Bill Clinton: Cardiovascular Risk Factors Over Time


cardiac risk
 
Clinton's cholesterol level, and, more generally, his overall cardiovascular risk, were a concern as early as 1992. Details are summarized on an accessory web page, where Dr. Zebra does some rather unattractive ranting, but it's in the good cause of getting more people to take statin medications... SEE BELOW.

In sum, Clinton had five exercise tolerance tests while President; it was felt at his last Presidential physical examination (in 2001) that another such test was unwarranted. He started taking simvastatin (Zocor) at that time, because of elevated cholesterol levels, as discussed in a press conference MORE.

In September 2004 Clinton needed urgent coronary bypass surgery (see below).



height & weight
 
Clinton is 6 feet 2 inches tall, or perhaps 6 feet 2.5 inches tall 1. From 1992 to 2001 his weight varied from 236 to 214 pounds SEE BELOW. The lower height and a weight of 226 gives him a body mass index of 29.1 kg/m/m -- overweight, but not quite obese.

After leaving office, Clinton was on the South Beach diet for an unknown time, and did lose weight 2 -- and then needed a bypass operation.


More...
Evaluation Date Weight Total Cholesterol Level LDL Cholesterol HDL Cholesterol Exercise Test Reference
about 1991 236 lb - - - - 3a
Oct. 1992 226 lb - - - - 3b
1999 - 196 134 46 "outstanding perfomance" 4 2
Jan. 12, 2001 214 lb 233 177 46 none 4

In 1992 Clinton's moderately elevated cholesterol level was "under control," by means unstated. On August 27, 1992 his blood pressure was 130/70, with a heart rate of 75/minute. An electrocardiogram was normal. Glucose level was 104 mg/dl (this is near the top of the normal range) and creatinine (renal function) was normal at 1.0 3a

On a ?1992 stress test (better called an "exercise tolerance test"), Clinton exercised for 14 minutes on a Bruce protocol to 91% of his maximally predicted heart rate (i.e. 91% of 175 is 159). There were no abnormal electrocardiographic changes during or after the test 3a.

This is an absolutely typical course for coronary artery disease. A seemingly fit person without classic risk factors for heart disease has cholesterol levels that for years do not evoke excitement. Exercise tests give a false sense of security. All of a sudden, it seems, chest discomfort develops and an angiogram shows advanced disease that requires urgent intervention.

Only now are cardiologists coming to the conclusion that the physiologically normal level of LDL cholesterol is 50 to 70 mg/dl 5, not the ridiculous 130 average found in the bloodstreams of Americans -- a nation of car-drivers and chair-sitters -- stuffing itself with fat and fast food.

New guidelines 6, issued in July 2004, "give permission" for doctors to aim for lower LDL levels than in the recent past, but do not encourage it. These new guidelines, for example, would not have recommended lower cholesterol levels for Clinton.

The current "statin" class of cholesterol-lowering medicines are remarkable in their ability to lower not only cholesterol levels, but death rates, too. More people should be taking a statin. Lots more. Some researchers have calculated that putting all persons over age 55 on a statin, regardless of cholesterol level, would drop heart disease by 80% 7.

Many people are reluctant to take medicines, on principle. Horse hockey. The statins are a medicine all persons should look forward to taking. The American diet and lifestyle are powerful anti-medicines that these same people gulp down each day.

Heart attack and stroke can kill a person as quickly and as unexpectedly as a hijacked airplane. A million people die each year from this arterial terrorism, just in the United States. In 20% of people who die suddenly from heart disease, death was their first symptom of the disease. That is really terrifying.

Cited Sources
  1. Mathews J. The shrinking field. Washington Post. August 3, 1999. Page C1.
        

    Comment: Accessed through washingtonpost.com: http://www.washingtonpost.com/wp-srv/politics/campaigns/wh2000/stories/tall080399.htm

  2. Milbank, D. Bill Clinton to undergo heart bypass surgery. Washington Post. washingtonpost.com on September 3, 2004 at 3:25pm.
        

    Comment: http://www.washingtonpost.com/wp-dyn/articles/A59226-2004Sep3.html

  3. Bumgarner, John R. The Health of the Presidents: The 41 United States Presidents Through 1993 from a Physician's Point of View. Jefferson, NC: MacFarland & Company, 1994.
        
    a  p.300  b  pp.298, 299

    Comment: Devotes one chapter to each President, through Clinton. Written for the layperson, well-referenced, with areas of speculation clearly identified, Dr. Zebra depends heavily on this book. Dr. Bumgarner survived the Bataan Death March and has written an unforgettable book casting a physician's eye on that experience.

  4. White House. Press release. Office of the Press Secretary. January 12, 2001.
        

    Comment: http://clinton5.nara.gov/library/hot_briefings/January_12_2001.html

  5. O'Keefe JH, et al. Optimal low-density lipoprotein is 50 to 70 mg/dl. Journal of the American College of Cardiology. 2004; 43: 2142-2146.
  6. Grundy SM, et al. Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation. 2004; 110: 227-239.
        

    Comment: http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3upd04.htm

  7. Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ [British Medical Journal]. 2003; 326: 1419.

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