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A Look at Heart Disease

Aired September 11, 2004 - 07:30   ET


In many cases, the leading killer of both men and women in this country can be prevented. That killer, of course, is heart disease. With President Clinton's heart scare fresh in our minds, Holly Firfer takes a look at what we call can learn from his experience.


UNIDENTIFIED FEMALE: Here's the collard greens, the chicken, the barbecue ribs.

HOLLY FIRFER, CNN MEDICAL CORRESPONDENT (voice-over): Former President Bill Clinton is famous for his diet, the stress of being one of the most famous men in the world, and now heart disease. Like most of the approximately 400,000 patients who get bypass surgery every year in this country, his symptoms really seemed to come out of nowhere.

BILL CLINTON, FORMER PRESIDENT OF THE UNITED STATES: I just had a feeling a couple of days ago, I had to have it checked, when I finally got some tightness in my chest. And I hadn't done any exercise. It's the first time that ever happened to me.

FIRFER: Even Bill Clinton, who exercised, started eating a healthier diet and got presidential level medical care for eight years, can fall prey to relentless arteriosclerosis, or hardening of the arteries.

When President Clinton left office, he did have elevated cholesterol, at 233. The upper edge of normal is 200. Most doctors recommend even lower. His so-called bad cholesterol was 177. It had jumped 40 points in his last year of presidency alone. Normal is less than 130.

But President Clinton was one of the lucky ones. He caught the disease in time.

DR. CRAIG SMITH, NEW YORK-PRESBYTERIAN HOSPITAL: In several of the vessels, the blockage was well over 90 percent. There was a substantial likelihood that he would have had a substantial heart attack in the near future.

FIRFER: Paying attention to the warning signs probably saved his life. President Clinton faces a long road to recovery, but now that he's been given a second chance, he must add eating well and exercising to his busy schedule of campaign stops and book signing tours.

Holly Firfer, CNN.


GUPTA: Thanks, Holly.

As we heard, President Clinton had some classic symptoms of heart disease -- chest discomfort and shortness of breath. There are other signs to watch out for, as well. Heart palpitations -- that's kind of a fluttering feeling. Also, if you feel your heart rate is faster than normal or that you're dizzy. Other signs might include nausea or extreme weakness.

With us this morning to talk about all your heart disease questions, Dr. John Gott.

He's a cardiothoracic surgeon at Piedmont Hospital.

He's in private practice here in Atlanta.

Welcome, first of all.

DR. JOHN GOTT, HEART SURGEON: Thank you very much.

GUPTA: Thanks for joining us.

GOTT: Appreciate it.

My pleasure.

GUPTA: You're a pretty busy surgeon.

How many cases do you do a year, roughly?

GOTT: About 300 operations a year.

GUPTA: You know, it's interesting, as we mentioned, President Clinton, former President Clinton had some early warning signs. Initially they thought it was reflux, or he thought it was reflux.

Is that pretty common?

GOTT: It is common and that's scary, because of the overlap of these symptoms. It can go down the wrong direction. Gastroesophageal reflux disease really doesn't have an immediate life threatening component, whereas heart disease certainly does. And it's scary how similar the symptoms are of one disease to the other.

GUPTA: I mean a lot of people get burning in the chest from time to time.

How do they know when to go to the doctor? GOTT: Even the doctor can't tell. And if you do have that and if there's any question, it's better to err on the side of continuing to investigate for heart disease.

GUPTA: These are pretty common operations, about 1,000 a day or so.

What sort of things, you know, how does it really work, a bypass operation? What is the patient going to go through?

GOTT: It is a fairly invasive operation, as we, you know, practice it now. There is on the horizon a potentially less invasive, there are less invasive procedures on the horizon. But typically an incision involving the sternum or breast bone, it's spread. And veins are taken from the leg, in many cases, and a small incision there, usually. We have a new way of taking the veins called endoscopic surgery.

Once upon a time, there was a very long leg incision. Now, it's very small. Patients do much better in terms of risk for infection and discomfort.

