At one time, a history of three heart attacks and quadruple bypass surgery would bode poorly for a 59-year-old man like Dick Cheney in his quest to stand one heartbeat away from the presidency. But no longer.
According to prominent heart specialists in Baltimore, doctors today generally give a rosy assessment for people with a history of heart disease, as long as they follow a healthy lifestyle, take appropriate medication and have annual checkups.
If his heart's desire is the vice presidency and he has followed a disciplined health regimen, the new Republican candidate for vice president should not let coronary heart disease slow his pace at all, the physicians said.
"I don't think because someone has a history of coronary heart disease you can project that he will be a problem as a vice presidential candidate," said Raymond Bahr, medical director of the Paul Dudley White Coronary Care System at St. Agnes Health Care.
"He should do real well if he's addressing the risk factors."
Dr. Roger S. Blumenthal, director of preventive cardiology at Johns Hopkins Hospital, agreed: "Assuming his doctors have motivated him successfully in optimizing his lifestyle and taking appropriate medications, his prognosis is good."
Questions about potential physical impediments have shadowed Cheney's career for more than a decade. He has been quizzed about how heart attacks in 1978, 1984 and 1988 affected his health and whether they signify further trouble.
In confirmation hearings for secretary of defense in 1989, Cheney met direct questioning from the Senate Armed Services Committee, whose members wanted assurance that one year after quadruple bypass surgery Cheney's health would not be an issue.
Again, in 1994, as he considered a run for the presidency, the same questions erupted.
Last week, he attempted to forestall concern with a physical examination that reportedly resulted in a favorable prognosis from his physician. Earlier this week, Cheney's personal cardiologist said the former defense secretary has no symptoms of heart disease and is in good health.
Coronary artery disease, which affects more than 12 million Americans, occurs when small arteries that feed the heart muscle clog with cholesterol plaques, diminishing the flow of oxygenated blood. When blockage is severe, the lack of oxygen can lead to a heart attack.
In cases like Cheney's, surgeons sometimes restore the blood flow with a bypass procedure. By grafting veins from another part of the body -typically from the leg - to the heart, they can reroute the blood flow that was blocked.
Explicit details of Cheney's medical history became public Tuesday when his physician at George Washington University Hospital reported that Cheney's abnormally high cholesterol levels have been "vigorously and successfully treated" with medication.
In an interview with CNN's "Larry King Live," Cheney revealed that he had given up a 20-year smoking habit after the first heart attack in 1978 and exercises regularly. It's also known that he has long enjoyed a challenging schedule of physical activities such as skiing, tennis, backpacking and biking in the mountains.
Stress also should not be a problem for Cheney as long as his heart is functioning well, said Stephen Gottlieb, director of the cardiac care unit at the University of Maryland Medical Center.
"The basic point of bypass is to supply blood to the heart via new vessels, so if those vessels are working properly, that person [with the bypass] should be able to tolerate stress as well as anyone else," he said.
Longevity of grafts
The other question likely to be raised about Cheney's heart is whether the four grafts will remain in good shape today, 12 years later.
At one time, it was not unusual after 10 or 15 years for blockages to afflict the grafts.
During the past 20 years, however, advances in science and technology have changed that.
"When he had his first heart attack, we knew very little about what caused heart disease and how to treat it," said Hopkins' Blumenthal. "But by 1994 we had conclusive evidence that lowering cholesterol could save lives.
"We also now know that his systolic blood pressure should be less than 130, whereas 20 years ago doctors would have been satisfied if it was 150. I'm sure that his care now is very different from what it would have been in the 1970s and 1980s."
Even if evidence of blockage appeared again, the doctors said, improved procedures such as angioplasty, in which a balloon is used to open a clogged artery, make treatment relatively uncomplicated.
"You have more possibilities today, in part because angioplasty has done exceptionally well over the past five years," Bahr said. "If he had problems, you could redo [the bypass], but even that's not a big thing and it's equally successful these days.
"With these advances, I'd say why not give him the benefit of the doubt and not castigate him for having an illness that's pretty common."