Clinton case shows why heart disease No. 1 killer

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 a half 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. The surprise factor has biological and psychological explanations, experts say.

“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.

Once there’s a blockage, “it’s not very far from there to closing the artery down completely,” he said.

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

Women often don’t have the same symptoms as men.

“They may feel more fatigue, a sense of just being ill without an explanation. They may have more shortness of breath than the chest pressure that’s classically talked about,” LaVan said.

“Heart disease is an equal opportunity killer. It doesn’t respect sex, race, age.”

As for the psychological factors, “there’s an element of denial that goes on … a human being’s natural tendency not to want to think it’s a cardiac problem,” Halperin said.

Surveys also show that many Americans ignore warning signs for relatively unimportant reasons like not wanting to bother someone to take them to a hospital or embarrassment if an ambulance or doctor visit turns out to be unnecessary, LaVan said.

His advice: “Take nothing for granted and don’t be embarrassed.”

People need to be alert to warning signs of trouble and to get help fast, experts say. Despite his risk factors for heart disease, when Clinton first noticed shortness of breath and tightness in his chest months ago, he shrugged it off as irregular exercise habits and acid reflux.

“I wish more people had the savvy to get to an emergency room at a hospital if they develop symptoms like this,” LaVan said.

Other experts urged parents to pay attention to the beginnings of heart disease in children. More than 8 million American children are overweight, many have diabetes and high blood pressure, and too few get enough exercise, said Dr. Louis Bezold. He is director of preventive cardiology at Texas Children’s Hospital and a pediatric cardiologist at Baylor College of Medicine.

All are signs of a future generation headed for Clinton-like problems.

“If you go looking for those things in kids, you’re going to see it in ever-increasing frequency,” Bezold said. “Those things all start in childhood.”