I am writing this letter with great sadness. Dr. Ralph L. Sacco, MD, MS, FAHA, FAAN, a luminary stroke expert and leader and the only physician who served as President of both the American Heart Association (AHA) and the American Academy of Neurology (AAN), died January 17, 2023, after losing a battle with glioblastoma. He was 65.

Dr. Sacco was the Chair of the Department of Neurology, the Olemberg Family Chair in Neurological Disorders, a Professor of Neurology, Public Health Sciences, Human Genetics, and Neurosurgery, the Chief of Neurology at Jackson Memorial Hospital, and the Executive Director of the Evelyn F. McKnight Brain Institute. He was also Director of the Miami Clinical and Translational Science Institute and Senior Associate Dean for Clinical and Translational Science at the University of Miami Miller School of Medicine.

Dr. Sacco was the founder of the Northern Manhattan Study, a longitudinal study of risk of stroke and cognitive impairment that was among the first to identify stroke disparities and the contributions of traditional and non-traditional factors to stroke risk and brain health. Ralph was internationally known for his dedicated work on stroke prevention, promoting ideal cardiovascular health, and brain health initiatives.

Dr. Sacco grew up on the Jersey Shore, attended Cornell University in New York, majoring in bioelectrical engineering. He completed his MD degree at the Boston University School of Medicine. At Boston University, he joined his mentor, Dr. Philip A. Wolf, in the Framingham Study, one of the longest running longitudinal study of the risk for cardiovascular disease. Through this research, in which he combined his analytical skills with medical knowledge, Ralph developed a love for epidemiology of vascular disease and set a course for the rest of his professional and scientific life. Ralph completed his residency in neurology at Columbia Presbyterian Hospital in New York in 1983, followed by a master’s program in epidemiology at Columbia University School of Public Health. He stayed on the faculty at the Neurological Institute at Columbia/New York-Presbyterian and rose to the rank of a professor and chief of the Stroke and Critical Care Division.

In 2007, Dr. Sacco moved to Miami to become the University of Miami Olemberg Chair in Neurology and chief of the neurology service at Jackson Memorial Hospital and University of Miami Hospital. He launched the Florida-Puerto Rico Collaboration to Reduce Stroke Disparities and the Miami Clinical and Translational Science Institute, serving as their founding director. He established the Florida Stroke Registry (FSR) that has become a premier, statewide, stroke surveillance and quality improvement program. Ralph was instrumental in the development of state stroke legislation informed by evidence-based results derived from the FSR, including the enactment of FSR, establishing a mandate that all stroke centers should be nationally certified, and defining statewide objectives towards improving stroke treatment, improving stroke outcomes, and reducing stroke disparity. FSR now includes a network of 168 Florida hospitals that provide care to stroke patients and carries on Ralph’s vision of improving quality of care for all.

Over the span of his career as a stroke expert-leader, epidemiologist, and researcher, Dr. Sacco published more than 1,000 peer-reviewed articles and seminal stroke textbooks. He was invited to lecture across all continents. He was the recipient of many professional and research awards, including the AAN Robert Wartenberg Lecture, the AHA Feinberg Award of Excellence in Clinical Stroke, the World Stroke Organization Global Stroke Leadership Award, the AHA Gold Heart Award, the National Institute of Neurological Disorders and Stroke Javits Award in neuroscience, and numerous named lectures. In 2018, he was elected to the prestigious National Academy of Medicine. In 2019, he was selected as editor-in-chief of the journal Stroke.

Dr. Sacco tirelessly worked on improving the quality of care for stroke patients by addressing stroke risk factors, stroke disparities and health equity. He contributed to our understanding of the impacts physical activity, alcohol, diet, obesity, diabetes, hypertension, and race-ethnicity have on risk of stroke and stroke prevention. His landmark Northern Manhattan Study was among first multi-ethnic population-based study of individuals living in the same community that lead stroke disparity research. Ralph was the first neurologist to be AHA President (2010-11), and he was President of the AAN (2017-19). Both positions reflect the highest reputation and respect Ralph had among cerebrovascular and neurology professionals.

On a personal note, I am deeply saddened by the passing of my chair, wonderful colleague, mentor, and dear friend. I have been fortunate to work with Ralph for more than 25 years. I moved with Ralph from New York to the University of Miami. Together, we created a vision and mission for our department and Evelyn F. McKnight Brain Institute (Fig. 1). He is the reason I am a competent clinician-researcher today. He taught me so much, beyond neurology and science. Ralph has given me love for clinical research, strive to constantly advance and be better, mentor and help careers of others, and inspired me to influence others as he was greatly influenced by his mentors and the careers of many. His impact as a leader, role model, and mentor will endure for generations to come. Although Ralph’s life was cut short, he had a tremendous impact on those who knew him. I have been missing Ralph very much, but mission we created together and his memory will stay with me forever. Knowing that gives me great comfort.

Dr. Ralph L. Sacco and Dr. Tatjana Rundek at the Evelyn F. McKnight Endowed Chair Ceremony.

Dr. Sacco will be remembered for his brilliance, the height and breadth of his accomplishments, and the warmth, kindness, and compassion that distinguished his person and his career. They say, “It is not how many footsteps you take or how many places you go but its about the footsteps you leave behind.” Ralph has left behind many, and it will take a long time to fill them.

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