Heart: An American Medical Odyssey Read Online Free PDF Page B

twenty-seven years as a physician. Melanie was brave and beautiful and doggedly refused to leave her husband, Marty, the love of her life, until the relentless disease finally consumed her with its singular, terrible malice. I remind patientswho continue to smoke that there are consequences even worse than another heart attack. There are some that are even worse than death.
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    The identification of individual behavioral and physiological characteristics associated with an increased likelihood of developing atherosclerotic heart disease (risk factors) was achieved in large measure through the efforts of a long-term study run jointly by the National Heart Lung and Blood Institute and Boston University. The study, which began in 1948, enrolled 5,209 men and women from the town of Framingham, Massachusetts, and followed these subjects every two years with physical examinations, blood work, and detailed interviews with the goal of identifying common factors associated with the development of heart disease. Over the past sixty-five years, the still ongoing Framingham Heart Study has identified hypertension, diabetes, tobacco use, high cholesterol, obesity, physical inactivity, and male gender as risk factors for heart disease.
    Framingham investigators have developed a variety of tools, now accessible with online calculators, that use readily available clinical data such as age, weight, blood pressure, and cholesterol to predict an individual’s risk of developing heart disease. At the time of Dick Cheney’s heart attack in 1978, he was thirty-seven years of age, had a blood pressure of 125/70 mmHg (normal) and serum cholesterol of 271 mg/dl (high), was an active smoker, and was 5 feet 9 inches tall weighing 196 pounds. Using these variables, the Framingham model estimates that Mr. Cheney had an 8.2 percent ten-year risk of developing heart disease (similar to that of a fifty-year-old man) compared to a normal risk of 3.4 percent and “optimal” risk for a man his age of 2.6 percent. Subtract the history of cigarette smoking from the model, and Mr. Cheney’s ten-year cardiac risk drops in half to 4.1 percent.
    Although disease of the coronary arteries typically announces its presence in middle age, a heart attack is usually the culmination of a process that begins decades earlier, typically when we are still children. It’s in childhood that we develop our eating habits and exercise patterns and,importantly, when we have our first cigarette.In the 1970s, doctors at Walter Reed Army Medical Center examined the hearts of soldiers killed in Vietnam and noted that although the young men were on average only twenty-two years old, evidence of atherosclerosis was identified in almost half.
    The seeds of heart disease are planted early.

CHAPTER 2
Echoes of Ike
VICE PRESIDENT CHENEY
    Although I’d suspected something was wrong when I woke up in the middle of the night with a strange sensation in my arm and hand, hearing the words was a blow: “You’re having a heart attack, Mr. Cheney.” Hours earlier, I was a thirty-seven-year-old in what I thought was great health, going all out, working around the clock, to try to win Wyoming’s congressional seat. I felt young and invincible. Now I was lying in the ER at Cheyenne Memorial Hospital, having passed out shortly after I arrived. I came to as physicians and nurses scrambled around me. I had a million questions. How could this have happened to me? Was my life at risk? How would this change my life? How would it change my race for Congress? Would I have to drop out of the race?
    Nobody had many answers in those first few hours. I was admitted to the hospital and began what would be an eleven-day stay. Although there were no cardiologists in Cheyenne in 1978, I was fortunate that my case was assigned to an internist named Dr. Rick Davis. I have never forgotten the advice he gave me in the first days after my first heart attack: “Hard work never killed anybody,