

evolve, integrate, and adapt to new data and 

emerging technologies. Researchers are already 

building upon the LungMAP CellCards with 

analyses that direct the identification of lung 

reference cell populations according to a 

dictionary of pre-compiled cell type terms and 

molecular markers derived from CellCards.

1 www.lungmap.net/

2

www.sciencedirect.com/science/article/pii/S153458072

1008923
NHLBI-25 

Puberty is a period marked by hormonal, metabolic, and immune changes that occurs between 

the ages of 8-13 years for girls and 9-14 years for boys, respectively.56 It also marks a shift in 

sex differences in susceptibility to asthma. Males have higher asthma prevalence in childhood, 

but starting from young adulthood, females are more affected.57 Sex hormones are hypothesized 

to play a role in this difference, but not much is known about gene expression changes in 

immune cells that occur during pubertal development—in particular, gene expression changes 

throughout puberty (peri-puberty). A recent NHLBI-funded study examined pubertal 

development and leukocyte gene expression in a cohort of 163 children with asthma between 10 

and 17 years old who were followed annually for up to 3 years.58 The investigators used 

quantitative measures of asthma symptoms59 (chest tightness, coughing, wheezing) and severity 

to investigate whether changes in gene expression in immune cells during puberty were also 

associated with changes in disease status. The researchers observed sex-specific patterns. In 

males, gene expression changes associated with puberty and age were inversely correlated with 

those associated with asthma symptoms and positively correlated with those associated with 

pulmonary function. Conversely, the opposite correlations were observed with gene expression 

changes linked to puberty and age in females. The study is the first to document these 

differences and also offers the first genome-wide characterization of patterns of gene expression 

changes in peri-pubertal males and females, adding to the knowledge base of epigenetic 

reprogramming of immune cells during puberty. 

Idiopathic pulmonary fibrosis (IPF) is an incurable lung disease characterized by progressive 

scarring that leads to air sac stiffening, reduced lung capacity, and poorer rates of gas transfer, 

and is eventually fatal.60 Disease progression is highly variable, and it is not clear why some 

individuals have different rates of decline than others. To investigate if there is a genetic 

component to disease progression in IPF, NHLBI researchers examined genetic variants 

associated with lung function decline.61 The researchers examined more than 1,300 individuals 

with significant IPF symptoms, looking for genetic variants associated with disease progression. 

They found that certain variants in one area of the genome were associated with more rapid 

decline. These genetic variations likely affect PKN2, a protein that regulates various cellular 

processes. Additional research is needed to confirm a possible new biological role for this 

protein, which may ultimately lead to novel therapeutic targets for IPF.

Pulmonary fibrosis is a chronic lung disease characterized by the ongoing formation of scar 

tissue in the lungs accompanied by impaired lung function.62 Currently, nintedanib and 

pirfenidone are the only FDA-approved drugs for the treatment of pulmonary fibrosis.63 These 

drugs ease symptoms and slow the progression of the disease but cannot repair lung damage. A 

56 www.nichd.nih.gov/health/topics/puberty/conditioninfo#:~:text=The%20time%20in%20one's%20life,between% 

20ages%209%20and%2014.

57 www.cdc.gov/asthma/most_recent_national_asthma_data.htm 58 www.nature.com/articles/s41467-022-35742-z 

59 www.nhlbi.nih.gov/health/asthma/symptoms 60 www.nhlbi.nih.gov/health/idiopathic-pulmonary-fibrosis 61 www.sciencedirect.com/science/article/pii/S221326002200251X?via%3Dihub 62 www.nhlbi.nih.gov/health/idiopathic-pulmonaryfibrosis#:~:text=This%20condition%20develops%20when%20that,progressively%20more%20difficult%20to%20br

eathe.

63 www.nhlbi.nih.gov/news/2022/experimental-anticancer-drug-shows-promise-treatment-idiopathic-pulmonaryfibrosis
NHLBI-26 

recent study conducted by NHLBI-supported researchers examined the link between the body's 

circadian rhythms and the development of lung diseases.64 The study, using observations from 

mice and human subjects, has uncovered a new mechanism underlying the link: a circadian 

rhythm protein called REV-ERBα. A lack of REV-ERBα contributes to lung scarring in mouse 

models by increasing production of collagen, a major component of connective tissue, and the 

enzyme lysyl oxidase, which makes connective tissue more rigid. Thus, REV-ERBα appears to 

be an important molecular regulator of fibrotic progression in the lungs. The team also found 

low levels of REV-ERBα and large amounts of collagen and lysyl oxidase in lung samples from 

patients with pulmonary fibrosis. Because REV-ERBα normally fluctuates throughout the day, 

peaking at noon and dipping at midnight, night shift work could make lungs more vulnerable to 

fibrosis development, especially if workers are also exposed to lung irritants during work hours. 

