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THE PONTIFICAL ACADEMY OF SCIENCES

VAtIcAn cIty 2010

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Introduction p. Programme p. Abstracts p.

Biographies of Participants p. List of Participants p. Memorandum p. 1412

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Working Group on

Atherosclerosis:the 21st Century Epidemic

31 May – 1 June 2010 • Casina Pio IV

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In carrying out its distinctive service, the Pontifical Academy of Sciencesalways relies on the data coming from science and the Magisterium ofthe church. In particular, concerning the present study group [on The

Signs of Death], christian Revelation also invites the man of our times, whoin many ways seeks the real profound meaning of his existence, to facethe theme of death casting his eye beyond human reality in its purest formand opening his mind to the mystery of God. Indeed, it is in the lightof God that the human creature better understands himself andhis final destiny, the value and meaning of his life, a preciousand irreplaceable gift of the almighty Creator.

Benedict XVI, Letter dated 8 September 2006 to his venerated Brother H.E. Msgr.Marcelo Sánchez Sorondo, chancellor of the Pontifical Academy of Sciences, con-cerning the working group on The Signs of Death, 11-12 September 2006.

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cerebrovascular disease in developing areas is lowercompared to the developed world.

Epidemiological studies from developing regions arescarce and often of limited reliability. Good epidemi-ology studies are costly, complex and demanding andresources in developing countries are limited. the de-tails on the distribution and characteristics of Vascu-lar Disease in the developing world are needed to iden-tify the areas in greater need to distribute resources ac-cordingly. Surveillance data helps countries to devel-op, implement and monitor prevention programs.

If Governments do not include health policychanges in their agendas, in the next five years noncommunicable vascular diseases will overcome infec-tious diseases (tB, HIV and malaria) as the number onecause of death in countries such as India and china.In the latter, there are about 300 million smokers, 160million hypertensive people and 20% obese childrenbetween 7 and 17 years of age, something unknownto this region in the past.

Cognitive decline: a major health burden caused byVascular Disease

Dementia poses a large burden of disease worldwide.cerebral vascular injury causes cognitive impairmentand dementia with a frequency similar to degenerativedementia. For a given load of neuropathology findingsof Alzheimer’s disease, the presence of cerebrovasculardisease correlates with earlier clinical manifestations.Some authors have speculated and provided data to sup-port that hypertension results in decreased cerebral bloodflow in brain structures commonly affected byAlzheimer’s disease predisposing a vulnerable state forthe development of degenerative dementia. Increasedblood pressure and cholesterol in the 4th and 5thdecades of life correlate with dementia onset in the 7thdecade.

There is a major ‘implementation’ problem bywhich the known measures and medications to pre-vent vascular disease are largely under-used

Prevention is the first step in the cure for VascularDisease. yet, there is a major gap between knowledgeand the implementation of measures for primary as wellas secondary vascular disease prevention. Effective treat-ments for the acute and chronic phases of coronary andcerebrovascular disease are largely underused. the sci-entific community and Governments through their Min-istries of Health are responsible for the effective im-plementation of policies that achieve lower smokingrates, increased physical activity, healthy eating habits,and high detection rates for hypertension, diabetes, ab-normal lipids and other vascular risk factors. StrokeUnits, proven effective by scientific evidence, should beavailable in most clinics/hospitals with coronaryUnits.

the Pontifical Academy of Sciences, whose purposeis to promote the progress of the sciences for the com-

mon good of the human person, in its Study Week of31 May – 1 June 2010 at its headquarters in the Vati-can, would like to focus on the wellbeing of the vascularsystem, taking into account the revolutionary contri-butions of the last century in relation to the humanheart and brain.

Vascular Disease accounts for 15 million deaths peryear worldwide. this represents 30% of all causes of mor-tality. Most vascular deaths are secondary to brain andheart infarctions. Stroke (cerebrovascular disease)ranks as 1st, 2nd and 3rd cause of death depending onthe country or world region. Public recognition of cere-brovascular disease lags significantly behind identifi-cation of coronary artery disease.

Risk factors for Vascular Disease: known and treat-able…

Genetic predisposition, hypertension, diabetes,cholesterol, smoking, lack of exercise and obesity arethe main risk factors that predispose to the occurrenceand progression of atherosclerosis.

Increased blood pressure causes heart, brain and kid-ney disease and accounts for 13% of all deaths world-wide. Hypertension is easily identified and treatable,yet only 2 out of 3 patients are diagnosed and up to 80%of those diagnosed are treated but do not reach targetblood pressure goals. Hypertension accounts for 54%of stroke and 47% of coronary heart disease deaths. With1 billion people affected, the prevalence of hyperten-sion is increasing worldwide. Against deeply rooted med-ical traditions, recent data has shown that patients old-er than 80 years also benefit significantly from strictblood pressure management.

Actively screening and treating hypertension, cho-lesterol and diabetes are justified since more than 50%of vascular deaths are due to few risk factors. Moreover,different studies have shown that coronary heart dis-ease and stroke share the same risk factors. Importantly,the most important vascular risk factor is a previous-ly suffered vascular event. this emphasizes the im-portance of stringent medical treatment of conventionaland other vascular risk factors once a cardiac, cerebralor other vascular event has occurred. Data from theFramingham study has shown that, counter intuitively,most vascular events occur in people with a moderateload of vascular risk factors.

How is Vascular Disease distributed throughout theworld?

In low income countries, vascular disease accountsfor 80% of all deaths (11 million per year). In these re-gions, cardiovascular disease occurs 1 to 2 decades ear-lier compared to developed countries. Sadly, becauseof a high case fatality rate, prevalence of cardiac and

INTRODUCTIONH.E. Msgr. Marcelo Sánchez Sorondo, ChancellorThe Pontifical Academy of Sciences

Atherosclerosis:the 21st Century Epidemic

there is no doubt that significantly more interestis devoted to acute and invasive techniques comparedto prevention. And it is paradoxical that patients haveartificial heart valves inserted with endovascular tech-niques and cerebral clots removed with cork-screw likedevices, among other novel techniques, but various stud-ies have shown that patients are frequently dischargedfrom hospitals following a vascular event without theadequate dose of anti-thrombotic, anti-hypertensive orcholesterol lowering medications. However, a measureas simple as counseling during hospitalization has beenproven to increase adherence to treatment after dis-charge from the Hospital. the general public and physi-cians need to be educated on the importance of vas-cular disease prevention. this teaching takes time butit is most effective when it starts as early as childhood.Healthy young adults must understand that a vast ma-jority have vascular risk factors that justify treatmentin the asymptomatic stage.

The challenge: Effective Prevention of Vascular Dis-ease

the knowledge on vascular disease that has accu-mulated over the last decade is greater than that gainedin the entire previous century. commitment withvascular disease prevention has resulted in a 70% deathreduction in the USA, canada, Australia and the UK.Primary prevention provides an invaluable opportu-nity for early intervention. Unfortunately, data showsthat the people at highest risk have the lowest knowl-edge about vascular disease. In one study following aneducation campaign in the year 2000, respondents couldonly name one warning sign of stroke. In one surveyin India, close to 50% of respondents did not know thatthe brain is the affected organ in stroke. In countriesfrom Africa and Latin America, up to 50% of patientsgo to alternate medical healers before consulting in aHospital. As an example, only 50% of people diagnosedwith atrial fibrillation receive anticoagulants and just1% of patients are treated among those who are can-didates to receive thrombolytic therapy in the first fewhours after occlusion of a cerebral vessel.

the pharmaceutical industry is a major player inthe vascular disease battle. Many subsets of the world’spopulation could benefit from a ‘polypill’ simultane-ously targeting various vascular risk factors. Among theimportant achievements to be expected in this sectoris the production of affordable medications through theconduction of affordable trials. Large amounts of mon-ey are invested by the pharmaceutical industry andbiotechnology companies in research and development

of new therapeutic molecules. the scientific commu-nity should increase the interaction with the industryand influence the research lines likely to have a nov-el and higher therapeutic yield.

ConclusionsIf the vascular disease burden could be reduced 2%

per year, 36 million untimely deaths could be avoid-ed by the year 2015. the World Health Organizationhas provided data showing that 80% of cardiac eventsand strokes could be reduced with diet, physical activityand smoking cessation. there is also data proving that80% of stroke risk would be reduced with adherence topractice guidelines. A wealth of studies has proven theeffectiveness of cardiac and stroke units. yet, with theexception of a few developed countries heading in thisdirection, results in most world regions drift far fromthese projections.

In summary, preventive measures that should be-gin during childhood are needed to educate individu-als on how to avoid the most common risks of vascu-lar disease. In addition to the former, disease specificinformation should be provided to the population asa whole. Behavioral changes at the community levelcould be expected following effective education and in-formation programs. Active Government participationand commitment with the appropriate health policiesare a sine-qua-non to achieve these goals. the HealthSystem, Unions, and other health players should un-derstand the social and financial benefits of vasculardisease screening and prevention programs.

