Robert Wartenberg Lecturer
Ralph L. Sacco, MD
On Stroke Prevention — An Unfinished Story with New Perspectives
ARTICLE IN BRIEF
Dr. Ralph L. Sacco discusses the people and events that influenced his choice to focus on stroke as a subspecialty.
The first neurologist ever to serve as the president of the American Heart Association — a role he took on in July 2010 — Ralph L. Sacco, MD, was the first in his family to go to medical school. Indeed, both of his parents had only a high school education.
“I was the eldest of five in a middle-class Italian family where most of the family worked in a restaurant rather than going to college,” he said. But an aunt who worked in a physician's office filled her young nephew's ear with stories of how magical the field of medicine was, and how with his aptitude for math and science, he should consider a career as a physician.
Dr. Sacco, now professor and chairman of the department of neurology at the University of Miami Miller School of Medicine and an international authority on the prevention and treatment of stroke, was a cautious young man. “I knew medicine was very competitive, so when I applied to colleges, I wanted to pick an undergraduate degree that still gave me flexibility in case I didn't make it,” he recalls.
So he chose Cornell, and pursued a dual degree in electrical engineering and premed. Engineering turned out to be a good, organized, system-based curriculum to prepare for medical school — and it also directed Dr. Sacco toward neurology. “A lot of the brain can be diagrammed like an electrical circuit,” he said. “So bio-electrical engineering was my first exposure to neurology, or at least to the nervous system.”
Early on in medical school at Boston University, Dr. Sacco encountered someone who would turn out to be a lifelong mentor: neurologist Philip Wolf, MD, since 1989 the principal investigator for the seminal Framingham Heart Study. “I was looking for a summer job my first year of medical school, and the medical school gave a stipend to place me in someone's office,” Dr. Sacco said. “Phil introduced me to epidemiology and stroke and the Framingham study, and this gave me exposure to the clinical world of neurology.”
Coincidentally, Dr. Wolf delivered the Wartenberg Lecture in 2010. “It's really nice to follow in his footsteps,” Dr. Sacco said.
When it came time to choose a residency, Dr. Wolf helped Dr. Sacco settle on the Neurological Institute at Columbia University in New York. There, he discovered another mentor, a friend of Dr. Wolf's — J.P. Mohr, MD, now the Sciarra Professor of Neurology and director of the Doris and Stanley Tananbaum Stroke Center at Columbia.
“I began working on the NINDS stroke databank with him, and presented my first paper at an international stroke conference,” Dr. Sacco said. Work with another eminent Columbia neurologist, W. Allen Hauser, MD, now professor emeritus, further helped to hone his skills in epidemiology.
From his earliest days in the field of neurology, stroke has been Dr. Sacco's passion. That came from two influences: meeting Dr. Wolf in medical school and working on Framingham, and his personal experience with his grandfather, who suffered a stroke and died during Sacco's intern year. “I saw stroke affect a pretty vibrant person in my family who was a role model to me,” he said. “That really affected me.”
While at Columbia, Dr. Sacco launched the Northern Manhattan stroke study, modeled after Framingham. Now in its 20th year, this study has provided important data about the risk factors for stroke, particularly in non-white populations. “That's sort of been my laboratory,” he says.
In the Wartenberg Lecture, Dr. Sacco discussed how and why, at a community level, the US has failed to enact simple lifestyle changes that are known to help modify stroke risk. “I talk about what the AHA has called ‘Life's Simple Seven’ — seven key behaviors that can help prevent stroke,” he said. “I also talk about what else might be coming down the pike in stroke research in the future, particularly with regard to genetics. We are beginning to find certain genetic factors that may be helpful for predicting stroke risk, which in turn may clue us in to other pathways that will open up new treatment targets.”