Should Cheney Slow Down?

By Christine Gorman

Armchair cardiologists were everywhere last week. After Dick Cheney's second unplanned trip to the hospital in four months, the tabloids were full of anonymous quotations from "worried pals" who thought Cheney should cut back on his work load. Talk-show hosts repeated their physicians' advice to take it easy. Political types made book on who would replace Cheney if he bows out before George W. Bush runs for re-election, and syndicated columnist Arianna Huffington wondered if the Vice President was on some kind of "suicide mission."

All these hyperconfident opinions assume that stress is bad for your heart and that scaling back can only improve your health. But life isn't as simple as that. True, there is growing evidence that stress plays a role in cardiovascular disease, both in the buildup of fatty plaques inside the arteries, a process called atherosclerosis, and in the triggering of heart attacks. But stress is by no means as clearly defined a danger as, say, smoking, obesity or high cholesterol.

Furthermore, it wasn't atherosclerosis or a heart attack that sent Cheney to the hospital. Rather, scar tissue had formed around the wire-mesh stent that was implanted last November to open a blocked coronary artery. This had led to a renarrowing, or restenosis, of the vessel. (Restenosis occurs in 20% of such cases.) Although one study suggests that "burnout" can trigger restenosis, the evidence is hardly conclusive and in any case doesn't apply to Cheney, who obviously relishes his job. "If you have a job you love, then you're lucky," says Dr. Alan Wasserman, chief of medicine at George Washington University Hospital, where Cheney was treated.

Indeed, stress may not be the primary issue. "It's really how you cope in situations that's critical," says Dr. James Blumenthal of Duke University. "Do you have control over your day and your schedule?" Studies have also linked depression or the lack of a trusted circle of friends and family to a greater likelihood of cardiac complications.

All of which sounds like good news for Cheney. "I very much enjoy my job, am having a very good time--don't consider it stressful," he told reporters last week, less than 24 hours after he was released from the hospital. And clearly Cheney's puckish sense of humor has suffered no blockage. "The stress level is a lot tougher when you're doing something you don't like, like being a reporter."

That doesn't mean that Cheney shouldn't look for ways to ease the pressures of his life. Blumenthal and his colleagues at Duke have found that relaxation exercises and a few changes in attitude helped lower the risk of heart complications in their cardiac patients 74% over a three-year period. "They can modify how they handle stress," Blumenthal says, "without affecting their ability to be successful on the job."

Cheney's doctors last week performed a repeat angioplasty to reopen his scarred-up coronary artery. They now estimate the chances of another restenosis within the next six months to be about 40%. Should that occur, they will probably turn to one of the radiation treatments approved by the Food and Drug Administration last year that melts away the internal scar. "This field is changing so rapidly," Wasserman says. "We didn't have stents a few years ago. We didn't have radiation therapy a few months ago." So what is Cheney's prognosis? "We can't predict the future," Wasserman says. "But personally, I think he'll do just fine."

--By Christine Gorman