Richey Sharrett, MD, DrPH ‘79, focuses on long term studies to evaluate the contribution of modifiable vascular risk factors to dementia and cognitive decline.
Experiences & Accomplishments
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.
Sharrett AR, Ballantyne CM, Coady SA, Heiss G, Sorlie PD, Catellier D. Coronary heart disease prediction from lipoprotein cholesterol levels, triglycerides, lipoprotein(a), apolipoproteins A-I and B, and HDL density subfractions: the ARIC Study. Circulation 2001;104:1108-13
Sharrett AR, Heiss G, Chambless LE, Boerwinkle E, Coady SA, Folsom AR, Patsch W. Metabolic and lifestyle determinants of postprandial lipemia differ from those of fasting triglycerides: the ARIC Study. Arterioscler Thromb Vasc Biol 2001;21:275-281
Golden SH, Folsom AR, Coresh J, Sharrett AR, Szklo M, Brancati FL. Risk factor clusters related to insulin resistance and their synergistic effects on subclinical atherosclerosis: the ARIC Study. Diabetes 2002;51:3069-76
Wong TY, Klein R. Sharrett AR, Nieto FJ, Boland LL, Couper DJ, Mosley TH, Klein BEK, Hubbard LD, Szklo M. Retinal microvascular abnormalities and cognitive impairment in middle-aged persons - The ARIC Study. Stroke 2002;33:1487-92
Wong TY, Klein R, Sharrett AR, Couper DJ, Klein BEK, Liao D-P, Hubbard LD, Mosley TH. Cerebral white matter lesions, retinopathy and risk of stroke, the ARIC Study. JAMA 2002;288:67-74