Vascular Disease is the field of interest for cardiol-ogists, Vascular neurologists, Diabetes, Lipid, Geneticsand nutrition experts, Epidemiologists, Vascular Sur-geons, and Endovascular specialists. they all have anincreasingly larger number of specialty meetings andseldom participate in strongly integrated conferences.Pulling the rope in the same direction will surely increasethe yield in the battle against Vascular Disease. A clos-er cooperation among the different vascular specialtiesshould be encouraged and the integrated meeting ofmost vascular disciplines at the Pontifical Academy ofSciences, is a significant contribution to this endeavor.

the moral imperative of our meeting is to make peo-ple and private and public institutions, at the nation-al and international level, aware, as was done in thecase of alcoholism, drug addiction and smoking, thatmost risk factors are either under treated or simply nottreated, and convince them to adopt adequate pre-cautions in order to avoid premature death or survivalwith physical and/or mental impairments.

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Atherosclerosis: the 21st Century Epidemic Introduction

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8:30 Introduction and Welcome

World Health Organization: EPIDEMIOLOGY

9:00 Epidemiology, Global Public Health; The Need for Equitable Action to Address Cardiovascular DiseaseShanti Mendis

DIABETES and OBESITY

9:45 The Importance of Diet, Obesity and Type II Diabetes for Vascular DiseaseArne Astrup

HYPERTENSION

10:30 Hypertension: So Much Published, So Little AccomplishedConrado Estol

11:15 Coffee break

LIPIDS

11:45 Lipids: HDL, LDL, Role in Primary Prevention, the Message from Trials?Terje R. Pedersen

RESEARCH NIH

12:30 Vascular Disease: Ongoing National Institute of Health Research & ResourcesWalter Koroshetz

13:15 Lunch at the Casina Pio IV

HEART DISEASE

15:00 Acute Myocardial Infarction: A Century of Progress and a Look into the FutureEugene Braunwald

15:45 Genetic and Environmental Factors for Ischaemic Heart DiseaseAttilio Maseri

16:30 Coffee break

17:00 The Heart and the Brain: AF, CHF, PFO, the AortaPierre Amarenco

17:45 Surgical Options in Myocardial InsufficiencyFelix Unger

18:30 Cardiovascular Disease: From Treatment to Promoting Health; A Challenge for the Next DecadeValentin Fuster

19:15 General Discussion

20:15 Dinner at the Casina Pio IV

MONDAY, 31 MAY 2010

PROGRAMMEAtherosclerosis:

the 21st Century Epidemic

Atherosclerosis: the 21st Century Epidemic Programme

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CEREBROVASCULAR DISEASE

8:00 Guided tour of the Vatican Museums, including the Sistine Chapel

9:00 Acute Stroke Treatment: A Window of OpportunityWerner Hacke

9:45 Cerebrovascular Frustrations: Cerebral Hemorrhage and NeuroprotectantsAllan Ropper

10:30 Stroke: Antiplatelets, Anticoagulants and the New Medical StrategiesGeoffrey Donnan

11:15 Coffee break

11:45 Vascular Cognitive Impairment: Concept, Epidemiology and the Effect of Risk Factors. Relation toAlzheimer’s DiseaseJohn O’Brien

12:30 Cerebrovascular Disease: Lessons from the Past for the Near FutureLouis R. Caplan

13:15 Lunch at the Casina Pio IV

14:15 Round Tables• Top 5 priorities for the next 5 years (10 minutes each participant)

• Focus on: Education/CulturalHealth PoliticsMedical Goals: PolypillLow Income/High Income Countries

18:00 Departure from the Casina Pio IV by bus to attend the concert at Prince Boncompagni’sresidence at Villa Aurora (via Lombardia 42)

19:00 Private concert of baroque music offered to the participants by Prince Boncompagni at hisresidence, followed by dinner and viewing of his unique art collection

22:00 Bus leaves Prince Boncompagni’s residence to take participants back to their hotels

TUESDAY, 1 JUNE 2010

CEREBROVASCULAR DISEASE

9:30 General Audience with the Holy Father. Open to all Participants.

WEDNESDAY, 2 JUNE 2010

Vascular Disease: Ongoing National Institute of Health Research & ResourcesWalter Koroshetz

the national Institutes of Health (nIH) is the pri-mary US agency for conducting and supporting

medical research. through the support of the Ameri-can people the nIH annually invests over 28 billion inmedical research. More than 83% of the funding isawarded through an open, competitive process tomore than 325,000 researchers at over 3000 universi-ties and other research institutions. the nIH fundsmost of the basic biological research in the US and it’smain focus has been on empowering scientists to makethe discoveries that will improve health. It also funds“translational research” aimed at turning scientific dis-coveries into better therapeutic or diagnostic products.Large expensive clinical trials are also funded by nIHto determine whether new treatments are efficacious.comparative effectiveness research is a longstandingpart of the nIH sponsored programs though there isincreased emphasis recently to redouble efforts in thisarea to inform US health care reform. Among itsachievements the nIH lists the fall in death rates fromheart disease and stroke which fell by 40% and 51% re-spectively between 1975 and 2000.

the nIH is composed of 27 institutes and centers.the bulk of research in cardiovascular disease isfunded by the national Heart Lung and Blood Insti-tute (nHLBI). the bulk of research in stroke is fundedby the national Institute of neurological Disorders andStroke (nInDS). the two institutes work together on avariety of large prevention and epidemiologic projects.Vascular disease research related to diabetes and obe-sity is also of interest to the national Institute of Dia-betes, Digestive and Kidney disorders. Vascular diseaseaffecting vision is funded by the national Eye Institute.the Fogarty International center at the nIH focuseson advancing global health. It develops grant pro-grams that are funded by the different nIH Institutes.the nHLBI and the national Institute for autoimmu-nity, infectious disease (nIAID) and the national can-cer Institute have substantial international researchefforts underway around the globe. the nHLBI has setup 11 centers of Excellence to combat chronic diseasein developing countries (Guatemala, Peru, tunisia,Kenya, South Africa, India, Bangladesh, china, SouthAfrica). the new nIH Director, Dr. Francis collins hasmade an enhanced nIH contribution to global healthone of his 5 major themes.

Major ongoing research areas in cardio and cerebro-vascular disease include: 1) A large study (SPRInt) of over 7500 persons to de-

termine whether aggressive blood pressure lower-ing reduces stroke, renal failure and heart disease.

2) A large epidemiological study (Regards) in 30,000people to understand why African Americans havehigher stroke mortality than caucasians.

3) A large study to determine whether patient out-comes are improved by tailoring warfarin dosage(an anticoagulant) based on gene polymorphismsthat affect drug metabolism.

4) Multiple studies to determine the association be-tween risk factors, vascular disease and cognitiveimpairment in the elderly (ARIc, SPRInt-MInD).

5) Studies of which medications are best to preventsecond small vessel stroke, stroke after transient is-chemic attack, and stroke in persons with heartfailure.

6) Relationship of obesity to vascular disease. 7) Multi-ethnic studies of atherosclerosis (MESA) in-

volving over 6000 men and women in US. 8) the center for Disease control and Prevention

(cDc) is another agency in the US Department ofHealth which is expert at surveillance studies suchas the national Health and nutrition Examinationsurvey which combines interviews and physical ex-aminations.

the greatest health impact in fighting the burdenof cerebro- and cardiovascular disease can be madeby wide dissemination of treatments for those riskfactors already established by high quality research.Hypertension is by far the greatest modifiable riskfactor. Decreasing tobacco use, obesity, sedentarylifestyle, and the treatment of atherosclerosis by lipidlowering agents and anti-platelet agents are rela-tively simple measures that research suggests couldsave millions of lives.

Cerebral Hemorrhage and NeuroprotectionAllan H. Ropper

Despite the advances in understanding and treat-ment of cerebral vascular disease, two areas stand

out as lagging behind. First, all attempts to amelioratethe effects of intracerebral hemorrhage have met withdisappointment. In particular, after numerous uncon-trolled or poorly controlled case series, the StIcH trialhas settled, within limits, that surgical removal of clotsdoes not improve outcome. this counterintuitive resultwill continue to be re-examined and the trial mayhave inadvertently legitimized removal of hemor-rhages that are small and close to the cortical surface.

these disappointing results point to an incompleteunderstanding of the effects of a rapidly expandingblood clot on the adjacent brain, both in the acute andsubacute phases. For example, studies conflict regard-ing an increase or decrease in cerebral blood flow inthe tissue adjacent to a cerebral hemorrhage. the ef-fects on intracranial pressure are also variable, furthersuggesting that we lack some elemental understand-ing. Decisions regarding blood pressure control afterhemorrhage are made on very tentative presumptionsabut autoregulation and IcP. Removal of the clot stillmay make sense to lower IcP, despite StItcH but how

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ABSTRACTSAtherosclerosis:


Atherosclerosis: the 21st Century Epidemic Abstracts

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Since 1950, several important advances have occurred:1) It is now recognized that AMI is usually secondary

to coronary atherosclerosis and occurs most often inpatients with predisposing (risk) factors such as smok-ing, diabetes, elevated serum cholesterol concen-trations and hypertension. this has led to measuresto reduce risk factors and these have been success-ful in lowering the incidence of AMI.

