The Significance of Bernie Sanders’s Heart Disease

Bernie Sanders was hospitalized yesterday after he “experienced some chest discomfort” during a campaign trip to Las Vegas, a senior adviser said in a statement today. The senator was subsequently “found to have a blockage in one artery, and two stents were successfully inserted."

This sounds scary, and it’s difficult to know exactly what it means for Sanders’s health. But there is evidence in the statement that Sanders will not necessarily be materially affected by the incident. Coronary stenting is one of the most common procedures in the United States. It involves feeding a wire up the femoral artery in the groin and into the heart, then inserting and expanding metallic coils to hold open the arteries that supply blood to the heart. It is used to treat coronary artery disease, the partial or complete blockage of the arteries and the most common cause of death worldwide.

Sanders is a 78-year-old American male working long hours at a high-stress job, so it is statistically expected that he would have some degree of coronary artery disease. As the average age of the presidential-candidate pool moves older, election after election, this is the primary health issue that will limit their abilities to carry out the duties of the office.

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The severity of Sanders’s case could range from almost inconsequential to very serious. While some cardiologists argue that stenting should only be used in cases of moderate to severe blockage, it has historically been deployed much more widely. In 2017,  after decades of doctors stenting most anyone with even moderate blockage, evidence finally emerged that the practice did not prolong life. But many cardiologists continue to do it because patients report subjective improvements in things like chest pain and shortness of breath.

The statement seems to suggest that Sanders’s case of coronary artery disease is on the less severe end of the spectrum. “Chest discomfort” is not synonymous with “heart attack,” and is more commonly used to describe angina, the clinical term for the pain that results when too little blood is flowing to the muscle of the heart. Recognizing and addressing angina before a serious heart attack is medically optimal, but it’s much less severe than a heart attack, which means total blockage of an artery and loss of blood supply to heart muscle. Angina is the result of compromised flow, and it is reversible. A heart attack, on the other hand, can cause permanent damage.

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The fact that only one of Sanders’s arteries was stented is likely meaningful, too. If multiple blood vessels are involved, the disease is usually more serious, and sometimes requires open-heart surgery for coronary-artery bypass grafts. Many people have undergone bypass surgery and continued to work for decades, including David Letterman and Bill Clinton. This is not apparently what’s happening in Sanders’s case, which bodes well for him.

The statement also noted that Sanders is currently “conversing and in good spirits.” If Sanders had suffered a major cardiac arrest and were sent to the intensive care unit, he would not be chatty.

Still, the campaign said it would be canceling Sanders’s public appearances until further notice. This would be expected for anyone undergoing coronary stenting. It’s important for doctors to monitor the patient in the days after the procedure to assure that symptoms improve and that no complications have been introduced. But there is no reason to suspect that, if all goes as well as expected, Sanders would be unable to appear on a debate stage in 12 days—and much less that he would be unable to campaign or perform the duties of the office of the president.