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Spotlight on Ralph Sacco, First Neurologist to be American Heart Association President-Elect

STUMP, ELIZABETH

doi: 10.1097/01.NT.0000352405.70057.d7
IN THE FIELD

Ralph L. Sacco, MD, chairman of neurology and Miller Professor of Neurology, Epidemiology, and Human Genetics at the University of Miami Miller School of Medicine, the Olemberg Family Chair in Neurological Disorders, and neurologist-in-chief at Jackson Memorial Hospital in Miami, has been named president-elect of the American Heart Association (AHA) for 2009–2010. Dr. Sacco's election marks the first time that a neurologist has been named this position in the history of the AHA.

In July 2010, Dr. Sacco will succeed Clyde W. Yancy, MD, as president of the largest US voluntary health organization dedicated to the prevention and treatment of heart disease and stroke. Dr. Sacco's term as president will end June 30, 2011.

After receiving his medical degree from Boston University School of Medicine, and a master's degree in epidemiology from Columbia University, Dr. Sacco completed a residency in neurology at Presbyterian Hospital of the City of New York and postdoctoral training in stroke and epidemiology at Columbia.

Before moving to Miami in 2006, he spent much of his career at Columbia University, where he was the director of the Stroke and Critical Care Division and the principal investigator of the New York Columbia Collaborative Specialized Program in Translational Research in Acute Stroke, an NIH program for acute stroke care in a high-risk and disadvantaged population.

Dr. Sacco spoke with Neurology Today about his new position and what's currently on the minds of stroke experts in the US today.

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WHAT DO YOU THINK YOU AS A NEUROLOGIST WILL BRING TO THE ROLE THAT NON-NEUROLOGIST PRESIDENTS CANNOT?

The AHA mission has always been fighting cardiovascular disease and stroke, and their mission continues to broaden. There is more recognition that stroke is very much a vital, important, and growing part of the mission of the AHA. As a neurologist, and really a “stroke-ologist,” I feel I'm helping the public and the constituency of the AHA to recognize that stroke is front and center.

I also feel that the AHA is expanding to thinking more about prevention; the new strategic plan is focused on the prevention of cardiovascular disease and stroke and on improving optimal cardiovascular health. My research and clinical interest has always been in prevention, as well. So I feel I wear two hats in this new role with the AHA — I'm very interested in treating stroke and also very interested in pushing the AHA's prevention mission.

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WHAT CAN NEUROLOGY LEARN FROM CARDIOLOGY AND VICE VERSA?

There is an overlap between neurology and cardiology because we both want to treat stroke. Cardiology is and has always been 10 years ahead of neurology in terms of the acute treatment of cardiovascular disease, and neurologists have already learned a lot from cardiologists. This includes the use of thrombolysis and tPA and acute approaches to stroke. Clot retrieval devices, that restore blood flow, are now becoming more frequently used in acute stroke. Neurologists can teach cardiologists about systematically treating and delivering care to stroke patients, and cardiologists can teach neurologists about better devices and prevention methods for acute treatment.

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HOW DO YOU ENVISION CLOSER COLLABORATION BETWEEN THE TWO SPECIALTIES?

There has already been some very close collaboration between the AAN and AHA, such as on guideline development and prevention and awareness campaigns, including the “Give Me 5 for Stroke” campaign, jointly developed and supported by the AAN, AHA, and American College of Emergency Physicians to promote awareness of symptoms of stroke in the public.

The ASA stroke support team has often attended the AAN annual meetings, and there also has been close dialogue between the two organizations. I hope to push for more joint funding for research fellowships and research support programs that have been AHA- and AAN-sponsored. In addition to the Brain Attack Coalition, where the AAN and the AHA and ASA have been members, there other common grounds where they can work together in the stroke mission. The AAN may be able to work with the AHA on certain advocacy issues that are in the mutual interests of both organizations.

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HOW DID YOU BECOME INTERESTED IN STROKE MEDICINE?

