Faculty Bibliography

Lack of physical activity (PA) increases risk of coronary heart disease. Metabolic risk factors increase the risk of coronary heart disease and development of advanced coronary artery calcium (CAC). We hypothesized that, in a population with multiple metabolic risk factors (> or =2), the degree of PA would be inversely associated with the degree and prevalence of CAC. After excluding subjects who had known diabetes and coronary heart disease, we studied 779 asymptomatic patients referred for electron beam tomography. All patients had > or =2 of the following metabolic risk factors: blood pressure > 130/85 mm Hg, serum triglycerides >150 mg/dl, serum high-density lipoprotein < 40 and < 50 mg/dl in men and women, respectively, and body mass index >30 kg/m(2). Advanced CAC was defined as a calcium score >75th percentile based on gender and age. In the study, 37% patients were sedentary, 26% engaged in moderate-duration (< 30 minutes 1 to 2 times/week) PA, and 37% engaged in long-duration (> or =30 minutes > or =3 times/week) PA. The median CAC scores were 24 (sedentary), 18 (moderate PA), and 11 (long-duration PA; p <0.002). Advanced CAC was prevalent in 26% of sedentary patients, 24% of patients who performed moderate PA, and 16% of patients who engaged in long-duration PA (p <0.05). On logistic regression analysis, long-duration PA had an independent inverse association with advanced CAC. Thus, asymptomatic patients who have > or =2 metabolic risk factors and who regularly engage in long-duration PA have a lower prevalence of CAC than do those who are sedentary or participate in moderate-duration PA.

Mr. [Bill Clinton]'s discharge from Columbia-Presbyterian Center of New York-Presbyterian Hospital was within the four- to five-day range his doctors had said was a usual hospital recovery period for the type of surgery he had. Earlier, Mr. Clinton's doctors said that they intended to prescribe a regimen of drugs to control his cholesterol and other lipids and to prevent recurrence of the fatty deposits that clogged his arteries, requiring surgery. ''His future diet will play a major role in preventing a recurrence,'' the doctors said. The Clintons thanked the public for its support and the doctors, nurses and staff who cared for him at New York-Presbyterian, Westchester Medical Center and Northern Westchester Hospital

In addition, a person's genetic makeup plays a powerful part in determining cholesterol levels. To complicate matters further, people respond differently to dietary fat. In some, a fatty diet will make cholesterol shoot up. A lucky few can eat almost anything and still have low readings. And though reducing saturated fat can help many people to lower their cholesterol, it does not always do enough. For people who need to lower their cholesterol, experts used to recommend a six-month trial of diet alone, before prescribing medicines. But the results were disappointing. For many people, the dietary changes would have to be so extreme to get results that they could not stick with the program. Now, experts advise trying diet alone for only three months, except for people thought to be at high risk of a heart attack -- they are urged to start drug treatment right away, along with a better diet. That is partly why so many people wind up taking statin drugs to lower their cholesterol. Staying on a statin drug to treat his high cholesterol might have helped Mr. [Bill Clinton], Dr. [Steven E. Nissen] said, noting that the former president had taken one but stopped. Three years ago, Mr. Clinton's L.D.L. cholesterol, the bad form, was 177 -- ''sky high,'' Dr. Nissen said

Mr. Clinton sat up in bed, walked across the room with assistance and sat in a chair at the Columbia-Presbyterian Center of New York-Presbyterian Hospital in Manhattan, the office said in a statement. The doctors said that in the final stage of Mr. Clinton's hospital stay, they would prescribe a new diet for him and a regimen of statin and other drugs that he would be expected to take for the rest of his life. Mr. Clinton started taking a statin drug at the end of his presidency but later stopped because his cholesterol level had dropped significantly. The new regimen is intended to prevent a build-up of fatty deposits in the blood vessels that the doctors took from his chest and left leg and grafted to bypass four coronary arteries that were nearly completely blocked by such deposits

In a four-hour open-heart procedure, a team of surgeons led by Dr. Craig Smith, the hospital's chief of cardio-thoracic surgery, took blood vessels from [Bill Clinton]'s chest and left leg and attached them to arteries feeding his heart, creating detours for the bloodstream around segments dangerously choked with plaque, the detritus of thousands of hamburgers, pizzas and fried eggs. [Allan Schwartz] and Smith, who led a 12-member team of surgeons, anesthesiologists, nurses and other staff members, spoke at the news conference with Dr. Robert Kelly, an anesthesiologist and the hospital's chief operating officer, and Dr. Herbert Pardes, the president and chief executive officer of New York-Presbyterian Hospital. They pronounced the operation a success

Mr. [Bill Clinton] was immediately transferred to Columbia-Presbyterian, where, in a four-hour procedure Monday, a team of surgeons led by Dr. Craig R. Smith, the hospital's chief of cardiothoracic surgery, took blood vessels from his chest and left leg and sewed them to arteries feeding his heart. Dr. Smith said that to make three of the grafts, the surgical team had taken blood vessels known as internal mammary arteries from beneath the left and right sides of Mr. Clinton's sternum, or breastbone. For the fourth graft, the team took a vessel from his left leg. The arteries that received the grafts were the left anterior descending, the first diagonal, the obtuse marginal and the posterior descending, Dr. Smith said. In performing coronary bypass operations of the type Mr. Clinton underwent, surgeons cut through the sternum to open the chest. The pain from the incision and the broken bone is usually intense for the first 24 hours after the operation, requiring strong medications like morphine, said doctors not connected with Mr. Clinton's case. But then the pain generally eases, and patients need only milder medications

Three days after tests prompted by chest pains and shortness of breath revealed Mr. Clinton's life-threatening heart disease, surgeons at the Columbia-Presbyterian Center of New York-Presbyterian Hospital in Manhattan rerouted his blood supply to circumvent four severely clogged arteries. They found several arteries more than 90 percent blocked, the edge of the cliff in coronary terms. In a four-hour open-heart procedure, a team of surgeons led by Dr. Craig R. Smith, the hospital's chief of cardio-thoracic surgery, took blood vessels from Mr. Clinton's chest and left leg and attached them to arteries feeding his heart, creating detours for the bloodstream around segments that were dangerously choked with plaque. Columbia-Presbyterian, a major teaching center for the Columbia University College of Physicians and Surgeons, was listed in a report by the New York State Health Department last week as having the highest death rate for coronary bypass surgery of any hospital in the state during 2001, the latest year for which data are available. The death rate, 3.93 percent, was nearly double the average for the 34 other hospitals that perform coronary bypass surgery in the state

Indeed, like many people who suddenly learn they have heart disease and need bypass surgery, Mr. [Bill Clinton] had little chance to study statistics or consult experts on where to go. He simply found himself on a medical-referral track that led from a small hospital near his home in Chappaqua, N.Y., to the Westchester Medical Center, where tests revealed the extent of his problem and cardiologists suggested Columbia-Presbyterian. Mr. Clinton, his family and the hospital have provided few details about the impending surgery, and have not publicly identified the surgeons who will perform the bypass. The state's death statistics cover bypass patients who die in the hospital during or after surgery. If a patient is discharged from the hospital, a death is reflected in the statistics if it occurs within 30 days of the procedure. The risk-adjusted death rate that the state uses is what the hospital's or surgeon's death rate would have been if all patients were identical, and if the hospitals' and surgeons' performances were identical throughout the state. As he reflected on the state's report, which he said he received on Aug. 30, Dr. [O. Wayne Isom] said he and other heart surgeons bitterly opposed efforts by the late Dr. David Axelrod, then the state health commissioner, to provide the statistics to patients in the late 1980's and early 1990's