Dr. J. David Spence

D Spence bio pic

Professor Emeritus, Professor of Neurology & Clinical Pharmacology
Phone: 519.685.8500 x25731
Fax: 519.931.5737
E-mail: dspence@robarts.ca

Professor Spence has focused on prevention of stroke throughout his career. He pioneered the measurement of 2-dimensional carotid total plaque area beginning in 1990, and since 1994 has collaborated with Dr. Aaron Fenster and Dr. Grace Parraga at the Robarts Research Institute in measurement of 3D plaque volume. He also pioneered a new approach to vascular prevention - “treating arteries instead of treating risk factors”, that has markedly reduced risk among high-risk patients with carotid stenosis. His research program focuses on measurement of atherosclerosis by ultrasound, for patient management, genetic research and for assessing effects of new therapies.  Other areas of expertise include vitamin therapy for homocysteine, the clinical pharmacology of stroke prevention, physiologically individualized therapy for resistant hypertension and identification of high-risk asymptomatic carotid stenosis. Despite a busy clinical practice, his publications include 4 books, 256 papers, 42 chapters, 47 editorials and 73 letters to Editors, with an H-index of 55.  He has been a member of the executive or operations committees of several NIH-funded trials including the NASCET, ACE, and VISP trials, and is presently a member of the Steering Committee and country leader for Canada of the NIH-funded trial on Insulin Resistance in Stroke study (IRIS), and a member of the Leadership Committee of the American Heart Association (AHA) Council on Peripheral Vascular Disease.   He was a member of the board of the Canadian Hypertension Society, and of the Leadership Committee of the AHA Stroke Council, and is a member of the International Societies of Stroke, Hypertension and Atherosclerosis. He was an Assistant Editor of Stroke from 2000-2010, and is presently a member of the editorial boards of three AHA journals:  Stroke,  Hypertension and Arteriosclerosis, Thrombosis & Vascular Biology.  

In 2008, Prof. Spence was inducted as a Fellow of the Canadian Academy of Health Sciences.  His role in  teaching  of stroke prevention to neurologists and general physicians includes more than 570 invited lectures in 36 countries. In 2009, he was chosen by the World Congress of Neurology to teach the workshop on Stroke Prevention to Neurologists from around the world. In November 2010 he was honoured by the Universidad Católica of Cordoba, Argentina for his role in education of Argentinean physicians in vascular prevention over the previous 10 years, and by the Obra Social Ferroviaria of Argentina (a health maintenance organization operated by the Railroad Workers’ Union) for his role in establishing early atherosclerosis detection programs at a number of Obras Sociales across Argentina, based on his method for measuring carotid plaque area. In 2012 he was elected to a 4-year term on the Board of Directors of the World Stroke Organization, representing the Americas. Prof. Spence is currently investigating, with funding from CIHR, the role of the intestinal microbiome in extremes of carotid atherosclerosis.

Research Activities

  • Measurement of atherosclerosis by ultrasound
  • B vitamins to lower homocysteine for stroke prevention
  • Nutrition in stroke prevention
  • Intestinal microbiome and atherosclerosis

Recent Publications

Peer-reviewed papers:

  1. Bogiatzi C, Hackam DG, McLeod AI, Spence JD. Secular Trends in Ischemic Stroke Subtypes and Stroke Risk Factors. Stroke. 2014 Nov;45(11):3208-13. PMID: 25213343
  2. Paraskevas KI, Nicolaides AN, Veith FJ, Spence JD. Identifying Which Patients With Asymptomatic Carotid Stenosis Could Benefit From Intervention. Stroke. 2014 Nov;45(11):3352-9. PMID: 25293664
  3. Viscoli CM, Brass LM, Carolei A, Conwit R, Ford GA, Furie KL, Gorman M, Guarino PD, Inzucchi SE, Lovejoy AM, Parsons MW, Peduzzi PN, Ringleb PA, Schwartz GG, Spence JD, Tanne D, Young LH, Kernan WN; IRIS Trial investigators. Pioglitazone for secondary prevention after ischemic stroke and transient
    ischemic attack: Rationale and design of the Insulin Resistance Intervention after Stroke Trial. Am Heart J. 2014 Dec;168(6):823-829. PMID: 25458644
  4. Katsanos AH, Spence JD, Bogiatzi C, Parissis J, Giannopoulos S, Frogoudaki A, Safouris A, Voumvourakis K, Tsivgoulis G. Recurrent stroke and patent foramen ovale: a systematic review and meta-analysis. Stroke. 2014 Nov;45(11):3352-9. PMID: 25293664.
  5. Huang SS, Eliasziw M, Spence JD, Filler G, Vezina WC, Churchill DN, Cattran DC, Richardson B, House AA. The Tc-DTPA Urinary Clearance Method May Be Preferable to the Plasma Disappearance Method for Assessing Glomerular Filtration Rate in Diabetic Nephropathy. Nephron Clin Pract. 2015 Jan 8. [Epub ahead of print] PubMed PMID: 25571980
  6. Spence JD. Measurement of carotid plaque burden. JAMA Neurol. 2015 Apr1;72(4):383-4. PMID: 25686472.
  7. Spence JD. Management of Asymptomatic Carotid Stenosis. Neurol Clin. 2015 May;33(2):443-457. PMID: 25907915.
    In press:
  8. Perez HA, Garcia NH, Spence JD, Armando LJ. Adding carotid total plaque area (TPA) to the Framingham risk score improves cardiovascular risk classification. Archives of Medical Science 2015; in press.
  9. Yang C, Bogiatzi C, Spence JD. Low risk of stroke at the time of carotid occlusion. JAMA Neurology 2015; in press