Can Cheney Take the Heat?

For a guy who had his first heart attack at age 37--and two more before his 48th birthday--Dick Cheney has been pretty lucky. When the first one hit in 1978, doctors were learning new ways to treat and prevent heart attacks, which occur when the flow of oxygen-rich blood is partially interrupted and some of the heart tissue dies. He had his second and third in 1984 and 1988, during a decade of extraordinary progress in the medical and surgical treatment of heart disease. By the time he underwent quadruple-bypass surgery in August 1988, the procedure had become almost routine.

So much for the past. What about Cheney's future health? He clearly did himself a big favor 22 years ago when he gave up a three-pack-a-day cigarette habit. He supervised the planning and execution of the 1991 Persian Gulf War with nary a complaint from his ticker. He was also lucky that his first attack struck the bottom wall of his heart, an area that is often associated with minimal tissue damage.

Last week the Bush campaign released two letters from Cheney's doctors asserting that the candidate's chosen running mate will be able to withstand the rigors of a national campaign and possible elected office. Most cardiologists we spoke to agreed. But they also noted that the cautiously worded medical statements were less than forthcoming and raised as many questions as they answered. For example:

--IN WHAT SHAPE ARE CHENEY'S BYPASS GRAFTS? For technical reasons, most of his grafts must have come from veins in his legs. After about 15 years, many leg-vein grafts become blocked as well.

--WHAT ARE CHENEY'S CURRENT CHOLESTEROL LEVELS? His doctors say he has a long history of high cholesterol that "has been vigorously and successfully treated with medication." But they don't provide any figures. Dr. Roger Blumenthal of Johns Hopkins Medical School cites a number of studies--one of which was published just three weeks ago--showing that bypass patients who lower their LDL (bad cholesterol) levels to 100 mg/dl or less reduce their likelihood of needing additional invasive treatment by 30%.

--JUST HOW STRONG IS CHENEY'S HEART? His physicians report that stress tests have been "stable and unchanged for the past several years." But they don't provide Cheney's so-called ejection fraction, a measurement that tells doctors how well the heart is pumping blood. "Stable and unchanged does not mean normal," says Dr. David Pearle at Georgetown Medical Center. "That is cautious wording. It could be mildly or even moderately abnormal and still be stable and unchanged."

--WHAT KIND OF DIET DOES CHENEY FOLLOW AND HOW STRENUOUSLY IS HE EXERCISING? "He doesn't look like the picture of health," notes Dr. Eric Topol, chairman of cardiology at the Cleveland Clinic. The former Secretary of Defense has gained an estimated 40 lbs. since he left the Pentagon for corporate life. He exercises 30 minutes on a treadmill "several days a week"; many doctors believe that a pace of 4 m.p.h. is the minimum needed to get any cardiovascular benefit.

We may never know the answers to these questions--at least not before the election. But this much is certain. Though Cheney's history of heart trouble places him at a statistically higher risk than the average 59-year-old man for another heart attack, his odds of surviving through healthy living and proper medical care have never been better.