Bush's blocked artery a reminder that even fit folks can be at risk

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By Linda Carroll

Former President George W. Bush was the picture of health when he was in office, an avid runner whose yearly exams showed a very low heart disease risk profile. Still, like many in his generation, the 67-year-old Bush has now found himself with a blocked artery -- and a stent.

“It’s a real reminder that we pay the piper for the life we live previously,” NBC chief medical editor Dr. Nancy Snyderman said on MSNBC Tuesday. “It’s possible the cheeseburgers and steaks caught up with him.”

During a routine physical exam at the Cooper Clinic in Dallas Monday, a blockage was discovered in an artery in the former president’s heart. At his doctor’s recommendation, the 43rd president agreed to have a stent placed to open the blockage. A stent is a metal scaffolding placed into an artery narrowed by cholesterol plaque. It restores blood flow and prevents a heart attack. The procedure was successful and Bush is expected to return home from the hospital Wednesday and be back to a normal schedule Thursday.

Between 700,000 and 1 million stent procedures are done each year, but the operation on such a high-profile patient could serve as a warning, alerting older Americans to the accumulating plaque in their arteries and the potential time bombs ticking in their chests. Even the most physically active can suffer from one of the major cardiovascular risk factors: advancing age.

“There’s a lot of reserve built into the system,” says Dr. Howard Herrmann, director of the interventional cardiology program at the University of Pennsylvania Medical Center. “Usually, the only way we know if someone has a blockage is when there is a large or small heart attack or if more than 70 percent of an artery is blocked and that interferes with blood flow. This is something that can be brewing for decades before it becomes clinically apparent.”

Evidence of that risk came from researching young men who died in their teens, says Dr. Jonathan Tobis, a UCLA Health professor of medicine and director of interventional cardiology.

“Coronary artery disease starts when men hit puberty when testosterone kicks in,” says Tobis. “Autopsy studies of 18-year-old soldiers who died in battle showed there was already a high incidence of atherosclerosis in teens. Bush is 67, so he had a long time for this to develop.”

Even people with healthy habits can be struck by heart disease and heart attacks. Tobis points to Jim Fixx, the famous runner who got America moving with a best-selling book in the 1970s. “He died of coronary artery disease,” Tobis says. “He had a family history. That’s very significant. And it shows that not just one thing can prevent coronary artery disease.” 

While we can't stop the aging process, there are heart disease risk factors that can be controlled through medications and lifestyle changes, including high cholesterol and blood pressure, smoking, a sedentary lifestyle and body-mass index, says Tobis.

And while apparently healthy folks like Fixx and Bush can end up with heart disease, that doesn't mean we shouldn't be choosing a healthy lifestyle, Tobis says. 

“If you’re interested in living longer, you should have regular physical exams and reduce the risk factors you have, like high cholesterol and high blood pressure,” he adds. “Multiple studies have shown that when people take medications to lower cholesterol and blood pressure they live longer.”

There’s even hope for those who gobbled down fat-laden foods for years, experts say. While you can’t roll back the clock on plaques that have already accumulated, you can slow down the process, Tobis says.

And if you do end up with a clogged artery and a stent, the prognosis can be good so long as there was no heart damage when the blockage was discovered, says Dr. Suresh Mulukutla, director of interventional cardiology at the University of Pittsburgh Medical Center.

Most people will keep their stents for a lifetime, though in a small percentage of cases the devices can get clogged with clots – but the risk of this can be lowered with aspirin therapy, Mulukutla says. Another rare problem: The blockage can return if the area around the stent gets scarred over.

Ultimately, though, a stent can’t solve everything. People still need to deal with their risk factors by achieving a healthy weight, stopping smoking and taking the medications they need to lower cholesterol and blood pressure, Mulukutla says.