Cheney's Heart

By Ian K. Smith, M.D.

In the wake of Dick Cheney's most recent heart attack, everybody (this columnist included) was quick to praise both Cheney and his doctors--him for checking into the hospital without delay; them for taking aggressive action once he arrived. Almost lost in the congratulatory spin, however, was the fact that the would-be Vice President is still a sick man.

Regardless of how well Cheney fields reporters' questions or waves to the cameras, he can't erase a history of four heart attacks, one quadruple-bypass surgery and a coronary artery propped open with a metal stent--all over a 22-year period in a man considered far too young to have suffered so many setbacks.

What makes his prognosis even more problematic should he take office is that the life of an active Vice President is hectic and not particularly healthy, with all the fast food and heavy state dinners that lubricate the business of government.

We still don't have all the facts about the state of Cheney's health, but new details revealed by his doctors last week indicate there is room for improvement. We knew that he waited until his third heart attack to quit smoking. We now know that he has gained 40 lbs. since his 1988 bypass and exercises just twice a week. His doctors can do only so much. If he wants to avoid another emergency trip to the hospital, he is going to have to take responsibility for his health and start making some changes.

At the top of the list is exercise. Twice a week is just not good enough. The standard minimum recommendation--working out for 30 to 60 minutes three or four times a week--is for people who don't have a history of heart trouble. Gone are the days when doctors advised heart patients to limit their physical activity for fear of adding more stress on the heart. Dozens of studies have shown that heart patients need to work their heart muscles more, not less. Aerobic exercise (walking, jogging and cycling) are generally the most beneficial, but weight lifting has recently been found to help fight heart disease as well.

An added benefit of stepping up his exercise routine is that it will help him shed his extra pounds. Obesity--defined as 30% or more over your healthy body weight--can increase the risk of heart disease as much as 15%. To lose his excess baggage, Cheney will have to start burning off more calories than he consumes. Exercise, however, is only half that battle. The other half will take planning and portion control. He may not be able to avoid state dinners, but he can push the creamy sauces and fatty meat to the side of his plate.

At first glance, Cheney's blood pressure (106/80) and total-cholesterol level (174 mg/dL) seem O.K., but given his medical history, they are not ideal. Cholesterol levels below 200 are normal for most people. But in a heart patient taking cholesterol-lowering drugs, doctors prefer to see levels from 130 to 150--targets best achieved by combining medication with strict diet and exercise.

Cheney may not be able to undo all the damage his heart has suffered over the past two decades, but if he cleans up his act, he may help ensure that the heartbeat away from the presidency is a strong one.

Dr. Ian is a medical correspondent for NBC's Today Show. E-mail: ianmedical@aol.com More on heart disease: americanheart.com