2) Arrhythmic deaths were prevented by the develop-ment of the coronary care unit, in which cardiac re-suscitation, including ventricular defibrillation,can be carried out; this development immediatelyreduced AMI hospital mortality by half.

3) next, efforts were made to reduce the extent of my-ocardial necrosis. this has been accomplished byreperfusion of the threatened ischemic myocardium.Reperfusion was carried out first, by lysing the of-fending clot (fibrinolysis), then by balloon angio-plasty (PtcA) and in the last 15 years by stentingthe occluded artery. these efforts have reduced 30day mortality to approximately 7-10%.

4) Heart failure post myocardial infarction has beenprevented or treated successfully by inhibitors of therenin-angiotensin system. this has reduced the late(post-hospital discharge) mortality by one third.

Despite these impressive accomplishments, totalmortality secondary to AMI remains high, especially inthe elderly (>75 years). Several approaches are now un-der consideration:1) commencing aggressive primary prevention earli-

er in life, i.e. in the thirties or forties in patients withcoronary risk factors;

2) Development of drugs which increase high densitylipoproteins;

3) treating patients with acute pump failure with as-sisted circulation and simultaneously obtaining theirown bone marrow cells that are then cultured in vit-ro and reinjected. Once these cells have restored thedamaged heart’s pumping action, the assisted cir-culation can be discontinued.

Hypertension: the Gap Between Knowledge and Achievementsconrado J. Estol

there are more than 1 billion hypertensive pa-tients worldwide. More than 7 million deaths (13%

of the world’s total) occur annually secondary to theeffects of hypertension. the life time risk for one per-son to develop hypertension is close to 90%. Hyper-tension accounts for more than half of strokes and al-most half of myocardial infarctions amply surpassingother known risk factors. In fact, as a risk factor forstroke, hypertension is only second to having suf-fered a stroke and equal to atrial fibrillation. thesefacts make hypertension the most important of treat-able vascular risk factors. Available data from a myr-iad of randomized clinical trials testing different hy-pertension treatments in both the cardiology andstroke arenas have shown a significant reduction invascular endpoints for treated patients. Even control

to incorporate this into clinical practice is unclear. Sec-ond, a putative benefit of corticosteroids has neverbeen proven and may be partly been negated by thecRASH trial in head injury.

In the field of neuroprotection, almost no progresshas been made despite enormous academic and in-dustry investment. Here again, very basic assump-tions may be flawed such as the apoptotic mecha-nism of ischemic neuronal cell death and its potentialfor amelioration. targeting free radical production,maintenance of membrane stability, and neurotoxic ef-fects of released neurotransmitters, have so far failed.An object lesson in this disappointing area has beennXy-059, a free radical trapper that was highly prom-ising in experimental models of stroke and an initialclinical trial but failed in SAInt-2. Aside from the dif-ferences between animal and human circumstances ofischemic cerebrovascular disease, it may be that en-dothelial cell and astrocytic damage is not being ad-dressed. the most persuasive pathobiological experi-ments of 40 years ago that detailed the “no reflowphenomenon” (described by Adelbert Ames) have notbeen taken into account.

In contrast, the success of hypothermia after Vt car-diac arrest suggests that a broader view of cell preser-vation might be taken. One of the most curious aspectsof recent medical sociology has been the lack of adop-tion of hypothermic protocols after arrest. One publicservice advance might be to raise public and physicianawareness of the need to institute hypothermia in thefield after arrest and continue it under close monitor-ing in order to improve neurologic outcomes for thissegment of the population.

Acute Myocardial Infarction: A Century of Progress and a Look into the FutureEugene Braunwald

Acute myocardial infarction (AMI) as a pathologi-cal-clinical entity that was first described in 1909

by two Ukrainian physicians, Obratsov and Strazhesko.Soon thereafter, AMI became recognized with increas-ing frequency and by the middle of the twentieth cen-tury it was established as the most frequent cause ofdeath in the industrialized countries. AMI seemed to oc-cur most frequently in middle-aged men at the heightof their productive lives and when they had their great-est family responsibilities. It usually occurred sudden-ly and without any warning and was likened to a “boltout of the blue”.

In 1950, approximately 25% of patients died sud-denly before they could arrive in a hospital. treatmentwas symptomatic and was directed principally to therelief of the pain which was often severe. About 30%of patients with AMI admitted to the hospital diedwithin 30 days – approximately one half succumbedto a fatal arrhythmia and the remainder died becauseof failure of the cardiac pump. Another 25% of sur-vivors who were discharged from the hospital diedwithin one year – most commonly from failure of thecardiac pump.

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that most patients evaluated at a neurology clinicwere hypertensive and either not previously diagnosedor diagnosed and uncontrolled. they were all referredto their primary MD or to a cardiologist for evaluationand treatment. However, a point of concern was thatfrom the 85% that returned for follow-up to our clinic,90% were still hypertensive and nothing had beendone by their evaluating MD’s. In a new study on1500 patients we observed the same rates of undiag-nosed and diagnosed but uncontrolled hypertensionbut this time we treated patients achieving a 40% con-trol rate.

Blood pressure is easily measurable and hypertensionis easily treatable. yet, there is a major problem withknowledge “implementation” and blood pressure con-trol. the public and the medical community need ed-ucation about the importance of hypertension control.consensus on the “normal” value is needed and effortshave to be placed in achieving the defined target.Blood pressure measurement techniques should beunified, myths have to be eliminated and an interna-tionally developed guideline needs to be published.

Lipids: HDL, LDL, Role in Primary Prevention, the Message from Trials?terje R. Pedersen

Epidemiological data demonstrate that bloodlipoprotein levels are the strongest determinants of

risk of cardiovascular disease. Randomized clinical tri-als have provided overwhelming and conclusive evi-dence that reduction in low-density lipoprotein (LDL)cholesterol blood levels proportionately reduce the riskof cardiovascular disease. the risk reduction can be ob-served in almost all populations that have been stud-ied, including the elderly and those with relatively lowcholesterol levels. the relative risk reductions per unitreduction in LDL cholesterol is essentially the same inall populations, with possible exception of those atthe highest age, indicating that the mechanism ofbenefit is the same in secondary and primary preven-tive situations. Statins are by far the most widely usedclass of drugs to reduce risk and have been shown to besafe with few and rare adverse effects. Simvastatinand pravastatin, two of the most popular statins, havelost patent rights and have become available as cheapgeneric drugs, and atorvastatin is about to loose patentrights soon. the budgets of health care providers de-termined for preventive clinical results measures willtherefore allow much greater proportions of the pub-lic to benefit from the advantages of statin use. Inchina and other Asian countries extracts from redyeast rice containing lovastatin have been used widelyfor centuries and such products have been shown to re-duce coronary morbidity and mortality as well. Surveyshave shown that physicians do not readily adopt themessage from clinical trials that intensive lipid inter-vention with drugs is necessary to achieve optimal re-sults in secondary prevention for middle aged or elderlyindividuals. In primary prevention the intensity ofstatin treatment among high risk individuals is prob-

of slight hypertension significantly reduces the risk ofcardiovascular events.

However, and despite the wealth of evidence showingthe negative effects of untreated hypertension, most pa-tients are either not diagnosed or diagnosed and un-controlled. A number of reasons could explain why.

First, a valid question is: What is “normal” bloodpressure? the VII Joint committee to address the issuedefined 130/80 mmHg as the threshold value splittingnormal from abnormal blood pressure. However, bloodpressure is a continuous vascular risk variable andthis means that each value, to a certain point, corre-lates with an increased vascular risk. Recent meta-analysis which have evaluated more than 1 millionpeople with anti-hypertensive treatment, have shownthat the benefit of blood pressure reduction is observeddown to values of 115/75 mmHg. the benefit withanti-hypertensive treatment was observed irrespectiveof previous blood pressure and of history of cardiovas-cular disease. the nIH will soon be launching SPRInt,an important randomized clinical trial to be conductedin the US to evaluate the benefit of maintaining a sys-tolic blood pressure lower than 120 mmHg. In sum-mary, current values used as “normal” may be higherthan those needed to prevent vascular damage.