Further research exploring the molecular mechanisms related to circadian rhythm proteins could 

open new possibilities for developing strategies to treatment other fibrotic diseases.

Obstructive sleep apnea (OSA) is one of the most prevalent chronic sleep disorders, estimated to 

affect up to 30 million people in the United States.65 It is associated with an increased risk for 

cardiovascular disease and mortality.66,67 The primary diagnostic tool for OSA is the ApneaHypopnea Index (AHI),68 which measures the average number of times per hour breathing either 

partially or fully stops during sleep; however, there are limitations. NHLBI-funded researchers 

have developed a more accurate tool for diagnosing OSA, using a metric called ventilatory 

burden (VB), which effectively captures breath-by-breath reductions in airflow and isolates the 

purely ventilatory burden of the disorder.69 The researchers leveraged data from 4 different 

NIH-funded cohorts to derive the normative range of VB from analysis of more than 34 million 

breaths. The team then assessed the relationship between the degree of upper-airway obstruction 

and VB and, using a unique algorithm, the relationship between VB and mortality risks, 

including cardiovascular disease and hypertension. Their method effectively assessed the 

severity of OSA and predicted mortality associated with cardiovascular diseases, which could 

potentially be a more successful diagnostic tool than the AHI. The team now plans to use an 

artificial intelligence algorithm along with the VB measure to identify patients who will benefit 

from continuous positive airway pressure treatment.

Budget Policy: The FY 2025 President’s Budget request for NHLBI lung disease research is 

$814.2 million, a decrease of $1.7 million or 0.2 percent compared with the FY 2023 Final level. 

64 www.nhlbi.nih.gov/health/idiopathic-pulmonaryfibrosis#:~:text=This%20condition%20develops%20when%20that,progressively%20more%20difficult%20to%20br

eathe.

65 www.ncbi.nlm.nih.gov/pmc/articles/PMC4909617/ 66 www.nhlbi.nih.gov/health/sleep-apnea/living-with 67 www.atsjournals.org/doi/10.1164/rccm.202209-1808OC 68 www.cdc.gov/pcd/issues/2012/11_0117.htm#:~:text=An%20AHI%20of%20more%20than,as%20severe%20O

SA%20(9).

69 pubmed.ncbi.nlm.nih.gov/37698405/
NHLBI-27 

Blood Diseases and Resources

Venous and arterial thrombotic disorders—

such as pulmonary embolism, venous 

thromboembolism, myocardial infarction, and 

stroke—are major causes of global morbidity 

and mortality.70 Certain diseases and 

conditions can also raise a person’s chances of 

thrombosis,71 commonly called a blood clot. 

These include a stroke, paralysis, chronic 

heart disease, high blood pressure, surgical 

procedure, or recent cancer treatment. 

Women who take hormone therapy pills, birth 

control pills, are pregnant, or are within the 

first six weeks after giving birth are also at 

higher risk for clotting disorders. People who 

smoke and older adults (ages 60 years and 

older) are also at increased risk. Current 

treatments to prevent blood clots, namely 

anticoagulants and platelet antagonists, can 

lead to an elevated risk of bleeding.72 A 2015 

study found that one-third of American adults 

ages 40 years and older were taking 

preventive aspirin or other antiplatelet 

medications.73 Improved therapeutic 

strategies that diminish this risk would have a 

huge clinical impact. In a recent animal study 

funded by NHLBI, researchers designed a new 

compound called macromolecular polyanion 

inhibitor (MPI-8).74 The compound prevented 

blood clots in mice, did not increase bleeding, 

and was well tolerated even in high doses. 

This finding may lead to significant changes 

in how doctors care for patients at risk for 

thrombosis, without raising the risk of 

bleeding. 

NHLBI started the REDS program in 1989 to 

protect the U.S. blood supply from threats, improve the benefits of transfusions, and reduce the 

risks of transfusions.75 After 30 years, now in its fourth phase, REDS aims to evaluate and 

70 www.nature.com/articles/nature06797#additional-information 71 www.nhlbi.nih.gov/health/venous-thromboembolism/causes 72 www.ncbi.nlm.nih.gov/books/NBK519025/#:~:text=Oral%20anticoagulants%20are%20classified%20as,be% 

20reversed%20with%20vitamin%20K.

73 www.ncbi.nlm.nih.gov/pmc/articles/PMC4612173/#:~:text=One%2Dthird%20(33%25)%20of,reported%

20taking%20other%20antiplatelet%20medications.

