george bushThe news reported that former President George Bush had a cardiac stent placed to prevent a heart attack and to help improve his heart blood flow.  Why did he have this?


Well, George Bush is 67 years old, a common age for men in the US (and across the world) to develop heart disease.  By heart disease I mean narrowing of the coronary arteries.  The stent,  a metal scaffolding, is inserted into one of these small arteries that provide blood flow to the heart muscle itself, to enhance the blood supply to the muscle and to reduce the narrowing from 70% or greater, to less than 10%.  In the process of establishing improved blood supply, it is felt that this protects the artery from further injury or the potential of heart attack.

Over a half-a-million stents are placed in the US yearly, so this is not unusual, but what is unusual is that he had this stent placed after having had a physical exam that disclosed the reduced blood supply and that it was done without him having any symptoms (so we are told…perhaps this is not true).

Narrowing of the coronary arteries can happen even in men and women who have good cholesterol, minimal risk factors for heart disease, and who follow good diets and exercise habits, as these developments are part of the aging process.  These risk factors enhance the potential for issues, but at least a third of people with heart disease do not have clear-cut risk factors that make them candidates fora heart attack.  The only way to find these patients is through screening tests like treadmill exercise testing.

When found, most people do not require treatment other than medications because many studies have shown that this approach is the safest and most effective in preventing future issues.  Although narrowed arteries that are not causing issue would seem best treated by ‘opening’ them, multiple studies have shown this NOT TO BE THE CASE.  Asymptomatic coronary artery disease is best left managed with medicines.

So why did George Bush have a stent?  Either he is having symptoms that the press did not tell us about or his doctors felt he was at an increased risk for a bad outcome if this was left untreated.  There are situations in which this could be the case, but the data is sketchy on these situations and the benefits of intervening.  It may be that as a ‘special person’ he is getting worse treatment that would generally be the case.  The medical care of the President of the US has been far from perfect in the past, as detailed by many historians.