Treatments

Dick Cheney And The Modern Heart Attack

Dick Cheney went home from the hospital Wednesday, three days after suffering his fifth heart attack. The 69-year-old former vice president "will resume his normal schedule soon," a spokesman says.

Former Vice President Dick Cheney speaks at the annual Conservative Political Action Conference on F
Robert Giroux/Getty Images)/Robert Giroux/Getty Images

Nothing so remarkable about that these days. And that's the point.

In the 32 years since Cheney suffered his first heart attack at age 37, the meaning of "heart attack" has changed. Not medically. A heart attack is still a blockage in a coronary artery. If doctors don't relieve the blockage fast, a patch of heart muscle downstream dies.

But the implications of this common event—it happens to 1.3 million Americans a year, and nearly a half-million of these heart attacks are repeats like Cheney's—are very different for the current generation of heart attack victims.

In fact, Dr. Clyde Yancy says Cheney is a veritable poster boy for progress in treating heart attack. "During this man's adult lifetime, we've made considerable strides in treating heart attacks and preventing death when a heart attack occurs," says Yancy, a Baylor University cardiologist who's president of the American Heart Association.

Consider Cheney's heart history. It's detailed by the Web site doctorzebra.com. We'll give you the condensed version.

Like many Americans of his era, Cheney was a longtime smoker before his first heart attack in 1978, when he quit.

In 1984, Cheney underwent open-heart surgery to bypass blockages in four coronary arteries—an operation that was becoming one of the most common types of surgery. On two later occasions, doctors have placed stents in his coronary arteries to relieve blockages—a sign that his atherosclerosis continued to progress.

In 1989, when Cheney was nominated to be Secretary of Defense, he disclosed he was taking medication to lower his cholesterol. Again, that was an increasingly common prescription at the time, reflecting large studies showing that cholesterol-lowering medication can prevent heart attacks and death among people with known coronary disease.

Two weeks after the 2000 election, Cheney awoke with chest and shoulder pain that signaled his fourth heart attack. At the time, doctors revealed that Cheney's heart was weakened — its output was below normal. That undoubtedly reflected the damage from successive heart attacks.

In 2001, when he was vice president, Cheney suffered episodes of rapid heartbeat called ventricular tachycardia—a common condition among people whose hearts have been scarred by heart attacks. To prevent a "sudden death" heart attack, doctors installed a device that had come into common use by that time, an implantable defibrillator. It detects abnormal heart rhythms and when necessary delivers a jolt of electricity to shock the heart back into normal rhythm.

Cheney has also suffered problems with his leg arteries, which can be a sign of atherosclerosis. He has gout, which can be related to obesity. And he has had episodes of fluid retention in his feet and lungs, which can reflect some degree of heart failure— a weakening of the heart that is common in heart attack survivors.

The former vice president's spokesman has described his latest heart attack as "mild." He is said to have undergone coronary angiography to check for new blockages in his heart's blood supply, but he and his doctors have not said whether he has had additional angioplasty or stents.

Yancy says the fact that Cheney's recent heart attack is mild is "a good thing, but one should not fully exhale. It's very predictive. His likelihood for another heart attack is much higher, and the next heart attack could be much more significant."

Cheney's risk of progressive heart failure, like millions of heart attack survivors, is also high. "Once you've had a heart attack, you've about nine times more likely to have heart failure over a lifetime than someone who hasn't had one," Yancy says.

That's why heart failure rates have skyrocketed as heart attack survivors have become much more common.

"When I was in training in the 70s and 80s, heart attack patients had a 15 to 20 percent likelihood of death during their initial hospital stay," Yancy says. "Now it's down to two percent."

In the last decade alone, there's been a 40 percent reduction in heart attack deaths, according to the American Heart Association.

Cheney embodies that success. But every day 3,400 Americans are still suffering heart attacks. That leaves lots of room for improvement. The Heart Association recently launched an online tool to help people assess their own risk of heart attack — and identify steps they can take to reduce that risk.

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