74 www.nature.com/articles/s41467-023-37709-0 75 www.nhlbi.nih.gov/science/recipient-epidemiology-and-donor-evaluation-study-reds-program

PATH-HHT Trial

Hereditary Hemorrhagic Telangiectasia (HHT), 

also known as Osler-Weber-Rendu disease, is a 

rare genetic disorder that affects 1 in 5,000 

people worldwide.1 Malformed blood vessels 

cause excessive bleeding from the nose 

(epistaxis) and gastrointestinal tract, requiring 

medical treatment, blood transfusions and 

impairing quality of life. Historically, there have 

been no effective medical therapies for HHT.2

People of all ages, sexes, genders, races, and 

ethnicities are affected by HHT and experience 

the problems associated with the disorder, some 

of which are life-threatening.

The Pomalidomide for the Treatment of Bleeding 

in HHT (PATH-HHT) trial was exploring the use 

of an oral medication called pomalidomide, 

approved by FDA to be used in some cancers, 

for the treatment of HHT symptoms at 11 

research centers across the United States. 

Adults suffering from HHT with moderate to 

severe epistaxis who require iron infusions or 

blood transfusions were enrolled in this study. 

NHLBI-funded researchers began enrolling 

patients in 2019 and with the active support of 

the patient organization CureHHT achieved 

sufficient number of participating patients to 

conclude, earlier than expected, that 

pomalidomide is efficacious to treat HHT.3

The early conclusion of the trial for 

investigational drug efficacy is strong evidence 

that pomalidomide will become the first ever 

effective treatment option for patients with this 

rare disorder.

1 my.clevelandclinic.org/health/diseases/15618-

hereditary-hemorrhagic-telangiectasia-hht 2 www.cdc.gov/ncbddd/hht/index.html

3 curehht.org/
NHLBI-28 

improve the safety and availability of the nation’s blood supply, as well as the safety and 

effectiveness of transfusion therapies across the lifespan with a new focus on understudied 

populations, including newborns, children, and pregnant women. This phase is a seven-year 

multicenter program in the United States and Brazil, charged with conducting epidemiologic and 

laboratory studies in blood donors and transfusion recipients. 

NHLBI funds the BLOODSAFE program,76 the goal of which is to enhance the availability and 

delivery of safe blood for transfusion into patients from low or lower-middle income countries in 

Sub-Saharan Africa. BLOODSAFE supports projects that develop and test effective and 

sustainable strategies to increase the number of safe blood donors. It also aims to improve the 

quality and safety of blood supplies and to enhance blood delivery to patients in need, especially 

in remote settings.77

The Cure Sickle Cell Initiative (CureSCi)78 is an NHLBI-led collaborative research effort to 

accelerate the development of genetic therapies to cure sickle cell disease. The initiative aims to 

transform the lives of many people affected by sickle cell disease—an estimated 100,000 

Americans and more than 20 million worldwide—by creating a collaborative, patient-focused 

research environment. At this time, only bone marrow transplants can cure sickle cell disease, 

but they are most effective in children who have well-matched donors. CureSCi has identified 

and supports promising genetic therapies, which are currently being evaluated in multicenter 

clinical trials. Two therapies have been submitted to the FDA for review and approval by the 

investigational new drug sponsors, and preliminary results of these clinical trials are expected 

within three to five years. CureSCi has focused on curative strategies that use genetic therapies 

to modify hematopoietic stem cells, which make red and other blood cells, to prevent genetic 

mutations from making sickle-shaped red blood cells. This could make curative therapies 

available to a wider range of people with sickle cell disease. One CureSCi clinical trial opened 

for enrollment in 2022,79 and enrollment is expected to begin in the second trial in the first half 

of 2024. 

Budget Policy: The FY 2025 President’s Budget request for this research program is

$491.9 million, a decrease of $1.0 million or 0.2 percent compared with the FY 2023 Final level. 

76 bloodsafe-research.org/#:~:text=BLOODSAFE%20supports%20projects%20that%20develop,need%2C%

20especially%20in%20remote%20settings.

77 pubmed.ncbi.nlm.nih.gov/37679772/ 78 www.nhlbi.nih.gov/science/cure-sickle-cell-initiative 79 clinicaltrials.gov/study/NCT05353647?term=NCT05353647&rank=1
NHLBI-29 

Center for Translation Research and Implementation Science

In July 2020, NHLBI and the National Institute on Minority Health and Health Disparities 

(NIMHD) started CEAL to establish a research approach that ensured the participation of racial 

and ethnic minority communities in COVID-19 vaccine research trials that were underway.80 

Moving forward, CEAL’s successes provide a foundation for broadening its mission to address 

the host of health disparities that plague the very same communities. CEAL teams are located in 

21 regions across the country, leverage existing relationships and partnerships, and recently 

expanded activities to address state and local concerns including social determinants that 

challenge health within specific communities. NHLBI is leveraging this community engagement 

research platform to support scientific initiatives that address other major public health issues, 

including maternal health and the impact of climate on health in areas across the country. 

