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News that former President Bill Clinton needs quadruple bypass surgery was sobering to many people but not surprising to cardiologists. There are hundreds of thousands of Americans living with severely clogged arteries, often only a heartbeat away from a heart attack.
And even with the expert medical care given to a former president, it's often hard to detect clogged arteries.
"All of our heart risk factors don't really tell us directly about what's going on in our arteries," said Dr. Laurence Sperling, director of preventive cardiology at Emory University School of Medicine. In one-third of cases, he said, the first symptom is a fatal heart attack.
Sperling and other cardiologists are hopeful, however, that new tests and more aggressive screening will help primary care doctors --- and not just heart specialists --- spot arterial blockage sooner and thereby prevent heart attacks, the often fatal result of clogged arteries.
The doctors also stress that the best treatment is prevention, which is best achieved by healthy diet and regular exercise. They also urge patients to know their cholesterol levels.
Clogged arteries are the main reason for heart attacks, but their symptoms are often subtle.
Clinton learned of the blockage in his arteries only because he experienced chest pains. He went to a hospital, where a cardiac catheterization test revealed the blockage. Otherwise, he might have never known he had severe blockage, doctors said.
Arteries become clogged over time with plaque --- fat, cholesterol and other microscopic debris. Sometimes heredity is at fault. In most cases, though, a diet high in fat and lack of exercise are to blame.
Clogged arteries are dangerous because they cut off blood supply to the heart muscle. That causes part of the heart muscle to die and can lead to heart attack, the cause of more than one-half million deaths a year.
Doctors have different ways to assess a person's risk for having a heart attack. A key indicator is the amount of bad and good cholesterol in a person's blood. Doctors also consider prior heart disease, blood pressure, family history of heart disease, diabetes, and weight and its distribution.
None of these, however, actually provides a clear window into the arteries and whether they are blocked. And, often, a person can appear to be in great health but have several clogged arteries and be on the verge of a major heart attack.
Such was the case with Clinton.
Closer to home, Haywood Curry, 62, was stunned to learn in April that he had 95 percent blockage in an artery.
Curry of Decatur regularly plays golf, exercises several times a week at his local YMCA and closely watches what he eats. He was 6 feet 2 and weighed 210 pounds when he went to his doctor for a routine annual exam and learned of the blockage.
An exercise stress test revealed a high pulse. His doctor suspected a problem.
Curry went into the hospital for an angiogram; doctors inserted a tube into an artery and took X-rays to look for blockage. They scheduled bypass surgery for Curry immediately. Curry said he feels fortunate --- and slim. He now weighs 190.
"The scary part about it is that they said I could have been one of those guys who falls down on the ninth tee," said Curry.
To catch arterial damage before the emergency stage, patients should talk to their doctors about whether other tests might be warranted, Sperling said. The tests include an exercise stress test, such as Curry had; a scan to measure calcium in the aorta; an ultrasound of the carotid artery, the main artery in the neck; a blood test to measure C-reactive protein, a marker of inflammation in the body; and an ankle-brachial index, which measures blood pressure in the arm and also in the ankle and compares the difference. An 80-point difference, for example, would be a red flag to doctors.
Those tests are not warranted in all patients, Sperling said, but could be important to patients at intermediate or high risk of heart disease, even if they show no symptoms.
Clinton was a perfect candidate for heart disease simply because he is a middle-aged American male. Half of all American men will die from heart disease, according to the American Heart Association.
Add Clinton's family history of heart disease, high levels of bad cholesterol, his well-known history of eating junk food --- not to mention a little stress along the way --- and the former president could have been a poster boy for heart attack risk, doctors said.
"It does tell us that the average American lifestyle does lead to the average American health problem, which is heart disease," Sperling said. "He's probably eaten one too many Big Macs."
Copyright 2004 The Atlanta Journal-Constitution