Secondly, there are a number of strongly rootedmyths that contribute to the poor results in bloodpressure control. It has long been accepted that ahigher blood pressure is normal in elderly people. theHyVEt study included almost 4000 patients older than80 years of age and showed that those treated with agoal of 140/80 mmHg had a significant reduction inall vascular endpoints, in the incidence of side effectsand, unexpectedly, in death from “any cause”. An-other difficult barrier has been the concept of “whitecoat hypertension” introduced after observing pa-tients that had normal blood pressure at home and in-creased values at the physician’s office. this appar-ently “benign” condition is strongly questioned by alarge number of well design studies that have showna correlation between “white coat” hypertension andincreased carotid plaque and carotid intima-mediathickness, left ventricular hypertrophy, MI, suddendeath and many other vascular disease markers. Mostimportant, an Australian study has shown that the dif-ferences between blood pressure measured at the officeand at home are never greater than a few millimetersof mercury. this implies that when pressures are mod-erately or significantly elevated at the office theyshould also be abnormal in home measurements. Weare now evaluating 20.000 patients that had bloodpressure evaluations at the office and were also in-structed to report a self-measured blood pressure 1week after the first office measurement and 3 weeks be-fore the second office determination. Results showthat the values reported by patients are significantlylower than those measured at both clinic visits and,more concerning; the proportion of normal bloodpressure values was significantly greater when self re-ported (i.e. false negatives).

Finally, in one study published a few years ago we de-termined, in line with observations from other groups,

ably less important than the timing of start of inter-vention. Strategies to increase high density lipoprotein(HDL) levels have so far largely failed to provide con-vincing evidence of benefit. Some drugs that increaseHDL-cholesterol modestly also modify other lipopro-teins and the specific effect on clinical results from theincrease of HDL has been difficult to separate from theother changes in lipids. Studies are under way thatmight shed more light on this aspect of lipid interven-tion. the lecture will deal with the present state of lipidintervention and discuss the implications for long-termstrategies of regulatory authorities in disease prevention.

Epidemiology, Global Public Health; The Need for Equitable Action to Address Cardiovascular DiseaseShanthi Mendis

cardiovascular diseases (cVD) are responsible fornearly 50% (17.1 million) of deaths due to non-

communicable diseases (ncDs). Almost 80% of thecVD burden is in low and middle income countries.cardiovascular diseases once associated with abun-dance are now heavily concentrated in poor and dis-advantaged groups.

Powerful global forces are shaping the health and dis-ease profiles in the world. Demographic ageing, rapid un-planned urbanization, and the globalization of unhealthylifestyles such as tobacco use, unhealthy diet, inadequatephysical activity and harmful alcohol use are universaltrends, but the consequences are not evenly felt.

Developing countries have the greatest vulnerabili-ty and the least resilience. they are hit the hardest andhave the least capacity to cope. these trends havetremendous implications at a time when the interna-tional community is pursuing better health as a pover-ty-reduction strategy. the costs of treatment and carefor cVD events such as heart attacks and strokes canbe catastrophic for patients, driving many millions ofhouseholds below the poverty line each year. the grow-ing cVD epidemic is also an impediment to econom-ic development due to its impact on labour productiv-ity and health care costs.

At present, many countries focus primarily on the careof acute cardiovascular events or complications of cVD.Sophisticated and costly technologies are often used forthis purpose ignoring prevention and simple inexpen-sive interventions which can be implemented in primarycare. this short-sighted approach will result in upwardspiralling health care budgets, due to increasing num-ber of people who develop cVD. the only solution liesin an integrated public health approach. Such an ap-proach has to focus on behavioural risk factors and de-terminants that lie outside the health sector. People haveto be provided opportunities for healthy eating and phys-ical activity and deterrents for tobacco use through up-stream policy actions. these measures need to becomplimented with equitable health services for pre-vention, through a total risk approach and acute andlong-term care for cardiovascular disease.

today, we have a global noncommunicable diseasestrategy and an action plan, endorsed by 193 MemberStates. It provides a roadmap for our work, the work ofour Member States and our partners under six main ob-jectives.

1. the World Health Organization (WHO) is joiningefforts with all partners to get ncD /cVD on the glob-al health and development agenda so that ncD will bethe subject of a resolution at the Un General Assemblyin September 2010.

2. WHO is promoting coordinated national healthstrategies and action plans against major ncDs in-cluding cVD with a special focus on low and middle in-come countries. Under an overarching ncD preventionand control policy, national programs with performancetargets need to be established in all countries for mon-itoring of risk factors, early detection and managementof cardiovascular risk including diabetes and preven-tion of recurrences of cardiovascular disease.

3. Prevention of major cardiovascular risk factors isa WHO priority reflected in the global public health: in-struments such as the Framework convention on to-bacco control (Fctc), Diet and Physical Activity Strat-egy and the proposed global strategy against theharmful use of alcohol which will discussed at the WorldHealth Assembly in 2010.

4. there is a clear need for bridging gaps in knowl-edge about what works in ncD prevention and control.A prioritized ncD/cVD research agenda which addressesthe priority needs of cVD prevention and control willbe finalized in 2010. the aim is to provide guidance todeveloping countries on implementation research foreffective translation of already available scientific ev-idence to action.

5. the recently established global ncD network(ncDnet) has facilitated partnerships processes acrossdiseases linking cVD advocates with their colleaguesfrom cancer, diabetes and lung diseases to jointly bemore effective and to promote innovative resource mo-bilization mechanisms.

6. We need to know more precisely the extent of thencD/cVD burden, its trends and determinants throughreliable monitoring and evaluation programs at coun-try level.

the mandate of the World Health Organization is tostrengthen the capacity of all countries to realize the fullpotential of prevention and curtail unnecessary humansuffering caused by disease through equitable and sus-tainable policies and programs.

Vascular Cognitive ImpairmentJohn O’Brien

Dementia is a huge and growing public health bur-den, affecting 25 million people worldwide and

with prevalence set to triple over the next 50 years withincreasing longevity. Although Alzheimer’s disease(AD) is responsible for around 60% of cases, vasculardementia (VaD) is the second commonest cause ac-counting for around 20% cases. the traditional view of

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two entirely different disorders, with different aetiolo-gies and outcomes, is now recognised as too simplisticfor a number of reasons. cerebrovascular disease is alsorecognised as an additional pathology with major clin-ical impact in those whose dementia is primarily due toAD, and vice versa, while vascular factors are also im-portant aetiological factors for AD pathology. However,progress in the field has been limited by difficulties interminology, for example use of the term dementia ne-cessitates the presence of memory impairment, whichis the norm in AD but not in cognitive disorders asso-ciated with cerebrovascular disease. the term vascularcognitive impairment (VcI) has been proposed torecognise the broad spectrum of cognitive, and indeedbehavioural, changes associated with vascular pathol-ogy. It is characterised by a specific cognitive profile,with predominantly attentional and executive impair-ments, together with particular non-cognitive features(especially depression) and a relatively stable course,at least in clinical trial populations. Subtypes of VcIhave been proposed, based on clinical and pathologi-cal differences, including cortical, subcortical, strategicinfarct, hypoperfusion, haemorrhagic and mixed (withAD) type. Diagnostic criteria are emerging but requirerefinement and validation, especially for mixed de-mentias. there remain fundamental gaps in our un-derstanding of pathophysiology, predicting prognosisand outcome and in therapeutics. clinical trials todate, mainly in populations selected using currentlyaccepted criteria for vascular dementia, have unfortu-nately generally been disappointing. A relatively mod-est cognitive benefit of agents such as nimodipine,memantine and cholinesterase inhibitors has been re-ported, though the clinical significance of these im-provements remains to be established. Risk factormodification may be a useful strategy, and there isemerging evidence that hypertension is associatedwith increased rates of brain atrophy and cognitive de-cline while white matter lesions are an important pre-

dictor of subsequent functional decline. Further studies,focusing on particular subtypes of VcI and involvingsubjects at earlier stages of the disease, are required.

The Importance of Diet, Obesity and Type IIDiabetes for Vascular DiseaseArne Astrup

Obesity, the metabolic syndrome, pre-diabetes andtype 2 diabetes are important risk factors for the

development of coronary artery disease and stroke (car-diovascular disease, cVD). Obesity, physical inactivity,diet composition, short sleep duration, and smoking arethe most important risk factors for type 2 diabetes, andmoderate alcohol and coffee consumption exerts a weakprotective effect. Excessive body weight together with in-activity can account for almost 90% of all new cases oftype 2 diabetes. So prevention and treatment of weightgain, excessive body weight and the metabolic syndromeare the cornerstones of prevention of type 2 diabetes.the major risk factors for weight gain and obesity aresedentary lifestyle with little physical activity, im-paired or short sleep duration, and an inappropriate diet.the dietary risk factors are large portion sizes, sugar-rich soft drinks, high intakes of energy-dense foods poorin fibre and whole grain, including low intakes of fruitand vegetables. the optimal diet for prevention of weightgain provides 20-25% of energy from protein (low-fatmeat, dairy, fish, shelfish, game, protein from plants;peas, beans etc.), 25-30% of energy from fat (high ra-tio of polyunsaturated to saturated), and 45-55% fromfibre-rich, whole-grain carbohydrates characterised bya low glycemic index. Moderate amounts of alcohol frombeer and wine contribute to the prevention of type 2 di-abetes and cVD, but should be recognised and a con-tribution to total energy intake. the dietary advises forobesity and type 2 diabetes are fortunately the same thatare considered to be the optimal for prevention of cVD.

