How Not To End Up Like Bill

The moment I heard about former President Bill Clinton's sudden need for heart bypass surgery I started having palpitations in my own heart. Clinton is 58, I'm 57. Clinton, like me, has long struggled with his weight but is now pretty close to the right weight. Clinton, also like me, stays in shape and exercises regularly.

The president has been overweight in the past but he recently slimmed down. At a book signing on Wednesday, he said, "I workout a lot, and I went on 'The South Beach Diet' for a while, that helped, but the combination -- I have a wonderful man that comes in two or three times a week and we workout."

Clinton, until a couple of days ago, was symptom free. Aside from slightly high cholesterol and borderline high blood pressure, he appeared to be in good cardiac shape until he experienced chest pains and shortness of breath on Thursday.

An exam at the hospital didn't turn up any problems but, on Friday morning, the doctors called him back in for an angiogram, which revealed significant blocking in his coronary arteries.

Clinton was lucky. Sometimes the first sign of heart problems is a heart attack or even death. After his bypass surgery, the former president is likely to "experience a normal life curve," according to Dr. Vincent Guadiani, a Redwood City-based cardiac surgeon who practices at Sequoia Hospital.

The question I keep pondering is what should the rest of us do? Is it really necessary to wait until you have chest pains to see a doctor or is there something we can do to prevent heart problems?

The heart, says Dr. Guadiani "is a pump that works a lot like the motor in your car. It can run just fine until it suddenly runs out of gas." In other words, it's not uncommon for an apparently healthy person to suddenly experience some type of heart problem.

Still, there are ways to test the heart, says Dr. Guadiani. "The way to defeat the disease is to go look for it and that's best done by stressing the heart so it has to do a lot of work and then test it."

A "stress test" typically involves exercising on a treadmill while you're hooked up to equipment that monitors your heart. The test, according to the American Heart Association, "can show if the blood supply is reduced in the arteries that supply the heart."

Dr. Guadiani likens a stress test to revving the engine on a car. "A car may idle perfectly well, but then sputter if you step on the gas." By putting a patient on a treadmill, you stress the heart. "Whether you have symptoms or not," said Dr. Guadiani, "a test will show that there is a problem." The test is non-invasive and very safe, except for patients with severe heart problems, he said.

He recommends the test for anyone over 50, especially for males or anyone with a family history of heart disease or diabetes or if they smoke. You can ask your doctor to refer you to a cardiologist who can perform the test.

Not all cardiologists agree. Dr. Mark Perlroth of Stanford Medical School said that it is not normal procedure to perform any tests on asymptomatic patients unless there are significant risk factors such as obesity or diabetes. Based on Clinton's condition prior to Thursday, there would have been no indication for any tests. An angiogram, which was performed on President Clinton after doctors suspected possible problems, is an invasive test that involves inserting a small tube through a blood vessel to the coronary arteries and then injecting a die that shows up on an X-Ray. Although complications are unlikely, they can occur. My mother, for example, suffered a stroke during an angiogram in 1990. The procedure is only performed if there is an indication of a problem.

Dr. Guadiani points out that that there are limits as to what medicine or even lifestyle can do to predict or prevent heart problems. "Deep in the American psyche is the notion that if we do everything right nothing bad will happen." But that's not the case. People who do everything right can have problems and then "there are people with certain genetic structures that smoke, drink and do well.

British Prime Minister Winston Churchill (1874-1965) was quite overweight, smoked, drank and had one of the world's most high stress jobs. He had a heart attack when he was 80, suffered three bouts of pneumonia and two strokes yet survived until he was 91 and led an active life during his eighties.

Still, there are things you can do to improve your odds. You can have your cholesterol and blood pressure checked. If cholesterol and blood pressure can't be brought down by diet and exercise they can be controlled through medication. In addition to the stress test, the doctor also advises people in their fifties to get a colonoscopy.

Like most doctors, Guardiani recommends a good diet, regular exercise and weight control which, of course, improves your odds but doesn't guarantee anything.

Finally, he says, "don't worry" which is exactly the advice I needed. There is only so much we can do to control our health but when it comes to staying alive, there are some factors that are outside of our control.