Politics
The Heart of the Matter - The Atlantic Monthly | June 2004
The Agenda
Is Dick Cheney physically a good risk as Vice President? Seven cardiologists weigh in
by Howard Markel
.....
his past spring Vice President Dick Cheney attended the Gridiron Club dinner—an annual ritual that brings together politicians, journalists, and other members of the Washington establishment for a lighthearted evening of political speeches, skits, and other frivolity. Cheney himself managed to bring down the house when he was called upon to speak. Addressing some of the performers, he said, "At one point during your skits I had a little scare. I felt a tightness in my chest. I started gasping for air and breathing irregularly. Then I realized it's called laughing."
The Vice President was poking fun at his health, of course. But his medical history is sobering. Cheney has suffered four heart attacks in the past twenty-six years. The first came when he was only thirty-seven, the second when he was forty-three, the third when he was forty-seven, and the fourth when he was fifty-nine—only two weeks after the stressful election of 2000. In 1978, shortly after his first heart attack, when the gravity of his condition had become apparent, Cheney quit smoking cigarettes, at least for a time (he had taken up the habit in his late teens and at its peak smoked three packs a day). After his third attack, in 1988, he had surgery: a quadruple coronary-artery bypass. He did remarkably well for the next twelve years, even though, according to one report, he exercised only twice a week and gained forty pounds.
Immediately after Cheney's fourth heart attack doctors inserted a stainless-steel stent in one of his most severely compromised vessels. Unfortunately, about three months later, as happens about 25 percent of the time, the stent became blocked, and to reopen it doctors performed an angioplasty. In June of 2001 a thirty-four-hour electrocardiogram demonstrated an abnormal heart rhythm; at the end of that month his doctors implanted under the skin of his chest a cardioverter defibrillator, which shocks the heart back into a normal rhythm in the event of a potentially deadly arrhythmia. Since that time Cheney has been on a strict dietary regimen (although he is still overweight), a routine of daily exercise, medications to significantly lower his blood pressure and cholesterol, and a daily dose of aspirin to prevent blood clots. By official accounts, since his last procedure he has had three routine checkups (in February and September of 2002 and July of 2003), each of which included an electrocardiogram, a stress test, and an echocardiogram.
Given the extent of Cheney's history of severe coronary-artery disease and multiple heart attacks, many have raised concerns about his present condition (which could put the speaker of the House, Dennis Hastert, within a heartbeat of the presidency); about his physical fitness to run again for Vice President; and, of course, about his ability to run the country if President Bush died or were incapacitated.
With this in mind I interviewed seven prominent cardiologists who practice at major academic medical centers in the United States and conduct advanced research on heart disease. After promising not to name these doctors but receiving permission to quote their impressions, I gave each of them Cheney's medical history. Initially I identified Cheney only as a nameless high-level executive with a stressful and remarkably demanding job that involved a great deal of travel, late nights, and frequent crises. Only after they had expressed their medical opinions did I tell the doctors who the patient was, and ask if they would change their assessments. None did.
Although our discussions hardly met the rigorous criteria of an opinion-research poll, all seven cardiologists concurred that the subject was at significantly higher risk for premature death from a heart attack than the average sixty-three-year-old American male. (Upon learning that the patient was Cheney, a cardiologist from Boston observed, "It's a pretty impressive history. I had no idea he'd had all this happen to him," and added, "It's a testament to medical science that he's alive.") All seven did note, however, that although the subject's condition—which doctors call "malignant atherosclerosis"—was hardly characteristic of patients in their practices, his situation is not uncommon. They agreed that his treatment regimen was appropriate.
Five of the seven cardiologists felt that so long as the subject had no evidence of impaired blood flow to his heart (a condition that would be easily determined by a cardiac stress test), the decision to stay on the job was really a matter of personal choice. But after hearing the blinded case history a Cleveland cardiologist said, "I would first ask, How is he doing financially? Can he retire?" When I told him that the patient was financially independent, the physician said that at a minimum he would advise a major cutback of work hours. In contrast, a cardiologist in Ann Arbor cautioned, "You can do a patient a big disservice by telling him to stop working. As long as he is functioning well, which he is, he should keep working, but under a tight watch by his doctors. He should lose some weight. But as long as his exercise tolerance is fine and risk factors under control, I don't know if he could do much more [to protect his health]."
After finding out that the patient was Cheney, a cardiologist in Washington, D.C., insisted that as long as he passed his medical examinations, the Vice President was "still fit to do the job." When asked if the job itself was a risk to Cheney's health, the cardiologist's only response was "The world is a stressful place." The Boston physician said he would not recommend restricting the Vice President's work activities or canceling his reelection bid, but he did add that since "the vessels used in a coronary-artery bypass graft do often close up over time, it's well possible he'll need a repeat procedure within five years." A cardiologist in Detroit strongly disagreed with those willing to give Cheney medical clearance for such a demanding job. "There is not a simple right answer," he observed, "but when you are in a position where a lot of lives depend on you, it's more than a personal choice."
Although the official White House position today is that Cheney is in "excellent health," the Washington-insider magazine National Journal has recently reported that if in the run-up to the 2004 election too many people raise concerns about his political fitness for office, Cheney "could use health and his history of four heart attacks to construct a credible exit." It's possible, in other words, that the Vice President's medical condition could—ironically—help the Bush campaign dodge other electoral liabilities.
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