Heart disease, including coronary heart disease, congestive heart failure, congenital heart disease, and heart attacks, is the leading cause of death in the U.S. Lowering stress, total cholesterol, particularly low density lipoprotein (LDL), lowering high blood pressure, eating a healthy diet, and exercise all help to lower the incidence of heart disease. But, our understanding is only partial because we know that even doing all these things prevents heart disease in some people, but not others. Further research is critical if we are to prevent heart disease before it ever becomes symptomatic, when cures are most possible. The COLS biobank will allow researchers to access biological samples and accompanying health information prior to diagnosis or any symptoms and follow the same person for years in order to understand the differences between those who never suffer from heart disease and others who develop the disease. The keys to early detection are having a large cohort, a longitudinal design with “healthy” (pre-diagnosis) biological samples, and data on the social determinants of health.

More than 71,000 Coloradans over age 65 and more than 5 million Americans were living with Alzheimer’s Disease (AD) in 2018. The number of people who will be diagnosed with AD and the healthcare costs to Medicare and Medicaid are rising dramatically. The pathogenic process of AD probably begins when neurons in the brain start dying, many years before the first signs of episodic memory loss appear as mild cognitive impairment (MCI). The inability to detect preclinical MCI or AD is thought to be one of the main obstacles to developing new treatments.

If we could diagnose MCI and AD when neurons first begin to die, it could well be possible to arrest progression or even reverse cognitive decline. COLS will allow researchers to analyze the molecules in blood to determine if there are biomarkers – or biological changes — that occur early in the disease inside the body well before outward symptoms appear. This is the first step to developing diagnostics and therapies to stop this devastating disease before it robs people of their lives.

In Colorado with its 5.76 million residents, 400,000 people are diabetic, and over 1.3 million people are prediabetic. Type 2 diabetes is caused by a combination of lifestyle, environment, and genetic factors. People with type 2 diabetes all share common symptoms, but the symptoms of prediabetes vary. Some people remain prediabetic for longer than others; they suffer fewer symptoms, and respond to exercise and changes in diet. Thus, it appears that prediabetes is not a singular state and that it is heterogeneous. The explanations for differential rates of progression, the differential expressions of the disease, and the differential responsiveness to treatments are unclear. The COLS cohort will be large enough that many of the different subgroups of this heterogeneous population will be captured. Not only will COLS have biological samples, but it will also have community health data and environmental information. This combination will allow researchers to develop diagnostics and therapeutics that target each of the subgroups and develop personalized treatments.

It has become clear that good nutrition is central to good health. Poor eating habits are associated with obesity, type 2 diabetes, heart disease, sleep disorders, morbidity, and shorter lifespan. We also know that some of the detrimental effects of obesity can be reversed if diet and nutrition are improved. But what is less well understood is the biological and sociological basis for the profound differences between individuals in dietary responses, disease risk, and complex changes in the microbiome. The COLS biobank will allow researchers to understand the relationship between weight, nutrition, the gut microbiome, and health. It will be possible to understand whether differences in the microbiome are a determinant of obesity risk.