NHLBI is utilizing the lessons learned through CEAL to enhance research within American 

Indian, Alaska Native, Asian, Native Hawaiian, and Pacific Islander communities, and partnering 

with other NIH programs to address other research priorities like the National Human Genome 

Research Institute’s interest in improving understanding of and participation in genomic 

research. Through meaningful community engagement, CEAL has the potential to transform 

discovery into health impact and reduce disparities.

According to the World Health Organization, approximately 38.4 million people globally are 

currently living with HIV;81 those with access to effective antiretroviral therapy and care are 

generally able to manage the virus to live long, full lives. The American Heart Association 

reports that, as people living with HIV age, they are at higher risk of various chronic medical 

conditions, including hypertension and other forms of cardiovascular disease.82 NHLBI’s Heart, 

Lung, and Blood Co-morbiditieS Implementation Models in People Living with HIV (HLBSIMPLe) program,83 is a collection of research studies co-funded by the NIH Fogarty 

International Center. Researchers from African and American universities are working together 

with governments, community partners, and health facilities to test strategies for delivering 

effective hypertension detection, prevention, and treatment initiatives to affected individuals. 

There are currently studies in Botswana, Mozambique, Nigeria, South Africa, Uganda, and 

Zambia. These distinctive implementation clinical trials are designed to test and estimate costs 

for strategies to foster sustainable and scalable uptake of effective interventions in routine 

clinical, public health, and community settings. These implementation studies will help to 

ensure that all people living with HIV can access the care they need to maintain their health and 

wellbeing—beyond just medications to suppress HIV. Moreover, the ongoing methodological 

training opportunities supported by this consortium will increase the late-stage translation 

research workforce available to move discoveries into practice.

Heart and lung disease are the leading causes of illness and death in the United States, and the 

disease burden is unequal across groups defined by race, ethnicity, sex, gender, and 

socioeconomic status.84 Numerous programs have been proven to reduce heart or lung disease, 

but too often they are not put into practice in the communities where they are most needed. In 

September 2020, the Disparities Elimination through Coordinated Interventions to Prevent and 

80 www.nhlbi.nih.gov/news/2020/COVID-19-nih-funds-community-engagement-research-efforts-areas-hardest-hit 81 www.who.int/data/gho/data/themes/hiv-aids 82 www.ahajournals.org/doi/10.1161/CIR.0000000000000695 83 www.hlbsimple.org/ 84 www.nhlbi.nih.gov/science/health-disparities-and-inequities
NHLBI-30 

Control Heart and Lung Disease Risk (DECIPHeR) Alliance85 was created, comprised of seven 

implementation research centers throughout the country. This seven-year (2020-2027) 

cooperative agreement has two phases.86 The first phase (2020-2023) was exploratory, including 

community engagement activities such as establishing community advisory boards and working 

with high-burden communities to articulate locally relevant implementation strategies. The 

second phase of the Alliance, which began in 2023, builds on connections made and lessons 

learned in the first phase to test implementation strategies for optimally and sustainably 

delivering proven evidence-based multi-level interventions in clinical practice and community 

settings to reduce or eliminate cardiovascular and pulmonary health disparities.

Budget Policy: The FY 2025 President’s Budget request for CTRIS is $126.6 million, a decrease

of $0.3 million or 0.2 percent compared with the FY 2023 Final level. 

Division of Intramural Research

The MRI Technology Program,87 within the NHLBI Division of Intramural Research (DIR), 

focuses on the development of novel MRI technology for cardiac imaging, lung imaging, and 

MRI-guided cardiovascular catheterization procedures. When doctors need detailed images of 

the lungs, they frequently use chest CT scans. Over the years, these scans have been particularly 

useful in diagnosing lung diseases—so useful, in fact, that around 80 million people in the 

United States get them every year.88 However, radiation doses for CT scans can be hundreds of 

times higher than conventional X-rays. NHLBI’s innovative MRI technology program now 

makes it possible to maintain good image quality when testing for certain lung diseases while 

eliminating radiation exposure. To achieve this, NHLBI researchers developed new techniques 

to capture and process images using low-field MRI scanners.89 Researchers then applied novel, 

advanced reconstruction methods using contemporary computational power integrated into the 

clinical environment using the “Gadgetron,” an open-source tool for medical image 

reconstruction. The program emphasizes translation of new methods to clinical applications by 

collaborating with cardiologists, pulmonologists, radiologists, and critical care physicians. 

Recently, these NHLBI researchers conducted a clinical trial to test a lower energy version of an 

MRI to make it possible to scan people with metal devices in their body, or to be used when 

conducting invasive heart procedures using metal tools. The technique provides accurate 

measures of a number of cardiac functions and locations within the heart without exposure to 

ionizing radiation. The researchers are now testing whether cardiovascular magnetic resonance 

(CMR) scans, which use lower power rays, can still create high image quality by technical 

optimization of the CMR signal. Among other goals, the trial will assess the potential of CMR 

to be used for accurate imaging instead of the conventional MRI scan. 

