Politics June 2004

The Heart of the Matter

Is Dick Cheney physically a good risk as Vice President? Seven cardiologists weigh in

This 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.

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