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chief of the IASO journal Obesity Reviews. He is a mem-ber of the editorial boards of The International Journalof Obesity and The Journal of the Danish Medical Asso-ciation. Arne Astrup was made Knight of the Orderof Dannebrog in 1999. Awards received include Servi-er’s Award for Outstanding Obesity Research in1990; IASO André Mayer Award 1994; Danonechair in nutritionat the University of Antwerp2002; the Faculty of Life Sciences, University of copen-hagen communication Prize 2007; International As-sociation of Business communicators 2009 EME Ex-cel Merit Award for communication Leadership.

Nicolò Boncompagni-Ludovisi, Prince of Piombino,Prince of the Holy Roman Empire, Prince of Venosa etc.;Knight of the Sovereign Order of Malta, and of the con-stantinian Order, chemical Engineer of the E.t.H. (Fed-eral Polytechnicum in Zürich-Switzerland). Romancatholic. Born in Rome (Italy) January 21,1941. Stud-ied in Rome and then attended an international board-ing school (German speaking) in Switzerland (LyceumAlpinum in Zuoz, Engadin Switzerland). Studies all inGerman language. After the A Levels went to the EtH(Eidgenoessische technische Hochschule) i.e. Poly-technicum in Zürich Switzerland where he attained in1965 under Prof. dr. Vladimir Prelog (nobel Prize forchemistry) the Master’s degree in chemistry and the ti-tle of chemical Engineer. 1990-1995 was appointed asan international consultant to the Russian Minister ofForeign trade Relations. 1991-1995 established labo-ratories in Russia which produced computer softwarewhich was then sold in western Europe. Presently he de-velops his land properties near Rome and restores thehistorical 500 years old Villa Aurora in Rome which de-rives its name from Guercino’s masterpiece; Villa Au-rora was, in the 16th century, a country retreat wherefamous artists, musicians and scientists and literary ge-niuses gathered under the patronage of cardinalFrancesco Maria del Monte first and in the 17th centuryunder the patronage of cardinal Ludovico Ludovisi. Vil-la Aurora was in fact sold by cardinal Francesco Mariadel Monte to cardinal Ludovico Ludovisi nephew of PopeGregory XV in 1621. the Villa is now owned by the Princeof Piombino XIII, nicolò Boncompagni Ludovisi. Lan-guages: English, French, German, Italian, Spanish, SwissGerman, basic Russian.

Eugene Braunwald, M.D. is the Distinguished HerseyProfessor of Medicine at Harvard Medical School, andchairman of the tIMI Study Group at the Brigham andWomen’s Hospital. Dr. Braunwald received his med-ical training at new york University and completed hisMedical Residency at the Johns Hopkins Hospital. Heserved as the first chief of the cardiology Branch andas clinical Director of the national Heart, Lung andBlood Institute, founding chairman of the Department

Pierre Amarenco is chairman of the Department ofneurology and Stroke centre at the Bichat Hospital,and Professor of neurology at Xavier Bichat MedicalSchool and Denis Diderot University in Paris, France.His principal research interests concern cerebrovas-cular diseases. He is especially interested in the man-agement of acute ischaemic stroke, and in the pre-vention of secondary stroke. Dr. Amarenco hasbeen an investigator in the Etude du Profil Genetiquede l’Infarctus cerebral (GEnIc) Study, the Blockadeof the Glycoprotein IIb/IIIa Receptor to Avoid VascularOcclusion trial, and the French Study of AorticPlaques in Stroke (FAPS) Study. He is a member of theFrench Society of neurovascular Disorders and thenew England Medical centre Posterior circulationRegistry. Dr. Amarenco was awarded several timesduring his career, with notably the Award of the Sec-ond European Stroke conference (1992) and recent-ly the Jean-Paul Binet award (clinical Research in car-diovascular Diseases) of the Medical Research Foun-dation (2001). He has actively taken part in redac-tion of more than 150 publication and articles on cere-brovascular disease in journals such as circulation,the Journal of neurology, Stroke, chest, neurology,cerebrovascular Diseases, the American Heart Jour-nal, and Blood.

Arne Vernon Astrup, M.D., Dr.Med.Sci., is Head ofthe Department of Human nutrition at the Facul-ty of Life Sciences, University of copenhagen, Den-mark. He was awarded the chair in nutrition at theUniversity in 1990. Arne Astrup is Director of the Dan-ish nordea Foundation OPUS research centre 2009-14. After receiving his medical degree from the Uni-versity of copenhagen in 1981 Arne Astrup completedresidencies in internal medicine at the Glostrup andHvidovre Hospitals in copenhagen. He attained aDoctorate in Medical Science at the University ofcopenhagen in 1986. Arne Astrup’s main areas of in-terest and research include physiology and patho-physiology of energy and substrate metabolism, witha special emphasis on the etiology and treatment ofobesity. the research of Arne Astrup and his groupcovers an extensive area. Major research collabora-tion includes participation in the EU multicenter stud-ies: EUROStARcH, cARMEn, nUGEnOB, DIABESI-ty, DIOGEnES, EMOB, and HEALtHGRAIn. Arne As-trup has written/co-authored over 330 original sci-entific papers and reviews published in internationalpeer reviewed journals, including papers in TheLancet, British Medical Journal, and The Journal of Clin-ical Investigation. citation H-index: 52. He has con-tributed to over 700 other scientific publications, suchas textbook chapters, scientific abstracts and letters.He is President of the International Association forthe Study of Obesity (IASO) 2006-09, and Editor-in-

BIOGRAPHIES OF PARTICIPANTSAtherosclerosis:


Atherosclerosis: the 21st Century Epidemic Biographies of Participants

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worked in the neurology clinic. He then returned toBoston and did his neurology residency from 1966to 1969 on the Harvard neurological Unit at theBoston city Hospital under Dr. Denny-Brown. Hisbackground in internal medicine and neurology andthe complexities of cerebrovascular disease led himto decide that stroke was to be his major life’s work.During the 1969-1970 year he was a cerebrovascularDisease Fellow at the Massachusetts General Hospitalwith Dr. c. Miller Fisher, who at that time was theoutstanding stroke clinician in the USA. In July 1970,he became a staff neurologist at the Beth Israel Hos-pital in Boston and Assistant Professor of neurolo-gy at Harvard Medical School. He devised the firstregistry in cooperation with Dr. Jay P. Mohr at theMassachusetts General Hospital. With Dr. Mohr hefounded and reported the results of the Harvard co-operative Stroke Registry in 1978. that same year hemoved to chicago to become neurologist-in-chief atthe Michael Reese Hospital and Professor of neu-rology at the University of chicago. there he con-tinued his work on stroke and became interested inracial differences in stroke subtypes and vascular le-sions. He returned to Boston in 1984 to become neu-rologist-in-chief at the new England Medical cen-ter and Professor and chairman of the Departmentof neurology and Professor of Medicine at tufts. Heremained at tufts until January 1998, when he re-turned to the Beth Israel Hospital and Harvard Med-ical School. He is currently Professor of neurology atHarvard Medical School and chief of the Stroke Serv-ice at the Beth Israel Deaconess Medical center.

Geoffrey Donnan, MB BS, MD, FRAcP, FRcP(Edin)is Professor of neurology, University of Melbourne, Di-rector of neurology Austin Health, and Director of thenational Stroke Research Institute in Australia. Heis an Honorary Principal Fellow of the Howard Flo-rey Institute. He co-founded the Australian Stroke tri-als network (AStn) which has numerous investiga-tor driven and commercially sponsored stroke trials.Subsequently he also co-founded neuroscience trialsAustralia to enhance Australian commercial and in-vestigator-driven clinical trial capability. He is PastPresident of the Stroke Society of Australasia and PastPresident of the Australian Association of neurolo-gists. He has over 300 peer reviewed journal publi-cations, 51 book chapters, edited 15 proceedings ofnational meetings, edited/authored three books,and sits on editorial boards of seven international jour-nals including Lancet neurology, Section Editor forStroke and Associate Editor of cerebrovascular Dis-eases. Dr. Donnan’s research interests include neu-roimaging and clinical stroke trials including acutestudies and secondary prevention.

