In Memoriam: Ralph L. Sacco, MD, MS, FAAN, FAHA

Ralph L. Sacco, 65, Dies; Stroke Expert With a Talent for Architectural Design

By Orly Avitzur, MD, MBA, FAAN

Ralph L. Sacco, MD, MS, FAAN, FAHA, the only physician to have served as both the president of the American Heart Association (AHA) and the American Academy of Neurology (AAN), the first neurologist to serve as president of the AHA, and an expert on stroke risk and prevention, died January 17, 2023 of a brain tumor at his home in Long Island, NY. The founder of the Northern Manhattan Study, a professor of neurology, public health sciences, human genetics, and neurosurgery at the University of Miami’s Miller School of Medicine and the Olemberg Family Chair in Neurological Disorders, he was 65.

For Dr. Sacco, who grew up in Margate City, NJ, 3 blocks from the Jersey shore, there was no more peaceful place than the beach. After settling in New York to do his residency in neurology in 1983 at Columbia Presbyterian Hospital, he began to spend his free time in the Hamptons where he developed a zeal for boating, interior design, and architecture.

The eldest of five children, Dr. Sacco occasionally worked in the family business, Sack O’ Subs, cutting cold cuts and stacking steaks. “I didn't like working around food because I ate too much,” he would later confess, adding that he preferred his paper route, except when being chased by dogs. He set his sights on medicine after an aunt suggested that he would be well-suited for the career. Growing up in the disco era, he and his sister, Bess, 2 years his junior, would frequent the dance clubs in Atlantic City and Wildwood, NJ, along with mutual friends. Few people knew that he was skilled at freestyle—save those who later invited him to their weddings, and the close friends that he called his chosen family who accompanied him and his husband, Scott Dutcher, on coastal vacations to villas in Easter Island, Puglia, Lake Como, St. Barts, and Santorini.

A graduate of Holy Spirit High School in Absecon, NJ, Dr. Sacco attended Cornell University, majoring in bioelectrical engineering. At the end of his first year at Boston University School of Medicine, he applied that analytical training to help his mentor, Philip A. Wolf, MD, FAAN, collect and interpret data for the Framingham Study, which would become the nation’s longest running longitudinal study of risk for cardiovascular disease. Pre-computers, he tediously fed 80 column IBM cards to an IBM 80 electric punched card sorting machine to create Kaplan-Meier life table curves. “He continued to work on Framingham stroke data during his medical school career and did not require much supervision, earning first authorship on 2 publications before he was even an intern,” recalled Dr. Wolf.

Throughout his years gathering degrees, he became known for his habit of studying in a rocking chair with Emerson, Lake & Palmer or Renaissance blasting on his headphones. His medical school classmate, Gérard Coste, MD, with whom he shared an apartment above a discotheque in the Boston area, marveled at his ability to concentrate through the din and still ace his courses. “Ralph was the student who had that enviable combination of incredible brilliance along with an innate bedside manner. He made direct eye contact with patients that conveyed, ‘I am really listening to you; I am here for you,’” he said.

During his residency training in neurology, master’s program in epidemiology at Columbia University School of Public Health, and later as chief of the Stroke and Critical Care Division at the Neurological Institute at Columbia/New York-Presbyterian, Dr. Sacco worked on improving the quality of care for stroke patients by addressing disparities within racial and ethnic groups and providing an increased understanding of the impacts diet, diabetes, hypertension, obesity, physical activity, and race can have on stroke risk and prevention. Dr. Sacco started the Northern Manhattan Study—a seminal multi-ethnic population-based study evaluating underserved and understudied Black and Latino populations—which issued a series of significant observations that catalyzed the field. 

In 2007, he moved to Miami to become Professor and the Olemberg Family Chair in Neurological Disorders and professor of neurology, public health sciences, human genetics, and neurosurgery. He launched the Florida-Puerto Rico Collaboration to Reduce Stroke Disparities and the Miami Clinical and Translational Science Institute, serving as its director. Dr. Sacco assumed the roles of senior associate dean for clinical and translational science; executive director of the Evelyn F. McKnight Brain Institute; and chief of the neurology service at Jackson Memorial Hospital. Over the span of his career as a stroke neurologist and researcher, Dr. Sacco published more than 1,000 peer-reviewed articles.

