author interview

A conversation with Dr. Steven M. Greenberg, MD, PhD, Professor of Neurology at Harvard Medical School and John J. Conway Endowed Chair in Neurology, Director of the Hemorrhagic Stroke Research Program and Vice-Chair for Faculty Development and Promotions at the Massachusetts General Hospital.

Interviewed by Kristina Shkirkova, Doctoral Candidate in Neuroscience at the University of Southern California. 

They will be discussing the article “Vascular Contributions to Brain Health: Cross-Cutting Themes.” Published in the February 2022 issue of Stroke, the article introduces a series of Focused Updates articles on topics related to brain health.

Kristina Shkirkova: To set the stage for this interview, could you briefly summarize the current understanding about the importance of vascular health towards brain aging and health span in general?

Dr. Greenberg: We think of brain health as central to healthy aging. Everybody wants to live a long life, but no one wants to live it without the ability to do activities that make you who you are. There is no healthy aging without brain health. It is important to note that vascular brain health is not the only part of brain health, but it is certainly a major part. We see that diseases of the large blood vessels and the small blood vessels (the major focus of this review series) are very common as people age. So almost everybody has some degree of vascular disease with aging. It’s an interesting contrast with some diseases that are less common that cause severe illness. Vascular disease is different: It’s highly prevalent, meaning that many people have it. It’s almost unusual for someone not to have some evidence of vascular disease. The contribution of each individual vascular disease is modest, but it becomes significant when they co-occur and especially if they are added on top of the other kinds of brain changes, such as Alzheimer’s disease. It’s the combination that is worse than either one by itself.

A conversation with Dr. Bruce Ovbiagele, MD, MSc, MAS, MBA, Professor of Neurology, University of California, San Francisco.

Interviewed by Dr. Saurav Das, MD, Fellow in Vascular Neurology, Washington University School of Medicine, St. Louis.

They will be discussing the article “HEADS-UP: Understanding and Problem-Solving: Seeking Hands-Down Solutions to Major Inequities in Stroke,” published in November 2020 issue of Stroke. The article is part of a Focused Updates series of articles on topics related to health equity.

Dr. Das: Dr. Ovbiagele, at the outset, I want to thank you on behalf of the Blogging Stroke team for organizing this timely and reflective series of articles. I read with enthusiasm your introduction to the series. Thanks for finding time for this interview.

Dr. Ovbiagele, COVID-19 and the killings of unarmed Black individuals by police recently have brought to the forefront discussions about pre-existing racial disparities in stroke care. However, the idea of HEADS-UP was envisaged even before these extenuating circumstances. Please throw some light on the origins of the idea.

Dr. Ovbiagele: My co-chair, Dr. Amy Towfighi, and I have been involved in stroke disparities research for a while (Amy doing work with the Latinx population in Los Angeles, and I doing work with people of African ancestry in South Carolina and Sub-Saharan Africa), and had lamented about both the lack of successful interventions and a clear pipeline of next generation stroke disparities researchers. We observed that with changing U.S. demographics and anticipated worsening of stroke inequities, stroke disparities research and publications seemed to mostly focus on repeatedly pointing out the existence and magnitude of racial/ethnic disparities, that the stroke disparities community was not routinely connected or integrated in a sustainable way, and that early career individuals interested in stroke disparities did not appear to have an established avenue through which to nurture that interest into a successful independent academic career. We thought that if we could bring key stakeholders together in a forum that routinely informs and inspires established and budding stroke disparities researchers to better solutions and greater heights, we might be able to accelerate the pace of discoverers and discoveries. We approached the American Stroke Association, National Institute of Neurological Disorders and Stroke, and several of our esteemed research colleagues about the idea, and then collectively planned and implemented the inaugural Symposium.

Dr. Das: Dr. Ovbiagele, you have summarized in your introduction a series of key papers from the 2020 HEADS-UP symposium in Los Angeles, California. These papers explore biological and social determinants of disparities and explore multi-level interventions. However, neither of these categories have explored “racism,” individual or systemic, as a study variable in stroke research. What are your thoughts, and will this be addressed in the HEADS-UP symposium in 2021?