What Tim Russert's Death Can Tell Us About Heart Disease

Saturday, June 14

This week we were all shocked by the untimely death of beloved political journalist Tim Russert. He died of an apparent heart attack, a fact confirmed by autopsy which showed a culprit coronary embolus, pervasive coronary disease, and an enlarged heart, according to his internist Dr. Michael Newman. Dr. Newman said that Russert was known to be suffering from coronary artery disease, but was being managed with "medication and exercise." In April, he had a stress test, with normal results. Precisely what medications he was on was not revealed at this time.

Russert was one of over 300,000 Americans who die each year of "sudden cardiac arrest" out of hospital. Of these, only a handful can be resuscitated, and even fewer survive. CPR was administered when Russert collapsed during a taping at the NBC Washington Bureau studios, followed by unsuccessful attempts at defibrillation when the EMTs arrived.

Monday morning quarterbacking is hard in these cases, and to suggest that Russert or his doctors were somehow remiss is disingenuous. But inevitably, we search for meaning in this seemingly senseless tragedy. Many folks Russert's age are inevitably asking themselves "Could this happen to me? What steps can I take to avoid this fate?"

The facts are these: Fully one half of people who suffer sudden cardiac death have no warning signs. One quarter of heart attack patients don't even make it to the hospital; a third eventually die, despite the best medical ministrations. So the best way to survive a heart attack is to avoid getting one in the first place.

I think in wake of the Russert death there will be a surge of interest in the EBT heart scan, now a proven way to demonstrate calcium in the coronary arteries which is strongly correlated with heart attack risk. New studies demonstrate its efficacy in picking up heart disease long before it's detected in standard exams like stress tests.

But the biggest risk factor for cardiovascular disease is the metabolic syndrome. This creates the "perfect storm" for a heart attack. Too often ignored until it's too late, if you possess three of five indicators of metabolic syndrome, your chance of heart disease increases a whopping 274%. The risk factors, some of which were clearly in play for Russert, are: 1) Fasting blood glucose greater than 100; 2) waist circumference equal to or greater than 35" for women and equal to or greater than 40" for men; 3) HDL cholesterol less than 50 for a female, or under 40 for a male; 4) triglycerides greater than 150; 5) blood pressure greater than 130/85.

Drugs help with some of the manifestations of metabolic syndrome, but it's not how low you go with blood pressure or cholesterol . . . it's how you get there. And getting there with good diet, exercise, and supplements like fish oil is clearly preferably to artificially manipulating endpoints with drugs.

Russert was returning from a whirlwind vacation in Italy, taking advantage of the short hiatus between the primaries and the long Presidential campaign ahead. He was said to have just gotten off a plane with around two hours of sleep. Studies show that hours of sitting on transoceanic flights can literally thicken the blood, resulting in "economy class syndrome", or dangerous blood clots. Bad air, bad food, and high levels of stress hormones, or caffeine could have further enhanced his risk.

And here's one other point to ponder: Russert was inflamed. Like many overweight people on high-glycemic index diets, he suffered from joint problems, and was recently seen on crutches during his testimony at the Scooter Libby trial. The inflammatory cascade is a hallmark of the metabolic syndrome, and it contributes to inflammation of the coronary arteries and unstable, ulcerated plaque. Inflammation can be measured with the highly sensitive C-reactive protein test, and is a major risk factor for heart disease and coronary events.

Additionally, Russert may have inadvertently compounded his risk by treating his pain with a non-steroidal anti-inflammatory drug (NSAID) like Motrin or Alleve. Prescription NSAIDs like Celebrex and Vioxx have been implicated in increased risk for thrombotic events like strokes and heart attacks, and their less potent over-the-counter cousins have the same pro-clotting effects.

Whatever the facts, I'll be missing an old friend who used to keep me company while I rode my stationary bicycle or jogged on the treadmill watching "Meet the Press" on Sunday mornings.