As a preeminent expert in epidemiology and stroke, Dr. Sacco was invited to lecture all over the world; those travels took him to Australia, Austria, Chile, China, England, India, Israel, Japan, Portugal, and more. He was the recipient of myriad 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 2019, he was selected as editor-in-chief of the journal Stroke.

Dr. Sacco was the only physician to have become both the president of the AHA (2010-2011) and the AAN (2017-2019), positions that reflected the respect and admiration of professional colleagues earned over the years. In 2019, he brought his family to Philadelphia to attend his presidential address and shared their Sack O’ submarines with over 5,000 attendees at the AAN Annual Meeting opening party. Until that moment, his siblings would say, they had not realized the breadth of his professional accomplishments. Dr. Sacco’s achievements belied his humility, a trait equally appreciated by friends, associates, trainees, and patients whose lives and careers he indelibly touched over the years. 

When he passed away with Dutcher by his side, Dr. Sacco was at his Amagansett cottage, his fifth house renovation in the Hamptons, 1 of 10 passion projects. Off-the-clock, he studied architectural design and sought inspiration from Frank Lloyd Wright, Frank Gehry, and Zaha Mohammad Hadid, among others. “It’s the 1 thing that takes me a little away from neurology,” he admitted. He loved open air design, modern homes with clean lines, and glass windows enveloping the exteriors to let light in. When he moved to Miami Beach in 2007, he purchased a ranch house on the Venetian Islands, adding a second story, giving the living room a double-heighted ceiling. He borrowed this feature when he worked on the construction of project #10, a large structure on Biscayne Bay comprised of squares, rectangles, and boxes that displayed a cantilevered section extending almost 14 feet off the front of the house. A floating staircase crafted of wood, glass, and metal led to his office overlooking the water and the Miami city skyline. Terrazzo tiles lined all the floors, which he graced with stylized modern furnishings. He loved abstract artwork and paintings of architecture, especially of mid-century homes like the Butterfly House by Andy Burgess, which he proudly displayed on his two-story living room wall.

Dr. Sacco was known for his hearty laugh and joyous sense of humor. In his last year of life, he would attribute moments of faulty recall to his disease. “It’s my glioblastoma,” he would quip, so as not to offend those who wanted to reminisce with him about their warm memories of moments passed. Admirers would remark that they sought his friendship from the instant of their first encounter, so compelling was his gift of forging an immediate and genuine connection with them. Above all, he was entirely without judgment; he only saw the best in others, which inspired those around him to be better people.

Dr. Sacco was predeceased by his mother, Annette Sacco. In addition to his husband, Scott Dutcher, whom he married in 2014, and their dog, Sofi, he is survived by his father, Anthony P. Sacco, and his wife, Rosemary; and his four siblings, Bessie Sacco-Varsalona, Esq. and her husband, Pete; Alfred T. Sacco and his wife, Nellie; Amie E. Sykes and her husband, Ray; and Tina Sacco-Roche and her husband, Jack, along with many nieces and nephews. 

Author’s Note
My friendship with Ralph began 10 years ago, when he sat next to me at a board of directors meeting dinner and shared his design plans for building project #10 in Miami. By the end of the evening, we were laughing so hard that my cheeks hurt the next day. Over the years, we worked on myriad projects, getting together for many meetings to set priorities for the AAN—which we both loved—and going on excursions on our time off. He liked exposing me to new adventures like a helicopter ride over the volcanoes of Hawaii, a hike to a bat-infested cave in the Caribbean, and a tiny 2-person go-kart ride in chaotic island traffic but would settle for walks next to almost any body of water and visits to architectural sites, especially mid-century modern. During the pandemic, he checked in with me regularly, establishing weekend FaceTime visits during lockdown to lift my spirits. In the last year of his life, he took me to Margate City so I could meet his entire family and visit his old stomping grounds. He introduced me to his wonderful close friends in Boston, Miami, and the Hamptons, who regaled me with stories of Ralph’s kindness, generosity, and thoughtfulness. The outpouring of love and prayers after his diagnosis—from colleagues, friends, patients, and trainees—has been extraordinary and meant the world to him.