Heart disease often a surprise

Bill Clinton was an active, jogging, jovial time bomb. Like thousands of others, he had no idea how close he was to a heart attack and possibly death — even though he had years of presidential health care and continued checkups.

His case is a stark illustration of how silently heart disease creeps up and why it continues to be the leading killer of men and women worldwide. Clinton’s symptoms may have been silent, but other things about him were saying plenty about the danger he faced — if only he and others close to him had listened.
In fact, in retrospect, his quadruple bypass on Monday doesn’t seem so surprising: Clinton had seven of the nine risk factors for heart disease, plus warning signs for several months of an impending heart attack.

“This guy was within a cat’s whisker of death. There’s no question in my mind,” said Dr. Donald LaVan, a University of Pennsylvania cardiologist and a spokesman for the American Heart Association.

Heart disease, which kills about half a million Americans each year, takes years or even decades to develop. Yet it still catches most people by surprise, especially women, who often regard it as a man’s disease. Half the time, a heart attack is the first sign of trouble.
With all that is known about heart disease and its risks, it shouldn’t be that way, specialists say.

Clinton, for instance, is male, over 50, with a family history of heart disease — all risk factors he can’t control. He also smoked (cigars), had high blood pressure, high cholesterol and was overweight.

He doesn’t have diabetes, and the only other major risk factor he didn’t have — lack of exercise — may have blinded him and even his doctors to some degree about the rest of his profile.

Average Americans make the same mistakes in underestimating their personal risk for heart troubles and are stunned to learn they’ve developed them.

“Until an artery is substantially blocked, there are no symptoms at all, because the heart’s still able to get enough blood and oxygen during exercise to meet its needs,” said Dr. Jonathan Halperin, director of cardiac clinical services at Mount Sinai Medical Center in New York City.

Likewise, tests don’t often find blockages until they’re severe, and there’s no reason to give tests to people with no symptoms.