J. David Spence, BA, MBA, MD, FRCPC, FAHA, FCAHS
Professor of Neurology and Clinical Pharmacology, Western University
Office: Siebens-Drake Building, Robarts Research Institute
Secretary: Patricia Mills
Dr. Spence has devoted his entire career to stroke prevention. During his first two years of training in Neurology at Western University with Dr. Henry Barnett, he saw over 1000 patients with strokes, half of which were due to hypertension. This led him to complete training in Internal Medicine at Western University, and then Clinical Pharmacology at the University of California at San Francisco. He returned to London to establish at Victoria Hospital the third hypertension clinic in Canada. With major efforts by the Department of Family Medicine and the hypertension clinic, stroke in London was reduced by half within 5 years. In 1995 he moved to University Hospital to join the stroke team and establish clinics aimed at stroke prevention and premature atherosclerosis.
Dr. Spence pioneered the measurement of 2-dimensional carotid plaque area for three main purposes: management of patients, genetic research and evaluation of new therapies. He developed a new paradigm for vascular prevention: treating arteries, based on carotid plaque measurements, rather than merely treating risk factors such as LDL cholesterol to target levels. Using that approach, he and colleagues reported that most patients with asymptomatic carotid stenosis are better off with intensive medical therapy, and that transcranial Doppler detection of microemboli can identify those (less than 5% of patients) who might benefit from endarterectomy or stenting. In these high-risk patients, the two-year risk of stroke, and the two-year risk of myocardial infarction were both reduced by intensive medical therapy, from 8% to 1%.
Atherosclerosis (Thickening of artery walls), Cholesterol, Diet, B vitamin therapy for Homocysteine, Hyperlipidemia (Abnormal blood lipid levels), Hypertension (Elevated blood pressure), Asymptomatic carotid stenosis, Stroke Prevention
Honours and Awards
- 2017, Alumni of Distinction Award, Western University
- 2015, Scientific Excellence Award, Canadian Society for Atherosclerosis, Thrombosis and Vascular Biology
- 2013, Lifetime Achievement Award, Schulich School of Medicine & Dentistry
- 2013, Named to the Faculty of 1000 in Cerebrovacular Disease
- 2010, Stroke Innovation Award, American Heart Association Journal Stroke
- 1998, Clifford J. Goodall Award of Merit, Stroke Recovery Association
- 1991, Dean's Honour List, University of Toronto
- 1981, Astra Research Award, Canadian Hypertension Society
- 1976, Francis McNaughton Young Investigator Award, Canadian Neurological Society
Søndergaard L, Kasner SE, Rhodes JF, Andersen G, Iversen HK, Nielsen-Kudsk JE, Settergren M, Sjöstrand C, Roine RO, Hildick-Smith D, Spence JD, Thomassen L; Gore REDUCE Clinical Study Investigators.. Patent Foramen Ovale Closure or Antiplatelet Therapy for Cryptogenic Stroke. N Engl J Med. 2017 Sep 14;377(11):1033-1042. doi: 10.1056/NEJMoa1707404. PubMed PMID: 28902580.
Spence JD. Systolic blood pressure targets, Diastolic J Curve and Cuff Artefact in blood pressure measurement: a note of caution. Eur J Neurol. 2017 Sep 8. doi: 10.1111/ene.13442. [Epub ahead of print] PubMed PMID: 28887862.
Spence JD. Letter by Spence Regarding Article, "Antiplatelet Regimen for Patients With Breakthrough Strokes While on Aspirin: A Systematic Review and Meta-Analysis". Stroke. 2017 Sep 8. pii: STROKEAHA.117.018919. doi: 10.1161/STROKEAHA.117.018919. [Epub ahead of print] PubMed PMID: 28887397.
Epstein KA, Viscoli CM, Spence JD, Young LH, Inzucchi SE, Gorman M, Gerstenhaber B, Guarino PD, Dixit A, Furie KL, Kernan WN; IRIS Trial Investigators.. Smoking cessation and outcome after ischemic stroke or TIA. Neurology. 2017 Sep 8. pii: 10.1212/WNL.0000000000004524. doi: 10.1212/WNL.0000000000004524. [Epub ahead of print] PubMed PMID: 28887378.
Akintunde A, Nondi J, Gogo K, Jones ESW, Rayner BL, Hackam DG, Spence JD. Physiological Phenotyping for Personalized Therapy of Uncontrolled Hypertension in Africa. Am J Hypertens. 2017 Sep 1;30(9):923-930. doi: 10.1093/ajh/hpx066. PMID: 28472315
Spence JD. Transcranial Doppler Emboli Identifies Asymptomatic Carotid Patients at High Stroke Risk: Why This Technique Should be Used More Widely. Angiology. 2017 Sep;68(8):657-660. doi: 10.1177/0003319716651525. Epub 2016 Jul 11. PMID: 27225699
Spence JD, Yi Q, Hankey GJ. B vitamins in stroke prevention: time to reconsider. Lancet Neurol. 2017 Sep;16(9):750-760. doi: 10.1016/S1474-4422(17)30180-1. Review. PubMed PMID: 28816120.
Cheng J, Ukwatta E, Shavakh S, Chow TWS, Parraga G, Spence JD, Chiu B. Sensitive three-dimensional ultrasound assessment of carotid atherosclerosis by weighted average of local vessel wall and plaque thickness change. Med Phys. 2017 Aug 7. doi: 10.1002/mp.12507. [Epub ahead of print] PubMed PMID: 28782187.