In the United States, rural populations have higher rates of death associated with heart disease 

compared to urban populations.90 Additionally, high blood pressure, a major risk factor for heart 

85 decipheralliance.org/ 86 www.nhlbi.nih.gov/node-general/frequently-asked-questions-decipher-ug3uh3-rfa-hl-20-003 87 www.nhlbi.nih.gov/science/mri-technology 88 www.nhlbi.nih.gov/news/2020/medical-imaging-advances-may-reduce-radiation-risk-vulnerablepatients#:~:text=Over%20the%20years%20these%20scans,higher%20than%20conventional%20X%2Drays.

89 pubmed.ncbi.nlm.nih.gov/31573398/

90 www.nhlbi.nih.gov/science/health-disparities-andinequities#:~:text=In%20the%20United%20States%2C%20rural,and%20stroke%20than%20urban%20populations.
NHLBI-31 

disease, is more common and not as well controlled in adults who are Black or Hispanic 

compared to adults who are white. In a recent study conducted by NHLBI, researchers examined 

the incidence of heart disease by rurality status across race and sex in a large community cohort 

of Black and White adults in the southeastern U.S.91 Among a large cohort of predominantly 

low-income Black and White participants, heart failure incidence was 21 percent higher among 

adults living in rural areas. Results varied by race-sex group, with Black men living in rural 

areas experiencing the highest rate of heart failure. This substantial excess risk persisted after 

adjustment for biological, behavioral, and sociocultural risk factors. The results underscore the 

importance of examining the effect of rurality by race-sex group, as researchers observed that 

both White and Black women had an increased risk of heart failure associated with rurality, in 

contrast to White men, who had no rurality-associated risk of heart failure. Researchers called 

for personalized prevention, focusing on rural women and rural Black men as key groups, and 

for further research to elucidate the association between rurality and risk of heart failure.

In 2023, more than 20,000 people will be diagnosed with acute myeloid leukemia (AML), a 

group of rare blood cancers associated with a 31.7 percent 5-year relative survival rate.92 One 

method of treatment is a stem cell, or bone marrow, transplant from donors for patients who are 

in remission. Unfortunately, the disease reoccurs in approximately 30 percent of patients after 

allogeneic hematopoietic cell transplant and is the most common cause of post-transplant death. 

NHLBI researchers aimed to create a metric to determine whether or not a patient receiving a 

stem cell transplant was at increased risk for subsequent relapse and death. Research suggests 

that measuring the small number of cancer cells that remain post-treatment, or measurable 

residual disease (MRD), may provide information regarding risk for subsequent relapse and 

mortality. However, there is no standard method for AML MRD testing. Researchers used 

targeted deep DNA sequencing to look for disease-associated variants using the blood of AML 

patients.93 Among patients with AML in first remission prior to stem cell transplant, the 

presence of two genetic variants (FLT3-ITD or NPM1) above a certain level was associated with 

increased relapse and worse survival compared with those without variants detected. This 

strategy may also be applied to diagnose and understand the etiology of other chronic diseases, 

such as sickle cell disease.

For individuals who have received organ transplantation, continual monitoring is needed to 

ensure continued health of the patient and prevent donor organ rejection. Given the need for 

intense immunosuppressive regimens, lung transplant patients are at especially increased risk of 

infection and organ rejection soon after transplant. Post-transplant monitoring typically involves 

routine bronchoscopies (a procedure to examine the interior of the lungs)94 along with biopsies, 

especially during the first year post-transplant. In an effort to implement a less invasive 

detection and monitoring approach during the COVID-19 pandemic, NIH researchers tested the 

cell-free DNA (cfDNA) levels in the blood of lung transplant recipients.95 When a cell dies, it 

releases pieces of double-stranded DNA into the bloodstream, collectively known as cfDNA. 

91 jamanetwork.com/journals/jamacardiology/article-abstract/2800877?resultClick=1

92 seer.cancer.gov/statfacts/html/amyl.html

93 jamanetwork.com/journals/jama/fullarticle/2802059?guestAccessKey=9e9d4fbc-d6f8-4dfa-993cf1ca98c07380&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl

&utm_term=030723

94 https://www.nhlbi.nih.gov/health/lung-tests

95 www.jhltonline.org/article/S1053-2498(21)02630-9/fulltext
NHLBI-32 

Transplant recipients have cfDNA from both their own cells and the donated cells. Previous 

research has shown that the relative amounts of donor-derived cfDNA (dd-cfDNA) compared to 

recipient-derived cfDNA has the potential to be a useful biomarker of organ rejection, but this 

has not been tested as a method of routine clinical monitoring. NHLBI researchers periodically 

collected blood from patients within three years of their transplant and found that increased 

levels of dd-cfDNA indicated either rejection or infection of the donated tissue, suggesting this 

method is a convenient and reliable way to monitor health. Additional testing is needed to 

establish clinical guidelines and may be applicable for the use of monitoring the health of other 

transplanted organs. 