GUPTA: But it is an invasive operation. You have to stop the heart in most cases. In some cases not. We're going to talk more about that.

But let's get to some of our viewer questions.

First of all, this is an e-mail from Mark in Toronto, who writes: "Could you please explain the difference between using veins from the legs versus arteries from the breast area? Is there better long-term success with one versus the other?"

You were just sort of talking about this a little bit, but arteries versus veins.

GOTT: He hit the nail on the head, and we saw a great example in former President Clinton's operation of the use of the internal mammary artery. That vessel, for some reason, tends to be immune to arteriosclerosis. There's certainly a Nobel Prize in the works there if somebody could figure that out and take it to other vessels. But it is usually placed to the most important blood vessel in the heart, which is the left hand tertising (ph), a vessel that runs down the front of the heart. It supplies about 40 percent of the muscle mass of the main pumping chamber.

GUPTA: Right.

GOTT: So if we take that arty, which appears to be relatively immune to the ravages of arteriosclerosis, and put that to the most important vessel, we get the most mileage out of the operation.

The veins from the leg, in contradistinction, have -- are more likely to become involved with the arteriosclerotic process, just as are the, what we call the native arteries or the arteries on the heart. So it confers better quality and length of life to use those vessels.

GUPTA: And what is the prognosis for him? How long before he might need a sort of replumbing, if you will, of his heart again?

GOTT: The prognosis short and long-term really revolves around the pumping function of the heart. As we have heard from his cardiologist and surgeons, the president, the former president, was fortunate in that he got help. He did pay attention to the symptoms. He got help, excellent help, before a heart attack.

GUPTA: Right.

GOTT: Many patients don't. The good pumping function will, it will tend to carry him indefinitely into the future. He may have his life expectancy approach that of the average 58-year-old man.

GUPTA: So for the rest of his life he should be OK from his cardiac heart perspective.

GOTT: There can be, out to a decade or so, a small but real incidence of development of the plaque in areas that were not previously bypassed or in the grafts that were placed to the heart. And many people will need to go on new medication, can have angioplasty of the grafts or the blood vessels even after an operation, or can have a repeat operation.


GOTT: Maybe 10 to 15 percent of most cardiac surgeons' schedule would be made up of repeat patients.

GUPTA: I should say, my father had this operation 13 years ago and is doing very well. It changed his life.

Another e-mail now from Dean in Washington, D.C., who writes: "I've been on statins for 10 years and I'm not sure of the benefits. Was it a problem for Clinton that he stopped his?"

So, you know, he lost some weight, doctor. President Clinton lost some weight, he decided to stop his medications.

How much of a problem was that for him?

GOTT: The statin drugs, from the perspective of a surgeon and from the internal medicine cardiology fields, it's a miracle drug. It really arrests the progression of this arteriosclerosis.

President Clinton's arteriosclerosis probably began decades ago and was fairly advanced, even when he started the statin drugs. There is a great danger, unless under the guidance of a physician, a great danger in stopping the statin because even over as short a period as one month from the time of unprescribed cessation of statins, the patients can have an increased risk for heart attack, a significantly increased risk. And so it's not to be taken lightly and it may have a rebound effect with cessation.

GUPTA: We're talking with Dr. John Gott. He's a campaign cardiothoracic surgeon at Piedmont Hospital here in Atlanta.

How can you tell if you have a heart problem before it's too late? We'll get to that question and more when House Call returns.

Stay with us.


UNIDENTIFIED MALE: I was just wondering if there was any type of regular screening process that would show the same type of problems that Bill Clinton had?


What tests should you be asking for when you see your doctor?

Plus, diet versus exercise, which is more important when it comes to heart disease?

All that's coming up.

But first, today's "Daily Dose" quiz.

How long is the network of blood vessels in your body? A, the length of a football field; B, the distance across the Atlantic Ocean; or C, nearly two and a half times around the globe? That answer when we come back.