Conrado J. Estol was born in 1959 in new york city,ny (USA). He obtained an MD and a PhD (summacum laude) from the School of Medicine at the Uni-

of Medicine at the University of california, SanDiego. From 1972 to 1996 he was chairman of the De-partment of Medicine at the Brigham and Women’sHospital. He was a founding trustee and chief Aca-demic Officer of Partners Healthcare System. Dr. Braun-wald’s first major paper was published in circulationResearch in July 1954, and he has been a major forcein cardiology in the past half century. His early workfocused on the control of ventricular function and hewas the first to measure both left ventricular ejectionfraction and left ventricular dp/dt in patients. His groupshowed the first neurohumoral defect in humanheart failure, defined the pathophysiology of hyper-trophic cardiomyopathy and demonstrated salvage ofischemic myocardium following coronary occlusion.they defined myocardial stunning and ventricularmodeling following myocardial infarction. For the past24 years, as chairman of the tIMI Study Group, he andhis colleagues demonstrated improved patient survivalwith a patent coronary artery which led to the wide-ly accepted “open artery hypotheses”. they were thefirst to show the benefit of preventing adverse re-modeling of the infarcted ventricle with AcE inhibi-tion. In the PROVE-It tIMI 2 trial, in 2004, they demon-strated the benefit of more intensive reduction of LDLin high risk coronary artery patients, which has alreadychanged practice guidelines and will favorably affectthe lives of millions. Dr. Braunwald is and has beenan editor of Harrison’s Principles of Internal Medicine for12 editions, and the founding editor of Heart Disease,now in its 8th Edition, the most influential textbooksin their fields. Science Watch listed Dr. Braunwald as themost frequently cited author in cardiology; he has anH index of 175. Based on his contributions, Dr.Braunwald has received numerous honors and awardsincluding the Distinguished Scientist Award of theAmerican college of cardiology, Research Achieve-ment, and Herrick Awards of the American Heart As-sociation, the Gold Medal of the European Society ofcardiology and is the recipient of fifteen honorary de-grees from distinguished universities throughout theworld. the living nobel Prize winners in medicine vot-ed Dr. Braunwald as “the person who has contributedthe most to cardiology in recent years”. Dr. Braunwaldwas the first cardiologist elected to the nationalAcademy of Sciences of the United States.

Louis R. Caplan, M.D. was born in Baltimore, Mary-land December 31, 1936. He attended Williams col-lege in Williamstown, Massachusetts and graduat-ed cum laude in 1958. Although he was a pre-medstudent he majored in history and was the recipientof the Williams college history prize. He attended theUniversity of Maryland Medical School in Baltimoreand graduated in 1962 summa cum laude. He wasan intern and junior resident in Medicine at theBoston city Hospital from 1962 to 1964. During thattime, he decided to become a neurologist. After hisinternship and junior residency in Medicine, heserved 2 years in the US Army as an internist but

versity of Buenos Aires, Argentina. Dr. Estol wastrained in Internal Medicine at Mount Sinai Hospi-tal (ny), completed a neurology Residency at Pres-byterian University Hospital (Pittsburgh University,Pennsylvania) and was a Stroke Fellow at the newEngland Medical center Hospital and Spaulding Re-habilitation Hospital (tufts University and Massa-chusetts General Hospital in Boston). He is certifiedby the American Board of Psychiatry and neurolo-gy. Dr. Estol is presently Director and Founder of theneurological center for treatment and Research. Hismain areas of clinical and research interest includecerebrovascular disease, neurological intensive care,cognitive dysfunction and headache. Dr. Estol is As-sociate Editor of the International Journal of Strokeand has participated in the Editorial Board of severalinternational journals. He is founder and Presidentof the Argentine cerebrovascular Association and wasPresident of the Harvard club Argentina. Among oth-er memberships, Dr. Estol is Fellow of the AmericanAcademy of neurology (AAn), a member of the Amer-ican neurological Association and has received sev-eral awards including the International Affairscommittee Award of the AAn and the young In-vestigator’s Award of the International Stroke Soci-ety. Dr. Estol has over 150 Journal and Book chap-ter publications and has given over 130 internationalinvited lectures.

Valentin Fuster serves the Mount Sinai Medical cen-ter as Director of Mount Sinai Heart, the Zena andMichael A. Wiener cardiovascular Institute and theMarie-Josée and Henry R. Kravis center for cardio-vascular Health. He is the Richard Gorlin, MD/HeartResearch Foundation Professor, Mount Sinai Schoolof Medicine. Dr. Fuster was the President of Scienceand is now the General Director of the centro na-cional de Investigaciones cardiovasculares carlos III(cnIc) in Madrid, Spain. Among the seemingly count-less positions of distinction that he holds are Past Pres-ident of the American Heart Association, Past Pres-ident of the World Heart Federation, Member of theInstitute of Medicine of the national Academy of Sci-ences where he serves as chair of the committee onPreventing the Global Epidemic of cardiovascular Dis-ease, former member of the national Heart, Lung andBlood Institute Advisory council, and former chair-man of the Fellowship training Directors Program ofthe American college of cardiology. twenty-sixdistinguished universities throughout the worldhave granted him Honorary Doctorate Degrees. Dr.Fuster is the recipient of two major ongoing nIH grant.He has published more than 790 Pubmed articles onthe subjects of coronary artery disease, atherosclerosisand thrombosis, and he has become the lead Editorof two major textbooks on cardiology, ‘the Heart’ (pre-viously edited by Dr. J. Willis Hurst) and ‘Atherothrom-bosis and coronary Artery Disease’ (with Dr. Eric topoland Dr. Elizabeth nabel). Dr. Fuster has been ap-pointed Editor-in-chief of the nature journal that fo-

cuses on cardiovascular medicine (nature Reviews,cardiology, April 2009) and he is the Editor of the new‘AHA Guidelines and Scientific Statements Handbook’,which compiles all the latest information. Dr. Fusteris the only cardiologist to receive the two highest goldmedal awards and all four major research awardsfrom the four major cardiovascular organizations: theDistinguished Researcher Award (Interamerican So-ciety of cardiology, 2005 and 2009), AndreasGruntzig Scientific Award and Gold Medal Award (Eu-ropean Society of cardiology, 1992 and 2007 re-spectively), Gold Medal Award and Distinguished Sci-entist (American Heart Association, 2001 and 2003respectively), and the Distinguished Scientist Award(American college of cardiology, 1993).

Werner Hacke, MD, PhD Dsc (hon) FAHA FESO, is Pro-fessor and chairman of the Department of neurolo-gy at the University of Heidelberg in Germany. He re-ceived his neurology training at the University ofAachen, Germany and at the University of Bern, Switzer-land. After one year as visiting scientist at the ScrippsResearch Foundation in La Jolla, california, he took thechair of neurology at Heidelberg in 1987. He was Deanof Medicine of the University of Heidelberg, Germany,between 1990 and 1993 and 1995-1996. His main sci-entific and clinical interest is in stroke and critical careneurology. He has pioneered the field of thrombolysisfor acute stroke and initiated several new managementoptions for large infarctions including hypothermia anddecompressive surgery. He was the President of the Ger-man neurological Society (2001-2002), the Presidentof the German Interdisciplinary Society of critical careMedicine (2003-2004) and the German Stroke Socie-ty (2008-2009). He is the founding President of the Eu-ropean Stroke Organisation (ESO), 2008. He is now theFirst Vice President of the World Federation of neu-rology. In 1998 he was the first European recipient ofthe Feinberg award for Excellence in Stroke Research,given by the American Stroke Association and the firstrecipient of the Karolinska Stroke Award in 2004. Hewas awarded the Pette Medal, the highest award of theGerman neurological Society in 2008. He received thePresidents Award by the World Stroke Organisation(2008), the Mihara Award by the Mihara Foundation(Japan, 2009), and the Jarecki Award (USA, 2009). ProfHacke is honorary member of several national soci-eties of neurology, including the American neurologicalAssociation (AnA), the Pan Russian Society of neu-rology and the French neurological Society, andholds an honorary doctorate in tblisi, Georgia. Prof.Hacke has published 300 original articles listed inpubmed and ScI.

Daniela Jezova, Vice-president of the Slovak Acade-my of Sciences, Senior Researcher of the Institute of Ex-perimental Endocrinology, Professor of Pharmacologyat the Medical School, comenius University, Bratisla-va, Slovakia. Publications: more than 200, mostly in

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Attilio Maseri (Udine, 1935) obtained his degree inMedicine and Surgery from Padua University in 1960and specialised in cardiology and nuclear Medicineat Pisa University. He continued his studies in the USAat columbia University in nyc, working with nobellaureate Dr. A. cournald. In 1967 he became asso-ciate professor of special medical pathology and Headof the coronary Research centre of the Italian na-tional Research council in Pisa. In 1979 he becamefull professor of cardiovascular Medicine at the Roy-al Postgraduate Medical School in London and Di-rector of Hammersmith Hospital. In 1991 he returnedto Rome and became full professor at the catholic Uni-versity and Director of the cardiology Institute of the‘Gemelli’ Polyclinic. From 2001-2008 he was full pro-fessor of cardiology at Vita-Salute San Raffaele Uni-versity and Director of the cardio-thoracic-Vascular Department at San Raffaele Hospital in Mi-lan. From 2004-2007 he was the President of the Ital-ian Federation of cardiology. Since January 2008 hehas been the President of Heart care Foundation, theItalian Foundation for the Fight against cardiovas-cular Diseases of the national Association of Hospi-tal cardiologists). He is a member of the Johns Hop-kins Society of Scholars (1998). During the course ofhis career he was also the cardiologist of Queen Eliz-abeth II of England and Pope John Paul II. He is thesingle author of a textbook on cardiology entitled ‘Is-chemic Heart Disease – Rational Basis for clinicalPractice and clinical Research’ (churchill – Living-stone new york 1995). He has also published over 750articles in international journals and has received nu-merous prizes and honours, including the KingFaizal International Prize in Medicine (1992), the ‘Dis-tinguished Scientist Award’ of the American collegeof cardiology (1997), the Premio Invernizzi for Med-icine (1998), the Grand Prix Scientifique de l’Institutde France (2004), the Medal of the Italian Presidentof the Republic. Pope John Paul II appointed himcommendatore of the Order of St Gregory the Greatand in 2005 he became a Knight of the Grand crossof the Order of Merit of the Republic of Italy. He wasamong the first five Europeans called to the Editori-als Board of the new England Journal of Medicine.He currently coordinates a series of clinical researchprojects on the biological causes that trigger the acutecoronary instability that leads to heart attacks, andon the biological mechanisms of myocardial dam-age and ways to repair it.

