Tim Russert has died of a heart attack, and many of his colleagues were shocked.

Yet as a doctor, I wonder: why are we shocked, when heart disease is still the major killer of Americans?

A lot of people were shocked because he appeared to be in good health, and his death was sudden. But another reason is that the baby boomer generation is now at an age where they will have to confront their own mortality.

Too often, the miracles of medicine are stressed so much that people forget that we are not really in charge of life. The Filipino “Behala na” or the Islamic “Inshallah” shows a bowing to fate that is unthinkable in Americans who feel they are the Captain of their own soul, and in charge of their own fate.

And sometimes this is true: When it comes to heart disease, we do have a lot of control over our lives.

One of the changes in medical practice over the last 40 years is that we now can prevent and slow down the development of heart disease.

In 1968, when the first Cardiac care units were just being opened, and when CPR was still in it’s infancy, about all we did for heart attacks was put people on bedrest.

Nowadays, you give Aspirin and/or a blood thinner, do an angiogram, and do an emergency angioplasty, and sent the guy home in a day or two. Sometimes you “stablize” the problem and after a week or two do a bypass graft around the blockages. Open Heart Surgery, which once was rare, is now common.

But it’s not just the surgery when heart symptoms start, what has changed is that we now can prevent the blockages from forming. When one hears about the “high price of medicine”, much of that money is going toward medicines to prevent and treat heart disease.

One of the first medicines we had to save people’s lives was the “diuretics” AKA water pills. In 1968, for congestive heart failure, where the heart would be so sluggish a person would fill with fluid, our main medicine was digitalis, an herbal medicine that dated back 200 years. We gave it until the person got better or got sick, and we saw a lot of side effects from that dangerous medicine. We still used bedrest to get rid of excess fluid, with an occasional shot from mercury based injections for severe edema. Then came Thiazide and loop diuretics that kept people going despite a sluggish heart…and later, the ACE inhibitors and beta blocker type medicines were found to prolong life.

Another  big breakthrough was medicine for  high blood pressure.Mild high blood pressure wasn’t a big problem: we’d see people in their sixties with big hearts from mild high blood pressure, and they’d have strokes or heart attacks. But some of the people with severe hypertension would die of strokes in their thirties.

Then came Aldomet, which had lots of sleepiness side effects, but worked…and later, many, many other medicines came around, and although we still see young people dying of strokes, it is much less common than 40 years ago.

Another big breakthrough was recognizing that simple aspirin could stop the blood from clotting when there was arteriosclerosis. In 1968, we knew the blood thinner coumadin could prolong the life of a person with heart disease, but it had so many side effects we rarely used it. Studies showing aspirin or newer medicines stopped the clots from forming saved many lives.

But probably the big breakthrough in prevention was the “Statin” medicines that lowered cholesterol. For years, we placed people on diets. A strict, low calorie semi vegetarian diet would probably work, but like the “low salt” diets for congestive heart failure, people being people would cheat, and end up in trouble.

But in the 1980’s the statins came out, and with the newer versions, we found that we could lower cholesterol, and with experience we found fewer side effects than expected, so we saw larger and larger doses used. Suddenly, we found hope we could stop heart disease in it’s tracks.

Combine this with the public health campaigns that lowered smoking rates and improved the American diets, and “premature” heart disease is now a preventable problem.

And this doesn’t even include the open heart surgery, angioplasties, and implantable pacemakers.

But of course nothing is perfect.

So when Tim Russert died last weekend of a massive heart attack, everyone was in shock. He was so young, said one article.

Ah yes. He was 58, but 58 is now considered young, especially with a cohort of yuppie baby boomers who think if they eat right, exercize and take their medicines they will live forever.

But his passing, although unexpected, was not an unusual death. As a doctor, one of the things that keep us humble in the face of medical “miracles” is that despite everything, people still die.

As one of my Cardiology teachers reminded us, that is why doctors are rarely pious, but rarely atheists: because if you didn’t believe that there was a fate or reason behind the tragedies we see everyday, we couldn’t keep going.

So prayers for Russert and for his family.

He left behind him a legacy of ethics and fairness, and a family who loved him.


Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket.

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