heart disease - Thoughts about Tim Russert and Heart Disease

Tim Russert was 58 when he collapsed and died of coronary thrombosis two days before Father’s Day. This is sad because his dad, known as Big Russ, the subject of Tim’s recent books Big Russ and Me, and the sequel. The Wisdom of Our Fathers, are still on best seller lists. And it is sad, too, his Dad is still alive andTim had just returned from Italy with his wife, after meeting with their son, to celebrate he son’s graduation from Boston College

Tim Russert had people and political gifts. He loved people, and they loved him. He was personable, generous, loyal, and full of insight. His love for people translated into his passion for politics and his deep understanding of how it worked, who would win and why, what defined leadership, where power resided, and when and when not to act. He had the Irish gifts of speech, humor, affability, and deep respect for family and religious values. He was a good guy and easy to like and trust.

But he could not contain his love and enthusiasm for his work and an abiding concern about the future of the nation. To him politics was a source of unending curiosity and a drive to know more. He could not contain his passions. Politics consumed him every waking hour. Before he died, he had slept only two hours the previous night, after returning from a trip to Italy.

Russert had some elements of a type A personality. Type A individuals are impatient, excessively time-conscious, highly competitive, and incapable of relaxation. They are often high achieving workaholics who multi-task and drive themselves with deadlines. Because of these characteristics, Type A individuals tend to be "stress junkies.” Type A traits may be desirable in a high-powered journalist seeking interviews with the high and mighty in D.C., but they may lead to heart attacks, especially in people like Russert, who was diabetic, had known coronary disease, and a stocky mesomorphic stature – traits common to coronary prone individuals.

Did his personality have anything to do with his death? I do not know. Nor do we generally know why in 30% of patients why die from heart attacks, sudden death is the first symptom.

Can sudden death from coronary disease be prevented? Yes, in those whose disease is symptomatic, or in those in which the underlying disease is otherwise spotted through stress tests, nuclear heart scans, ECGs, and use of technologies showing calcium in coronaries, and in whom preventive measures are taken.

Can we predict candidates for sudden death? Can we present them with evidence to change behavior? Can we put the “scare of death” into them?
Of course, doctors do it all the time. But maybe we can develop more convincing evidence than we do.

A new technology, called SHAPE(Superior Health and Pulmonary Evaluation ) developed in St. Paul, Minnesota and tested by the Mayo Clinic may help. It is a modified and improved coronary stress test consisting of minimal stress (stepping up and down 1 ½ steps), magnifying this small stress signal of this minimal stress into a cardiogram, breathing through a snorkel-like device to have pulmonary gases analyzed, and then using predictive modeling informtion from a massive data base gathered from hundreds of thousands of similar patients to predict the likelihood of hospitalization or sudden death from coronary disease.

This kind of objective predictive data may convience high-powered, driven, logical, skeptical individuals to stop smoking, take other preventive steps, and change their life-style. The beauty of this low-risk procedures is that it can be done anywhere, without the dangers of the treadmile and without the presence of a doctor should the subject collapse on the treadmill.

Would this approach have persuaded Russert to slow down? We will never know. Probably not. He may have felt he had to do what he had to do. Would it reduce the rate of sudden deaths among others? Maybe not. Coronary artery disease will remain a silent killer in asymptomatic individuals, even though the danger signs are there before sypmptoms develop. But SHAPE is worth a shot, once it receives final FDA approval.