NHLBI’s Intramural Sickle Cell Branch96 conducts research to understand sickle cell disease and 

identify markers of disease severity. Specific projects aim to better predict long-term outcomes 

and to develop therapies through genetics and genomics. The Branch is also developing and 

improving treatments for severe pain episodes, also known as pain crises. These pain crises may 

occur without warning, when sickled cells block blood flow. People describe this pain as sharp, 

intense, stabbing, or throbbing.97 Recently, a proof-of-concept clinical study showed that the 

pyruvate kinase activator, mitapivat (AG-348), has disease-modifying potential in patients with 

sickle cell disease.98 It improved red and white blood cell counts and hemoglobin concentration, 

increased blood oxygen levels, and reduced sickling in patients with sickle cell anemia. Pain 

crises are a main clinical feature for people with sickle cell disease. Finding ways to lessen these 

occurrences provides much needed benefit.

Budget Policy: The FY 2025 President’s Budget request for NHLBI intramural research is 

$266.8 million, an increase of $12.6 million or 4.9 percent compared with the FY 2023 Final 

level. 

Research Management and Support

RMS activities include administrative and technical functions that support and enhance the 

effectiveness of the Institute’s research investments. This includes providing administrative, 

budgetary, logistical, and scientific support in the review, award, and monitoring of research 

grants and clinical trials, training awards, and research and development contracts. RMS 

functions also encompass strategic planning, trans-NHLBI and NIH coordination, evaluation of 

the Institute’s programs, regulatory compliance, international coordination, interactions with 

other Federal agencies and Congress, and dissemination of research findings to the public. 

Budget Policy: The FY 2025 President’s Budget request for RMS at NHLBI is $164.1 million, 

an increase of $6.6 million or 4.2 percent compared with the FY 2023 Final level. 

96 www.nhlbi.nih.gov/about/intramural-research/sickle-cell 97 www.nhlbi.nih.gov/health/sickle-cell-disease/health-effects

98 https://ashpublications.org/blood/article-abstract/doi/10.1182/blood.2022015403/485276/A-Phase-1-DoseEscalation-Study-of-the-Pyruvate?redirectedFrom=fulltext 
NHLBI-33 

APPROPRIATIONS HISTORY

NATIONAL INSTITUTES OF HEALTH

NATIONAL HEART, LUNGS, AND BLOOD INSTITUTE

Appropriations History

Fiscal Year

Budget 

Estimate to 

Congress

House 

Allowance

Senate 

Allowance Appropriation

2016 $3,071,906,000 $3,035,062,000 $3,135,519,000 $3,115,538,000

Rescission - - - $0 

2017 1 $3,113,533,000 $3,190,474,000 $3,242,685,000 $3,206,589,000 

Rescission - - - $0 

2018 $2,534,803,000 $3,256,521,000 $3,322,774,000 $3,383,201,000

Rescission - - - $0 

2019 $3,112,032,000 $3,423,604,000 $3,490,171,000 $3,488,335,000

Rescission - - - $0 

2020 $3,002,696,000 $3,658,822,000 $3,694,771,000 $3,624,258,000

Rescission - - - $0

Supplemental - - - $103,400,000 

2021 $3,298,004,000 $3,655,428,000 $3,728,307,000 $3,664,811,000

Rescission - - - $0 

2022 $3,845,681,000 $3,866,828,000 $3,841,998,000 $3,808,494,000

Rescission - - - $0 

2023 $3,822,961,000 $3,943,702,000 $3,946,557,000 $3,982,345,000

Rescission - - - $0 

2024 $3,985,158,000 $3,982,345,000 $3,982,345,000 $3,982,345,000

Rescission - - - $0

2025 $3,997,086,000 1 Budget Estimate to Congress includes mandatory financing.
NHLBI-34 

AUTHORIZING LEGISLATION

NATIONAL INSTITUTES OF HEALTH

NATIONAL HEART, LUNGS, AND BLOOD INSTITUTE

Authorizing Legislation

Recipients

PHS 

Act/Other 

Citations

U.S. Code 

Citations

2024 

Amount 

Authorized FY 2024 CR

2025 

Amount 

Authorized

FY 2025 

President’s 

Budget

Research and 

Investigation

National Heart, Lung, 

and Blood Institute

Section 301

Section 401(a) 