Shanthi Mendis, MBBS, MD, FRcP, FRcPE, FAcc, com-menced her medical career in Bristol, England in 1974and worked in the UK in the nHS for 6 years. She hadher post doctoral training in Scotland and USA for 4 years.Subsequently she worked in Sri Lanka and, prior to be-ing recruited to WHO in 1998, was the Professor and Head,Department of Medicine, Faculty of Medicine, Universi-ty of Sri Lanka. As Senior Adviser in cardiovascular Dis-eases at the World Health Organization HQ, GenevaSwitzerland, she has gained extensive experience in pro-

peer review international journals. citations: more than2000 ScI/WOS, Hirsch index 29. Invited meeting pre-sentations: more than 70. Field of research: She is in-ternationally recognized for her work in stress researchincluding investigation of risk factors for cardiovascularand brain diseases, in the fields of neuroendocrinolo-gy, physiology and psychopharmacology particularlyin relation to stress hormones and psychiatric disordersboth in clinical studies and animal models. ScientificGrants: coordination of a successful EU centre of Ex-cellence project in 5FP. Scientific School: supervisor of12 completed and 2 running PhD theses in pharma-cology or physiology; Scientific Boards: serving as ex-pert for projects of the 6th an 7th FP for Ec; referee forhigh impact international journals; assistant editor injournal neuroendocrinology. Membership in Scientif-ic Societies: President of the Slovak Physiological Soci-ety, Scientific Secretary of the czech neuropsycho-phar-macological Society, member of the central Eastern Eu-ropean committee of the collegium Internationale ofneuropsycho pharmacology, member of the AcademiaEuropaea. Honours and Awards: Prestigious nationalprize crystal Wing for Medicine and Science, Gold Medalof the Slovak Medical Society, Gold Medal of the Fac-ulty of Medicine of the comenius University, Gold Jesse-nius Medal for advances in medical sciences, charvat’sLecture, Slovak Endocrinological Society, Purkyn’s Lec-ture, Slovak Physiological Society. Familiar status:Married, two children.

Walter J. Koroshetz, M.D. was named Deputy Directorof nInDS in January of 2007. He works with the nInDSDirector in program planning and budgeting, andoversees Institute scientific and administrative func-tions. Before joining nInDS, Dr. Koroshetz served asvice chair of the neurology service and director of strokeand neurointensive care services at Massachusetts Gen-eral Hospital (MGH). He was also a professor of neu-rology at Harvard Medical School and has led neu-rology resident training at MGH since 1990. A nativeof Brooklyn, new york, Dr. Koroshetz graduatedfrom Georgetown University and received his medicaldegree from the University of chicago. He trained ininternal medicine at the University of chicago andMassachusetts General Hospital. Dr. Koroshetz trainedin neurology at MGH, after which he did post-doctoralstudies in cellular neurophysiology at MGH and theHarvard neurobiology department. He joined the neu-rology staff, first in the Huntington’s Disease unit andthen in the stroke and neurointensive care service. Asa member of the nInDS intramural review and over-sight committees, Dr. Koroshetz has been involved invarious nInDS symposia and clinical trials, and servedas the Institute’s representative to the Americanneurological Association’s career Development Sym-posium. He was a member of the nInDS-chaired BrainAttack coalition (BAc), a group of professional, vol-untary and governmental entities dedicated to re-ducing the occurrence, disabilities, and death asso-ciated with stroke.

viding technical support to developing countries for pol-icy and programme development. At present she also co-ordinates the global programs on prevention and man-agement of noncommunicable diseases. She is a Fellowof the Royal college of Physicians of Lond. and Edin. andFellow of the American college of cardiology. She hasextensive public health, teaching, clinical and researchexperience and has published widely.

John O’Brien’s research interests include: the applicationof MR, SPEct and PEt imaging in dementia and de-pression; neurobiological changes (in particular the roleof vascular factors) in late-life affective disorders andcognitive impairment; dementia with Lewy bodies; clin-ical trials. His group is undertaking serial imaging (struc-tural and functional MR, blood flow and ligandSPEct and PEt) studies on subjects with Alzheimer’s dis-ease (AD), dementia with Lewy bodies, Parkinson’s dis-ease (PD) and PD dementia to elucidate i) relationshipsand imaging correlates of diagnosis and symptoms ii)usefulness in improving accuracy of differential diag-nosis iii) markers of early diagnosis and iv) how struc-tural and chemical changes alter with disease pro-gression. His current research projects include a MRc-funded study of cognitive dysfunction after stroke, astudy of MR imaging in AD and DLB funded by the Julesthorne Foundation, a study of functional MRI fund-ed by the Alzheimer’s Research trust, an Alzheimer’sResearch trust Fellowship to Dr Emma Burton (inves-tigating the neuropathological basis of MR changes),a study of autonomic and imaging changes in late lifedepression, and a study of predictors of dementia inParkinson’s disease. Prof. O’Brien is also the clinical Leadfor north East Dementia and neurodegenerative Dis-eases clinical Research network, Deputy Editor Inter-national Psychogeriatrics, Board Member of the In-ternational Psychogeriatric Association, Head of north-ern Deanery Postgraduate School of Psychiatry, Leadconsultant for newcastle Memory clinic, President ofthe International college for Geriatric Psychoneu-ropharmacology (IcGP) and Member of Vas-cog Ex-ecutive committee.

Cristiana Paoletti del Melle, MD has graduated inthe University of Rome with highest honors and laude.Specialized with highest honors and laude in car-diology, Endocrinology, Gastroenterology, neu-ropsychiatry, Psychiatry Forensic and criminology,Legal Medicine. Expert in Gender Medicine. coordi-nator of the Medical and Emergency staff of the Ital-ian Parliament for 20 years. currently she is coor-dinator of the Medical college of the Senate of the Re-public. Member of Scientific committee of Italian nIH.consultant of the Minister of Health for Multimedi-al communication.

Terje R. Pedersen, MD is a certified specialist of internalmedicine and cardiology, Professor of Medicine (Pre-ventive cardiology) at the University of Oslo, norway

and Head of the centre for Preventive Medicine at OsloUniversity Hospital, Ullevål. His main interest is in pre-ventive cardiology and he has been the principal in-vestigtor in several major clinical trials like the nor-wegian timolol trial, the Scandinavian SimvastatinSurvival Study (4S), the IDEAL study to determinewhether lowering of cholesterol beyond what wasachieved in the 4S is beneficial for cHD patients andthe SEAS study to investigate the effect of cholesterollowering in patients with aortic valve stenosis . He iscurrently involved in several intrnational collabora-tive clinical trials in the field of preventive medicineas a member of Executive committees, Steering com-mittees and Data Safety and Monitoring committees.

Patrizio Polisca (born 11 December 1953 in the Ital-ian region of Marche) is a specialist in cardiology,anaesthetics and reanimation and a professor at thecardiosurgery Institute of tor Vergata University inRome. In June 2009 he was appointed vice directorof the Department of Health and Welfare of the Gov-ernatorate of the Vatican city State and is thePope’s personal physician. He is also the President ofthe Medical consultation Unit of the congregationfor the causes of Saints.

Giovanni M. Rocchi was born in 1939 in Rome, Italy,and is married with a son and a daughter. He obtainedhis MD from ‘La Sapienza’ University of Rome in 1963and his PhD from the same University. He graduatedfrom the Departments of Infectious Diseases and In-ternal Medicine in Rome, and was promoted to As-sociate Professor in 1983. In 1985, he became Profes-sor and chairman of the Department of Infectious Dis-eases. He is currently Professor of Medicine at ‘tor Ver-gata’ University Medical School in Rome where he holdsthe chair of Infectious Diseases in Internal Medicine.Since 1967, Prof. Rocchi has been consultant physicianin internal medicine in the clinical department of theVatican city. Since July 2005, he has been in chargeof the Direzione di Sanità ed Igiene of the Vatican citywhere he acts as director with specific interest in themanagement of the clinical department. Prof. Rocchi’sresearch and clinical interests are medical care in in-ternal medicine and infectious diseases. He has au-thored over 150 publications and made contributionsto several textbooks. He is a member of several pro-fessional societies, including the Italian Society of In-ternal Medicine and the Italian Society of Infectiousand tropical Diseases.