UNIDENTIFIED FEMALE: Checking our "Daily Dose" quiz, we asked how long is the network of blood vessels in your body, the length of a football field, the distance across the Atlantic or nearly two and a half times around the globe? The answer is C. Your network of blood vessels measures about 60,000 miles.


GUPTA: That is a remarkable fact, 60,000 miles. And you've got to take care of those miles of blood vessels. Here to tell us how to do just that, Dr. John Gott. He's a cardiothoracic surgeon at Piedmont Hospital.

Doctor, we received lots of questions about how people can avoid ending up in former President Clinton's position.

Let's take a look at one of them now. Matt from Texas writes: "Is there a way to tell if your arteries are getting clogged before you have a heart attack or have symptoms like President Clinton? It seems like this happens to people who doctors claim are healthy, which is scary."

President Clinton, just to review some of the facts, when he left the presidency in 2001, he had a treadmill test, a stress test, which was normal. Four years later, he's having major heart surgery.

How does that happen?

GOTT: That's a real bone of contention. It is scary. We hear those stories all the time. The history and physical that we talk about on a yearly basis, the annual physical, is only predictive to a degree, maybe 50 percent predictive. The treadmill, putting ball park figures on it, maybe 70, 80 percent predictive. Some of the studies where material is injected that's radioactive into the body that helps illuminate the heart might take it up to 90 percent predictive. A PET scan may be 95 percent predictive.

But as the former president said, the angiogram is really the gold standard and gives us an idea -- it gives the surgeon a great roadmap...

GUPTA: Of what it is.

GOTT: Of what it is.

GUPTA: Let's hear what the president -- before his surgery, President Clinton actually had some recommendations for people who might be at risk.

Let's take a listen.


CLINTON: I think if people have a family history there and high cholesterol and high blood pressure, they ought to consider the angiogram, even if they don't have the sense of diet. There is some chance of damage there, but it's like one in a thousand. And I really think it probably saved my life.


GUPTA: Preventive angiograms. Is that something that's going to catch on, don't you think?

GOTT: I doubt it. And all of these other tests that we've mentioned are preludes to this. It, really, to get into the system, we need to have -- it needs to be based on risk factors. Otherwise we would be working night and day with inadequate resources to do angiograms on everybody that might want one.

GUPTA: So to be clear, an angiogram is a test that you would order as a cardiothoracic surgeon if you were potentially planning an operation, not just to diagnose something? GOTT: No, it is a method of diagnosis. All these tests screen people and try to steer people away from the test. It is accepted that one of three angiograms would lead to a normal diagnosis in the coronary arteries. And that sounds like wow, you're doing, you know, 33 percent of the tests unnecessarily. But that's accepted, again, to lower the threshold, to try to prevent us from missing somebody that does have the blockage.

GUPTA: Could have a heart attack.

GOTT: So we're at a pretty low threshold as it is.

GUPTA: Let's distill this down a little bit more. A new study shows stress tests may not catch heart disease early on. More study is needed, but researchers say many patients who had normal stress tests and then went on to have special electron beam C.T. scans showed a significant calcium buildup in their hearts. The study points out C.T. scans could be helpful in predicting your future risk of heart disease.

We've got a question on this topic from Steve in New York. He says: "It seems that a stress test may not be enough to detect advancing heart disease. What about those body scans that are advertised that measure the calcium deposits around the heart area?"

So that, you know, these are these fancy gadgets. They're not covered by insurance, by the way. It costs about $400. I had one myself, actually, just because I was interested in showing it. And we've got some video of that. You can see me actually in the C.T. scanner there. My test came out fine. It just said that it was normal.

What do I do with that information? Am I normal?

GOTT: Pat yourself on the back. Congratulations. I'm happy for you.

There is a score that's generated from this C.T. scan and it can help stratify the patient. It can be complementary, supplementary to the radionuclide scan. It can find more patients, you know, we talked about that maybe the radionuclide scans maybe would only be 80 percent predictive.

