Tim Russert was a good patient, taking medications for his heart disease and exercising, his doctor said. He had no chest pains and he passed an exercise stress test weeks ago. Yet at 58, he suffered a heart attack and died.
That's not uncommon, say cardiologists. Heart disease patients can significantly reduce their chances of a heart attack, but they can't totally prevent it, said Dr. Howard Hodis of the Keck School of Medicine at the University of Southern California.
"Under the most ideal circumstances, there's still going to be individuals who succumb to the disease process. It's never going to be 100 percent," said Hodis.
Experts say that shouldn't discourage heart patients from doing everything they can to lower their risks of a heart attack: control blood pressure and cholesterol, quit smoking, lose weight, change their diet, exercise and reduce stress.
"If you have heart disease, does it mean that it's all over? No. But it really means that you have to pay attention," said Dr. Suzanne Steinbaum, a preventive cardiologist at Lenox Hill Hospital in New York.
For many patients, the hardest part is changing their diet and getting exercise, she said.
"It's easier to take a pill than it is to get up and do something," said Steinbaum. "It's very difficult. It's a big commitment."
Russert, host of NBC's "Meet the Press," had a heart attack Friday in Washington while recording voiceovers for the news program.
His physician, Dr. Michael A. Newman, said in a statement that the heart attack was caused by a clot in an artery, blocking blood flow to the heart. That led to a fatal cardiac arrest _ an abnormal heart rhythm that stops the heart from pumping blood to the body.
Newman said Russert had hardening of the arteries but no symptoms, and his blood pressure and cholesterol were well controlled. Russert exercised on a treadmill regularly, including the morning that he died, Newman's statement said. An autopsy showed Russert had an enlarged heart and significant blockage in the coronary artery where the clot formed.
Newman, who declined an interview request from The Associated Press, noted Monday night on CNN that Russert was overweight.
"Tim was a good patient. Are there things all of us as patients could be better at? Sure. But Tim was a good patient," Newman said on CNN's "Larry King Live."
About 920,000 Americans have a heart attack each year and 38 percent are fatal, according to the American Heart Association. Half of men and 64 percent of women who die suddenly of heart disease have no previous symptoms.
Despite impressive advances in preventing and treating heart disease, experts say there's no easy way to know which patients are going to have a heart attack and which aren't. Most heart attacks occur when fatty deposits in the arteries rupture and a clot forms.
The goal of preventive measures is to stabilize the plaque and prevent a rupture, or to prevent a dangerous clot from developing if the plaque does burst open.
Steinbaum said patients have difficulty understanding how someone can have a normal stress test like Russert, and then have a heart attack later. She said Russert apparently didn't have enough blockage when he had a stress test in April to indicate any problems. The test shows how the heart reacts to exertion and whether there's adequate blood flow to the heart.
"A stress test is important for us to assess how well the heart is functioning, but it doesn't give you a bye." said Steinbaum.
Not all heart attacks result in the heart suddenly stopping, as in Russert's case. Dr. Paul Wang of Stanford School of Medicine said only a small percentage lead to cardiac arrest, and it's not clear why, although the size of the heart attack can be a factor.
"This is far from uncommon though, unfortunately," he said. "There's still a substantial number of people who do have cardiac arrest," after a heart attack.
Few people survive a sudden cardiac arrest; a prompt shock from a defibrillator is needed to restore a normal heartbeat. Wang said the Russert case highlights the need for workplaces to prepare for a cardiac arrest, just as they plan for fire drills.
But not everyone can be saved. Russert's doctor said on CNN that efforts to revive him began immediately and paramedics shocked his heart three times before reaching the hospital.