Richey

Sharrett

,

MD

Areas of emphasis:

1. Microvascular contributions to ischemia. Most research on human ischemic diseases has focused on atherosclerosis. Methods have not been available to study contributions of the arterioles. However, retinal arteriolar changes may independently predict stroke, cerebral white matter disease, and dementia.

2. While Alzheimer's disease is the primary cause of dementia in the elderly, the vascular contribution to dementia is poorly understood, in part because the primary mechanism involves small cerebral vessels difficult to evaluate in living populations.  Vascular risk factors assessed in midlife predict dementia in the elderly; an important observation, particularly since cognitive impairments due to vascular disease are at least potentially more preventable than those due to the Alzheimer's process.

3. HD prevention potential. In 1910-20, William Osler and Paul Dudley White recognized but rarely saw angina pectoris. A review of the 20th century rise in CHD incidence, the Seven Countries Study, and other studies of special populations suggests that CHD may be more preventable than suggested by contemporary clinical trials or risk-factor equations. Yet recently discovered risk factors add little to overall prediction. However risk prediction, though similar in blacks and whites, is much more effective in women than men, and the substantial incidence in even those men who are at low-risk holds the promise of undiscovered risk factors. A key unrealized predictor may be lifetime diet, which may effect plasma cholesterol levels more than suggested by available short-term dietary trials. These considerations affect our views regarding the limits of CHD prediction and may have implications for the scope of future CHD research on prevention.