Sörös P, Teasell R, Hanley DF, Spence JD. Motor recovery beginning 23 years after ischemic stroke. J Neurophysiol. 2017 Aug 1;118(2):778-781. doi: 10.1152/jn.00868.2016. Epub 2017 May 17. PMID: 28515288
Spence JD. Cuff Artifact, J Curve, and Application of Hypertension Guidelines in the Elderly. Can J Cardiol. 2017 Aug;33(8):1067.e5. doi: 10.1016/j.cjca.2017.04.014. Epub 2017 May 3. PubMed PMID: 28669700.
Spence JD. Approaching Automated 3-Dimensional Measurement of Atherosclerotic Plaque Volume. J Am Coll Cardiol. 2017 Jul 18;70(3):314-317. doi: 10.1016/j.jacc.2017.05.036. PubMed PMID: 28705311.
Spence JD, Solo K. Resistant Atherosclerosis: The Need for Monitoring of Plaque Burden. Stroke. 2017 Jun;48(6):1624-1629. doi: 10.1161/STROKEAHA.117.017392. Epub 2017 May 9. PMID: 28487327
Blanco PJ, Müller LO, Spence JD. Blood pressure gradients in cerebral arteries: a clue to pathogenesis of cerebral small vessel disease. Stroke Vasc Neurol. 2017 Jun 8;2(3):108-117. doi: 10.1136/svn-2017-000087. eCollection 2017 Sep. PubMed PMID: 28989801; PubMed Central PMCID: PMC5628379.
Spence JD. Rational Medical Therapy Is the Key to Effective Cardiovascular Disease Prevention. Can J Cardiol. 2017 May;33(5):626-634. doi: 10.1016/j.cjca.2017.01.003. Epub 2017 Jan 19. Review. PMID: 28449833
Spence JD. Asymptomatic carotid stenosis: Why a moratorium is needed on intervention outside clinical trials. Neurology. 2017 May 23;88(21):1990-1991. doi: 10.1212/WNL.0000000000003967. Epub 2017 Apr 26. No abstract available. PMID: 28446650
Spence JD. Cuff Artifact, J Curve, and Application of Hypertension Guidelines in the Elderly. Can J Cardiol. 2017 May 3. pii: S0828-282X(17)30206-4. doi: 10.1016/j.cjca.2017.04.014. [Epub ahead of print] PubMed PMID: 28669700.
Spence JD. 3D Ultrasound for Imaging and Quantifying Carotid Ulcers. AJNR Am J Neuroradiol. 2017 May;38(5):E34-E36. doi: 10.3174/ajnr.A5130. Epub 2017 Mar 31. No abstract available. PMID: 28364013
Jones ES, Spence JD, Mcintyre AD, Nondi J, Gogo K, Akintunde A, Hackam DG, Rayner BL. High Frequency of Variants of Candidate Genes in Black Africans with Low Renin-Resistant Hypertension. Am J Hypertens. 2017 May 1;30(5):478-483. doi: 10.1093/ajh/hpw167. PMID: 28052878
Cocker MS, Spence JD, Hammond R, Wells G, deKemp RA, Lum C, Adeeko A, Yaffe MJ, Leung E, Hill A, Nagpal S, Stotts G, Alturkustani M, Hammond L, DaSilva J, Hadizad T, Tardif JC, Beanlands RS; Canadian Atherosclerosis Imaging Network (CAIN). [18F]-NaF PET/CT Identifies Active Calcification in Carotid Plaque. JACC Cardiovasc Imaging. 2017 Apr;10(4):486-488. doi: 10.1016/j.jcmg.2016.03.005. Epub 2016 Jun 15. No abstract available. PMID: 27318719
Spence JD. Diastolic Hypotension and Myocardial Ischemia: A Reason to Remember Cuff Artifact in Blood Pressure Measurement. J Am Coll Cardiol. 2017 Mar 28;69(12):1646-1647. doi: 10.1016/j.jacc.2016.11.085. No abstract available. PMID: 28335850
Pettersen JA, Keith J, Gao F, Spence JD, Black SE. CADASIL accelerated by acute hypotension: Arterial and venous contribution to leukoaraiosis. Neurology. 2017 Mar 14;88(11):1077-1080. doi: 10.1212/WNL.0000000000003717. Epub 2017 Feb 15. PMID: 28202707
Spence JD. Transcranial Doppler monitoring for microemboli: a marker of a high-risk carotid plaque. Semin Vasc Surg. 2017 Mar;30(1):62-66. doi: 10.1053/j.semvascsurg.2017.04.011. Epub 2017 Apr 27. PubMed PMID: 28818260.
Spence JD. Carotid plaque burden is associated with higher levels of total homocysteine. Stroke Vasc Neurol. 2017 Feb 24;2(1):40. doi: 10.1136/svn-2017-000076. eCollection 2017 Mar. PubMed PMID: 28959489; PubMed Central PMCID: PMC5435215.
Spence JD. Increased Coagulation With Aging: Importance of Homocysteine and Vitamin B12. Circ J. 2017 Jan 25;81(2):268. doi: 10.1253/circj.CJ-16-1011. Epub 2016 Dec 16. No abstract available. PMID: 27980280
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