GUPTA: Right.

GOTT: This can help bump that up.

GUPTA: Bump it up.

GOTT: If the score were high, that might lead to an angiogram or catheritization as the person had.

GUPTA: Why don't they -- why don't people get this test? I mean if the stress test isn't predictive enough, why not throw a test like this into the mix to try and give people a better sense if they're going to have a heart problem? GOTT: That is -- the algorithms, the pathways that lead us down one way to another in investigation of heart disease are convoluted and becoming more so because of newer and newer tests that are coming onto line. And it's even more complicated by those that have the means to pay for them and the sophistication to ask for them.

GUPTA: Right.

GOTT: And not all of them are covered by insurance.


GOTT: So it's, it is, it's still being hashed out. But this C.T. scan may be finding people who had silent arteriosclerosis. It may steer them toward early medication, the statin drugs, which can slow down the progression of the disease at a very early stage.

GUPTA: So it may change the whole algorithm by which they do it? It's not a perfect process. I think you'd admit that. A lot of people obviously concerned about that.

More of your questions on preventing heart disease coming up.

That's coming up on House Call.


UNIDENTIFIED FEMALE: From genetics to diet and exercise, what can you do to stop America's number one killer?

Plus, watching the numbers -- how high is too high for your blood pressure and cholesterol?

Stay tuned.




CLINTON: Some of this is genetic and I may have done some damage in those years when I was too careless about what I ate. So for whatever reasons, I've got a problem and I've got a chance to deal with it and I feel that I've really got -- let me just say this. The Republicans aren't the only people that want four more years here.


GUPTA: Always the consummate politician, I guess. A good sense of humor there. The president, like so many other Americans, had some risk factors for heart disease he could not control, like the fact that he's a man and his age. While he's still relatively young at 58, heart disease risk does increase as you get older. Also, if you have a family history of heart disease, you need to take special care. There are several risk factors you can control. Arguably, the most preventable heart disease risk factor is smoking, whether it's cigarettes, pipes or cigars. Smoking nearly doubles your risk of having a heart attack.

Also, having high cholesterol or high blood pressure and uncontrolled diabetes; diets high in saturated fats and cholesterol; and drinking too much alcohol. Also, all of those things put you at a higher risk, along with stress.

When you're overweight, your heart has to work harder. And if you're not physically active, that also puts you in jeopardy of developing heart problems.

We're talking today about how you can prevent heart disease with Dr. John Gott.

He's a cardiothoracic surgeon here in Atlanta.

Thanks again, doctor.

GOTT: Thank you.

GUPTA: First of all, which seems to player a larger role, genetics or your overall lifestyle?

GOTT: Genetics may account for five percent of our patient population, this early, very early heart disease, where yes, my father died when he was 40 years old, my brother just had his coronary bypass, 35 years old. That may account for roughly five percent, a relatively small proportion. But they are very difficult to control, very difficult to modify that disease process.

Which leaves the bulk of patients with things that we can do things about, which you outlined very nicely.

GUPTA: Well, thanks. So most people can actually control some of these risk factors, which is good news.

GOTT: The scary thing, really scary, is when you have two or more of those things that you can control; three of them, if you, they begin to add up and synergize and become even more powerfully negative with the acceleration of arteriosclerosis.

GUPTA: Right. Let's keep on topic here.

Let's get to an e-mail now from Merri Helen from Idaho. She asks: "What can be done to help prevent hereditary heart problems? All my male relatives have heart disease. I have an 8-year-old son who I want to protect from heart problems."

She's, you know, planning ahead here for her 8-year-old son.

But what do you tell her?

GOTT: It, with the advent of these new drugs, there are pediatricians that are becoming more and more aggressive with...

GUPTA: Really?

GOTT: Yes, with these familial, with this familial predisposition, particularly with prescribing diets, exercise programs, watching for early childhood obesity.

GUPTA: What's the youngest that a child might be on a statin medication or a medication like that?

GOTT: Even below 10 years of age.