42 Section 

241 

42 Section 

281

Indefinite $3,982,345,000 Indefinite $3,997,086,000 

Total Budget Authority $3,982,345,000 $3,997,086,000
NHLBI-35 

AMOUNTS AVAILABLE FOR OBLIGATION

NATIONAL INSTITUTES OF HEALTH

NATIONAL HEART, LUNGS, AND BLOOD INSTITUTE

Amounts Available for Obligation1

(Dollars in Thousands)

Source of Funding FY 2023 Final FY 2024 CR 

FY 2025 

President's 

Budget

Appropriation $3,982,345 $3,982,345 $3,997,086

Mandatory Appropriation: (non-add) - - -

Type 1 Diabetes ($0) ($0) ($0)

Other Mandatory financing ($0) ($0) ($0)

Subtotal, adjusted appropriation $3,982,345 $3,982,345 $3,997,086

OAR HIV/AIDS Transfers $2,813 $0 $0

Subtotal, adjusted budget authority $3,985,158 $3,982,345 $3,997,086

Unobligated balance, start of year $0 $0 $0

Unobligated balance, end of year (carryover) $0 $0 $0

Subtotal, adjusted budget authority $3,985,158 $3,982,345 $3,997,086

Unobligated balance lapsing -$237 $0 $0

Total obligations $3,984,921 $3,982,345 $3,997,086 1 Excludes the following amounts (in thousands) for reimbursable activities carried out by this account:

FY 2023 - $23,861 FY 2024 - $23,861 FY 2025 - $23,911
NHLBI-36 

BUDGET AUTHORITY BY OBJECT CLASS

NATIONAL INSTITUTES OF HEALTH

NATIONAL HEART, LUNGS, AND BLOOD INSTITUTE

Budget Authority by Object Class1

(Dollars in Thousands)

OBJECT CLASSES FY 2024 CR FY 2025 President's 

Budget

Total compensable workyears:

- Full-time equivalent 966 966

- Full-time equivalent of overtime and holiday hours 1 1

- Average ES salary $224 $230

- Average GM/GS grade 12.8 12.8

- Average GM/GS salary $140 $144

- Average salary, Commissioned Corps (42 U.S.C. 207) $124 $130

- Average salary of ungraded positions $170 $174

- Personnel Compensation - -

11.1 Full-Time Permanent $84,655 $87,026

11.3 Other Than Full-Time Permanent $44,475 $45,720

11.5 Other Personnel Compensation $7,208 $7,410

11.7 Military Personnel $2,863 $2,997

11.8 Special Personnel Services Payments $13,345 $13,719

11.9 Subtotal Personnel Compensation $152,546 $156,871

12.1 Civilian Personnel Benefits $49,984 $51,657

12.2 Military Personnel Benefits $519 $543

13.0 Benefits to Former Personnel $0 $0

- Subtotal Pay Costs $203,049 $209,072

21.0 Travel & Transportation of Persons $2,899 $2,963

22.0 Transportation of Things $474 $484

23.1 Rental Payments to GSA $0 $0

23.2 Rental Payments to Others $9 $9

23.3 Communications, Utilities & Misc. Charges $234 $240

24.0 Printing & Reproduction $3 $3

25.1 Consulting Services $120,470 $123,717

25.2 Other Services $118,900 $113,326

25.3 Purchase of Goods and Services from Government Accounts $324,346 $328,189

25.4 Operation & Maintenance of Facilities $421 $424

25.5 R&D Contracts $152,631 $155,989

25.6 Medical Care $1,989 $2,067

25.7 Operation & Maintenance of Equipment $16,475 $16,630

25.8 Subsistence & Support of Persons $0 $0

25.0 Subtotal Other Contractual Services $735,233 $740,342

26.0 Supplies & Materials $15,848 $16,193

31.0 Equipment $10,407 $10,630

32.0 Land and Structures $4,253 $4,346

33.0 Investments & Loans $0 $0

41.0 Grants, Subsidies & Contributions $3,009,858 $3,012,725

42.0 Insurance Claims & Indemnities $0 $0

43.0 Interest & Dividends $78 $78

44.0 Refunds $0 $0

- Subtotal Non-Pay Costs $3,779,296 $3,788,014

- Total Budget Authority by Object Class $3,982,345 $3,997,086

1 Includes FTEs whose payroll obligations are supported by the NIH Common Fund.
NHLBI-37 

SALARIES AND EXPENSES

NATIONAL INSTITUTES OF HEALTH

NATIONAL HEART, LUNGS, AND BLOOD INSTITUTE

Salaries and Expenses

(Dollars in Thousands)