Allan H. Ropper is Professor of neurology of HarvardMedical School and Executive Vice chairman of theDepartment of neurology at Brigham and Women’sHospital, Boston, Massachusetts. He was born in 1950in new york, new york. He received his B.A. from cor-nell University in Ithaca, new york and his M.D. fromcornell University Medical college in new york in

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1974. Dr. Ropper trained in internal medicine at UcSF-Moffit Hospital and in neurology at MassachusettsGeneral Hospital. His work has been mainly in thefield of neurological intensive care and related dis-orders such as Guillain-Barrè Syndrome. His presentfocus includes studies of gene therapy as a potentialtreatment for peripheral neuropathy and he is con-ducting an nIH sponsored study of vascular en-dothelial growth factor (VEGF) for the treatment ofdiabetic neuropathy. He has over 150 publications andis an author of the most widely consulted textbookof neurology, Principles of neurology, which is in itsninth edition. He is a longtime contributor to sever-al major textbooks of medicine including ‘Harrison’sPrinciples of Internal Medicine’. He has received nu-merous awards for teaching and service. Dr. Ropperis an associate editor of the new England Journal ofMedicine.

Felix Unger is an Austrian, born in March 1946. Heis a cardiac Surgeon at Paracelsus Medical Univer-sity Salzburg. He attended the Medical Faculty of theUniversity of Vienna and graduated 1971. After hisgraduation he trained at the University clinic for car-diology and the clinic for Surgery at the Universityof Vienna to become a cardiac surgeon. In 1974 hevisited the texas Heart Institute, the cleveland clin-ic and the University of Salt Lake city where he in-vented a new type of artificial heart. In 1978 he be-came Univ. Dozent at the University of Vienna. In1979 he moved to Innsbruck University, where he es-tablished the coronary Artery Surgery programme.In 1983 he became Professor of cardiac Surgery. In1985 he moved to Salzburg, where he established a

new centre for cardiac Surgery at the Paracelsus Uni-versity for Medicine, the University clinic for cardiacSurgery. Out of his enormous experience in cardiacsurgery his specific scientific interest has been in re-placing the heart in all forms and assist devices. In1986 he implanted in Salzburg the First Artificial Heartwith a consecutive Heart transplantation. Beside theseefforts in Assisted circulation he focused on clinicaltopics, as the gastro-epiploic artery as new device. Healso worked in the area of artificial blood. His mainspecific interest is coronary Artery Surgery. When inthe 1990s stenting became a new alternative to Sur-gery, he directed the surgical arm in the ARtS-study,a randomized study enrolling 1.200 patients. In 1997he founded the European Heart Institute for moni-toring cardiac interventions in Europe. Overall he haswritten/co-authored over 450 publications in the mostimportant journals in the field such as the new Eng-land Journal of Medicine, cardio and thoracic Sur-gery, circulation, European Heart Journal, and he hasedited 17 books on Surgery. He is a member of allmayor national and international societies in his field,member of 8 different Academies of Sciences and hiswork has been awarded 8 Honorary Doctor Degrees.In 1990 he founded with cardinal König and niko-laus Lobkowicz the European Academy of Sciencesand Arts, the Academia Scientiarum et Artium Eu-ropaea. Since 1990 he has been the president of theAcademy which has 1.400 members mainly in Eu-rope. Its mission is to contribute to the future of Eu-rope and its unity by promoting knowledge, coop-eration and tolerance. Prof. Unger is married to Moni-ka von Fioreschy, father of two sons and grandfatherto one grandchild.

17


For the biographies of the other Academicians of the PAS, cf. Pontificia Academia Scientiarvm, Yearbook (Vatican City 2008), p. 15 ff.

18

LIST OF PARTICIPANTSAtherosclerosis:


Prof. Pierre AmarencoProfessor of neurology at Xavier Bichat Medical School and Denis Diderot UniversityParis (France)

Prof. Arne V. AstrupDirectorDepartment of Human nutritionUniversity of copenhagen(Denmark)

Prof. Eugene Braunwald, MDDistinguished Hersey Professor of MedicineHarvard Medical Schoolchairman, tIMI Study GroupBrigham and Women’s Hospital (USA)

H.S.H. Prince Nicolò Boncompagni-Ludovisichemical EngineerProperty Developer(Italy)

Prof. Nicola CabibboPresidentthe Pontifical Academy of Sciences(Vatican city)

Dr. Louis R. Caplan, MDDivision of cerebrovascular DiseaseBeth Israel Deaconess Medical centerBoston, MA (USA)

Prof. Geoffrey DonnanDepartment of neurologyUniversity of Melbourne(Australia)

Dr. Conrado J. Estol, MD, PhD, FAANDirector neurological center for treatmentand Research, Buenos Aires(Argentina)

Prof. Valentín Fuster, MD, PhD DirectorMount Sinai HeartMount Sinai Medical center(USA)

Prof. Werner Hacke, MD, PhDchairmanDepartment of neurologyUniversity of Heidelberg(Germany)

Prof. Daniela Jezová, PharmD., DSc.Head of Laboratory and Scientific Secretary,Institute of Experimental EndocrinologyBratislava (Slovak Republic)

Prof. Attilio MaseriPresidentHeart care Foundation OnLUS Milan (Italy)

Dr. Walter J. KoroshetzDeputy Directornational Institute of neurological Disordersand Stroke (nInDS)Bethesda, MD (USA)

Dr. Shanti Mendis, MDSenior Adviser cardiovascular Diseasescoordinator, chronic Disease Prevention andManagement; World Health Organization,Geneva (Switzerland)

Prof. John O’BrienProfessor of Old Age Psychiatry Institute for Ageing and Healthnewcastle University (UK)

Dr. Cristiana Paoletti del Melle, MDGender Medicine, coordinator Medicalcollege of Republic Senate;Member of Scientific commitee of ItaliannIH; Scientific Journalist, Rome (Italy)

Prof. Terje R. Pedersen, MD, PhDProfessor of Medicine (Preventivecardiology), University of Oslo(norway)

Prof. Patrizio PoliscaVice DirectorDepartment of Health and Welfare(Vatican city)

Prof. Giovanni M. RocchiDirectorDepartment of Health and Welfare(Vatican city)

Dr. Allan H. Ropper, MD, FRCP, FACP, FAANDepartment of neurologythe Brigham and Women's Hospital (BWH)Boston, MA (USA)

H.E. Msgr. Prof. Marcelo Sánchez Sorondochancellorthe Pontifical Academy of Sciences(Vatican city)

Univ.Prof.Dr.Dr.h.c. Felix UngerParacelsus Medical University SalzburgPresident, European Academy of Sciences and Arts(Austria)

Memorandum

– Every day a bus will leave the Domus Sanctae Marthae for the Academy, fifteen minutes before thebeginning of the session. A bus will depart from the Academy after dinner at the end of the afternoonsessions to take participants back to the Domus Sanctae Marthae. Lunch and dinner for the partici-pants will be served at the Academy every day except dinner on tuesday.

– On tuesday, a bus will take the participants from the casina Pio IV at the end of the Round tablesto the concert and dinner at the residence of Prince Boncompagni and back.

– On Wednesday, for those wishing to attend, there will be the General Audience with the Holy Fa-ther Benedict XVI at 9:30 in Saint Peter's Square.

notePlease give your form for the refunding of expenses to the secretariat at least one day before yourdeparture so that you can be refunded immediately.

29 May 2010 • (28)

19

Atherosclerosis: the 21st Century Epidemic Memorandum

FRONT COVER:by Lorenzo Rumori

Ingresso Sant’UffizioThe ‘Sant’Uffizio’ gate

Ingresso del PeruginoThe ‘Perugino’ gate

Chiesa di Santo Stefanodegli Abissini

St Stephenof the Abyssinians Church

DomusSanctae Marthae

Altare Tomba S. PietroAltar of St Peter’s Tomb

Ingresso Sant’AnnaThe ‘Sant’Anna’ gate

IngressoMusei Vaticani

Entrance gateto the Vatican Museum

THE PONTIFICAL ACADEMY OF SCIENCESCASINA PIO IV • V-00120 VATICAN CITY

Tel: +39 0669883451 • Fax: +39 0669885218Email: [email protected]

For further information please visit:http://www.vatican.va/roman _curia/pontifical_academies/acdscien/index.htm

Sede della PontificiaAccademia delle Scienze

Seat of the PontificalAcademy of Sciences(CASINA PIO IV)

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