GUPTA: Really?

GOTT: Even in their teens. There are certain genetic subtypes, very rare, that have extremely accelerated arteriosclerosis, such that something that might happen in a 60 or 70-year-old patient typically might happen in their teens, even warranting angioplasty or bypass.

GUPTA: We sent our cameras out to get some more questions on this topic.

Let's take a listen.


UNIDENTIFIED MALE: Just how important is exercise in relation to diet in preventing coronary problems, arty problems?


GUPTA: And I say that, doctor, there was a study out recently that said in women, fitness may be more important than weight when it comes to preventing heart disease.

In general, which of these has more of an impact, your diet or your physical activity?

GOTT: I'm not sure we can say that one has more of an impact than the other. I think it's something to be paid attention to in both arenas. I did see that study which you referred to and that was very encouraging that even patients that are overweight can greatly reduce their risk by staying active, becoming active.

GUPTA: So really getting active even if you're not necessarily losing the weight?

GOTT: Absolutely.

GUPTA: Throw away the scales, potentially?

We have time for one more question.

Clint, all the way in Beijing, he's writing: "I'm a 42-year-old man. I am slightly overweight, but otherwise in good health. Should I be taking an aspirin each day to prevent cardiovascular disease?" I mean an aspirin a day sounds pretty simple.

Is there any reason he shouldn't take that?

GOTT: Absolutely. There, the preponderance of patients who really have heart disease, we know they have heart disease through heart pain or these other screening tests, they reduce their risk of heart attack or a bad event by as much as 25 percent. And even some asymptomatic patients that don't have confirmed heart disease who do have high risk factors benefit from aspirin.

But this 42-year-old gentleman in Beijing, I'm not sure that he ought to be on it. If you're less than 50, asymptomatic and not too many risks, the risk of taking aspirin daily may exceed the benefit. And so I would...

GUPTA: Bleeding...

GOTT: Bleeding, gastrointestinal bleeding.

GUPTA: Right.

GOTT: Bleeding from the stomach, ulcers, gastritis and a very small risk, particularly in hypertensive patients, of a bleed within the brain.

GUPTA: Clint's 42 years old, so maybe he should wait a few more years before he starts that aspirin a day.

We'll take -- we'll be talking more about preventing heart disease when we come back.

Plus, take a look at other medical news stories making headlines.

That's coming up.


UNIDENTIFIED FEMALE: They're touted as finding diseases before they can strike. But how safe are those body x-rays?

Plus, get a pad and pen. We'll show you where you can calculate your heart disease risk, plus other helpful Web sites.

Stay tuned.




CHRISTY FEIG, CNN CORRESPONDENT (voice-over): People who pay money to have their entire body x-rayed in hopes of finding early signs of disease may, in fact, be raising their risk for cancer. Researchers from Columbia University found that whole body CAT scans exposed patients to relatively large doses of radiation, in some cases, nearly 100 times that of a typical mammogram.

Proponents of the scans say that they are an effective way to detect diseases in their early stages, when they are more easily treated.

Also, a new study by the American Dietetic Association suggests that a majority of teens have tried dieting. The study surveyed 146 high school students and found that over 60 percent have made efforts to lose weight before the age of 15. Researchers caution, though, that dieting should be avoided during the teenage years, except when ordered by the doctor.

Christy Feig, CNN.


GUPTA: Christy, thank you.

You can read more about heart disease on the American Heart Association's Web site. That's at

Also, check out Use their heart risk calculator to see how your numbers stack up.

We're out of time for today.

I want to thank Dr. Gott for making time in your busy schedule to talk with us.

Thank you very much.

GOTT: My pleasure.

Thank you.

GUPTA: A very good show.

And thank you at home, as well, for all of your e-mails.

Make sure to watch House Call every weekend, 8:30 Eastern, and e- mail your questions on the week's topic to

Thanks for watching.

I'm Dr. Sanjay Gupta.

Stay tuned now for more news on CNN.


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