Object Classes FY 2024 CR FY 2025 

President's Budget

Personnel Compensation

Full-Time Permanent (11.1) $84,655 $87,026

Other Than Full-Time Permanent (11.3) $44,475 $45,720

Other Personnel Compensation (11.5) $7,208 $7,410

Military Personnel (11.7) $2,863 $2,997

Special Personnel Services Payments (11.8) $13,345 $13,719

Subtotal, Personnel Compensation (11.9) $152,546 $156,871

Civilian Personnel Benefits (12.1) $49,984 $51,657

Military Personnel Benefits (12.2) $519 $543

Benefits to Former Personnel (13.0) $0 $0

Subtotal Pay Costs $203,049 $209,072

Travel & Transportation of Persons (21.0) $2,899 $2,963

Transportation of Things (22.0) $474 $484

Rental Payments to Others (23.2) $9 $9

Communications, Utilities & Misc. Charges 

(23.3) $234 $240 

Printing & Reproduction (24.0) $3 $3

Other Contractual Services

Consultant Services (25.1) $120,470 $123,717

Other Services (25.2) $118,900 $113,326

Purchase of Goods and Services from 

Government Accounts (25.3) $224,717 $228,262 

Operation & Maintenance of Facilities (25.4) $421 $424

Operation & Maintenance of Equipment (25.7) $16,475 $16,630

Subsistence & Support of Persons (25.8) $0 $0

Subtotal Other Contractual Services $480,983 $482,359

Supplies & Materials (26.0) $15,848 $16,193

Subtotal Non-Pay Costs $500,451 $502,252

Total Administrative Costs $703,500 $711,323
NHLBI-38 

DETAIL OF FULL-TIME EQUIVALENT EMPLOYMENT (FTE)

NATIONAL INSTITUTES OF HEALTH

NATIONAL HEART, LUNGS, AND BLOOD INSTITUTE

Detail of Full-Time Equivalent Employment (FTE)

Office 

FY 2023 Final FY 2024 CR FY 2025 President’s Budget

Civilian Military Total Civilian Military Total Civilian Military Total 

Division of Intramural Research

Direct: 432 13 445 443 12 455 443 12 455

Reimbursable: 18 - 18 18 - 18 18 - 18

Total: 450 13 463 461 12 473 461 12 473

Office of the Director

Direct: 166 2 168 175 2 177 175 2 177

Reimbursable: - - - - - - - - -

Total: 166 2 168 175 2 177 175 2 177

Division of Blood and Resources 

Direct: 26 1 27 27 1 28 27 1 28

Total: 26 1 27 27 1 28 27 1 28

Division of Lung Diseases

Direct: 44 - 44 45 - 45 45 - 45

Total: 44 - 44 45 - 45 45 - 45

Center for Translation Research and 

Implementation Science

Direct: 18 1 19 18 1 19 18 1 19

Total: 18 1 19 18 1 19 18 1 19

Division of Cardiovascular Sciences

Direct: 121 - 121 122 - 122 122 - 122

Total: 121 - 121 122 - 122 122 - 122

Division of Extramural Research 

Activities

Direct: 101 - 101 102 - 102 102 - 102

Total: 101 - 101 102 - 102 102 - 102

Total 926 17 943 950 16 966 950 16 966

Includes FTEs whose payroll obligations are supported by the NIH Common Fund

FTEs supported by funds from 

Cooperative Research and Development 

Agreements.

0 0 0 0 0 0 0 0 0 

FISCAL YEAR Average GS Grade

2021 12.7

2022 12.7

2023 12.8

2024 12.8

2025 12.8
NHLBI-39 

DETAIL OF POSITIONS

NATIONAL INSTITUTES OF HEALTH

NATIONAL HEART, LUNGS, AND BLOOD INSTITUTE

Detail of Positions1

GRADE FY 2023 Final FY 2024 CR FY 2025 President's Budget

Total, ES Positions 1 2 2

Total, ES Salary $212,100 $447,044 $459,561

General Schedule

GM/GS-15 100 100 100

GM/GS-14 187 188 188

GM/GS-13 223 225 225

GS-12 75 81 82

GS-11 41 43 42

GS-10 0 0 280

GS-9 28 28 36

GS-8 1 1 1

GS-7 7 7 7

GS-6 3 3 3

GS-5 5 5 5

GS-4 6 6 6

GS-3 5 5 5

GS-2 2 2 2

GS-1 1 1 1

Subtotal 684 695 695

Commissioned Corps (42 U.S.C. 207)

Assistant Surgeon General 1 1 1

Director Grade 4 4 4

Senior Grade 4 4 4

Full Grade 7 7 7

Senior Assistant Grade 0 0 0

Assistant Grade 0 0 0

Junior Assistant 0 0 0

Subtotal 16 16 16

Ungraded 286 286 286

Total permanent positions 650 650 650

Total positions, end of year 987 999 999

Total full-time equivalent (FTE) 

employment, end of year 943 966 966

Average ES salary $212,100 $223,522 $229,780

Average GM/GS grade 12.8 12.8 12.8

Average GM/GS salary $133,033 $140,262 $144,189 1 Includes FTEs whose payroll obligations are supported by the NIH Common Fund.