It was partially a personal issue and partially due to mentorship opportunities. I had an AHA medical student scholarship, given out to engender interest in stroke medicine. As a medical student, I was mentored by Philip Wolf, MD, professor of neurology at Boston University School of Medicine, and in my first year of medical school I started working in the Framingham Heart Study (1980). [Dr. Wolf, principal investigator of the Framingham Heart Study, began all the stroke-related work in the Framingham study.] One of my first projects was looking at predictors of survival and recurrence after stroke. That was my first foray into epidemiology and stroke, under Dr. Wolf's strong guidance. My induction into stroke continued with the mentorship of Dr. JP Mohr as a resident and fellow at Columbia.

On a personal level, my grandfather had a stroke, while I was in medical school, and I experienced the issues of a family member seeing their relative struggling to recover, and not managing to do so. Heart disease has also touched my family, including my mother who passed away last year from a long battle with coronary disease and heart failure.

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TELL US ABOUT YOUR INVOLVEMENT IN THE AHA PRIOR TO BECOMING PRESIDENT-ELECT

Anybody who is involved with research or clinical care in heart disease and stroke can't avoid being involved with the AHA — it is the number one organization with funding (other than government funding) for research and awareness campaigns in the public for stroke and heart disease. Besides taking advantage of their student scholarship, my earliest involvement was attending the annual international stroke meeting, which the AHA had sponsored, as a medical student.

As a young attending physician at Columbia University, I got involved with the local affiliate of the AHA where they had an Operations Stroke Committee, and I was one of the chairs of the committee. Eventually I became president of the AHA New York City Regional Board of Directors (2005–2007). My most recent position was chair of the Stroke Advisory Committee, which is the number one committee for the ASA, and by virtue of that position, I sat on the AHA national board for three years (2005–2008).

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WHAT ARE THE GAPS IN PATIENT CARE THAT YOU SEE AS NEEDING THE MOST ATTENTION, AND WHAT REMEDIES DO YOU OFFER?

Our health care system has to focus on prevention, much more than it ever has. We are really good when it comes to high-tech, very expensive approaches to treating stroke, but we need to do just as much to prevent cardiovascular disease and stroke. That's going to take fundamental change in the heath care system, helping to support preventative health as well as improving access to care to those who need preventative health the most.

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THE 2009 AHA UPDATE SHOWS THAT DEATH RATES FROM HEART DISEASE AND STROKE HAVE CONTINUED TO DECLINE, BUT THE BURDEN OF DISEASE REMAINS HIGH. WHY DO YOU THINK THIS BURDEN IS STILL HIGH AND WHAT CAN BE DONE ABOUT IT?

The burden of disease is calculated by the numbers of strokes that occur, the disability associated with the stroke, and the quality of life that's threatened by someone with a stroke. Keep in mind that stroke, while the third leading cause of death, is not always fatal; the majority of people who have a stroke do not die of a stroke. Instead, they assume a burden regarding disability, cognitive decline, functional impairment, and quality of life that's impaired due to stroke.

In earlier strategic plans for the AHA, one goal was to reduce mortality for both heart disease and stroke by 25 percent by the year 2010. And we actually met that goal for both, for heart disease first and then stroke.

So new goals are being set, but haven't yet been declared. However, because of the high burden, there will be a greater emphasis on prevention: what we can do to reduce the risk of stroke with better detection and treatment of high blood pressure, improved lifestyle management, and reducing obesity. I think we all are concerned that although mortality may be decreasing from cardiovascular disease and stroke, there still remains a very high incidence of stroke, and the number of strokes predicted in the future may be going up — partially due to increasing age of the population, and partially due to the change in demography of the population, with more African-Americans and Hispanics (who have greater risk of stroke) having an impact on these future predictions.

We'll also be continuing our already successful work on acute treatment and trying to improve quality of life post-stroke — mitigating functional disability, depression, physical disability, cognitive impairment — by more effective and rapid treatments.

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©2009 American Academy of Neurology