Telltale heart

September 08, 2004

WORD THAT former President Bill Clinton had heart disease serious enough to require a quadruple bypass seemed shocking at first.

He's only 58, and was the most visible of our jogging chief executives, often heading right down Constitution Avenue, entourage in tow.

Thinking back on it, though, produces memories of Mr. Clinton jogging to fast-food joints - and of his famous pig-outs with another leader of enormous appetites: former German Chancellor Helmut Kohl.

Yet Mr. Clinton had recently cut back on carbs, and looked trim and healthy at the Democratic National Convention in July.

Alas, heart trouble ran in his family. Maybe he was just stuck with a bum ticker.

In gauging the odds that any individual is at risk of a heart attack, all of these factors and more come into play. Mr. Clinton's experience with the nation's leading killer should serve as a cautionary tale.

The lessons to be learned underscore the importance of genetics, proper diet and exercise early in life, and diagnostic screening that goes beyond a simple stress test.

A family history of heart disease is such a reliable indicator of potential problems that screening measures should at least be broached with a primary care physician, even without symptoms or other risk factors, according to Roger S. Blumenthal, director of the Johns Hopkins Preventive Cardiology Program.

If Mr. Clinton, whose cholesterol levels and blood pressure also signaled trouble when he was in the White House, had been more thoroughly screened for heart disease at that time, he could have taken steps to avoid what became a 90 percent blockage of major arteries.

Over the past year, the former president had been taking much better care of himself, he said. He was on the South Beach diet, and had dropped 40 pounds.

But it's very hard to undo a lifetime of cheeseburgers and fries. Far better to instill healthy eating and exercise habits at a young age, says Dr. Blumenthal, who laments the trend in schools to serve pizza and sodas for lunch while eliminating gym classes.

Further, Mr. Clinton's experience revealed the inadequacy of exercise stress tests - the most common form of noninvasive screening for heart disease. He "aced" his stress test five years in a row, the former president said, including the most recent one three months ago, despite being on the verge of a potentially catastrophic attack.

In such cases, a more accurate reading could have been obtained from a coronary calcium screening, which would measure the amount of plaque in his arteries, Dr. Blumenthal said.

What may have mattered most in Mr. Clinton's case, though, is that he acted on his symptoms as soon as he recognized them. He dodged what likely would have been a fatal or at least debilitating attack because he listened to his heart. That alone is a lesson worth learning.

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