Surviving five heart attacks makes former Vice President Dick Cheney pretty unusual — showing that he has good medical care as well as a particularly aggressive form of heart disease.
But the number, attention-grabbing as it is, isn't the real issue: It's how much damage a heart attack does to the muscle of your heart that determines how well you recover, and the quality of remaining years.
"One really significant heart attack can be much more worrisome, in fact life-threatening, than several heart attacks that have not resulted in significant injury," explained Dr. Clyde Yancy, a cardiologist at Baylor University Medical Center in Dallas and president of the American Heart Association.
Still, "even one mild heart attack proves you have blocked blood vessels around your heart and establishes a higher risk for a next heart attack."
Cheney was fortunate; Monday's heart attack was described as mild. But at 69, he's now lived almost as long with heart disease as he has without. His first heart attack came at the early age of 37.
A heart attack occurs when blood flow to the heart is blocked, and how long that happens, in how big a blood vessel, determines the resulting degree of cardiac muscle damage.
Cheney was admitted to George Washington University Hospital on Monday experiencing chest pains, and officials revealed Tuesday that lab tests uncovered the heart attack. Blood tests look for enzymes the heart releases when it has been damaged, and the degree of enzymes helps assess the severity.
Cheney aide Peter Long said the former vice president was "feeling good" Tuesday after undergoing a stress test plus a heart catheterization to examine blood flow to the heart. He didn't say whether an angioplasty — a procedure to clear a blockage — was performed during the catheterization. It's possible to have blockages in blood vessels too small to warrant that procedure.
Deaths from heart disease have dropped nearly 40 percent in the past decade, thanks to cholesterol-lowering medications and the kinds of surgical treatments Cheney has received: bypass surgery, two angioplasties to clear clogged arteries, a special pacemaker implanted to help a weakened heart beat properly. He also has undergone electric shock to treat an abnormal heart rhythm called atrial fibrillation, also more common in heart attack-weakened hearts.
Still, the heart attacks keep coming.
"It unfortunately tells us he's got bad luck in the gene pool. His genetics have given him an aggressive" form of heart disease, said Dr. William O'Neill, an interventional cardiologist and executive dean for clinical affairs at the University of Miami School of Medicine.
Even mild heart attacks cause cumulative damage. While his doctors haven't revealed the extent of Cheney's damage, O'Neill said it's likely he "doesn't have much reserve."
The average person who survives a first heart attack may survive a second, sometimes a third, but very few survive more, said Dr. Edward I. Morris, a cardiologist at Washington Hospital Center, across town from Cheney's hospital.
Heart disease is progressive. Cheney's bypass was in 1988, and they typically last about a decade before the grafts begin to narrow. Arteries cleared by angioplasty re-clog, too.
And that first survived heart attack is a crucial teachable moment, when suddenly doctors' warnings — about diet and exercise, and to quit smoking, and to treat high blood pressure, diabetes and high cholesterol — take on new meaning. The right care can indeed prevent a second heart attack and provide years of quality life, Yancy said.
Attention to Cheney offers a different teachable moment: How to avoid even that first heart attack. Yancy points people to the heart association's "seven simple steps" Internet program, at www.heart.org/mylifecheck. Get three easy measurements from your doctor — blood pressure, blood sugar, cholesterol level — and answer four lifestyle questions, and the program will tell where you need to improve.